Background: Endogenous endophthalmitis is a rare complication of pyogenic liver abscess. It is a devastating intraocular infection which constitutes a vision-threatening emergency. Recently, a significant increase in the incidence of endogenous endophthalmitis associated with pyogenic liver abscess has been reported in East Asia. In this study, the authors investigated the incidence, risk factors, clinical features, and treatment outcomes of endogenous endophthalmitis arising as a complication of pyogenic liver abscess. Methods: The medical records of 8 cases of endogenous endophthalmitis associated with a pyogenic liver abscess treated from 1997 to 2013 at a single tertiary hospital in Korea were retrospectively reviewed. Results: Median patient age was 71.1 ± 9.8 years. The most common underlying disease was diabetes mellitus (4 patients, 50%). Klebsiella pneumoniae was isolated from all patients, and all were treated with intravenous antibiotics including ceftriaxone. Seven patients received an intravitreal injection. Four patients needed additional surgical interventions. Outcomes were generally poor; only 1 patient achieved a slight improvement in visual outcome. Conclusion: Old age, diabetes mellitus, and K. pneumoniae infection could predispose the development of endogenous endophthalmitis in patients with a pyogenic liver abscess. Physicians should pay attention to ocular symptoms as early diagnosis and intensive treatment are required to achieve improvements in visual outcome.

Journal Section:
Original Paper
Keywords:
Liver abscess, Endogenous endophthalmitis, Klebsiella pneumoniae, Diabetes mellitus
1.
Cheng D, Liu Y, Yen M, Liu C, Wang R: Septic metastatic lesions of pyogenic liver abscess: their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med 1991;151:1557-1559.
[PubMed]
https://doi.org/10.1001/archinte.1991.00400080059010
2.
Durand M: Endophthalmitis. Clin Microbiol Infect 2013;19:227-234.
[PubMed]
https://doi.org/10.1111/1469-0691.12118
3.
Yoon YH, Lee SU, Sohn JH, Lee SE: Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis. Retina 2003;23:366-370.
[PubMed]
https://doi.org/10.1097/00006982-200306000-00013
4.
Chen YJ, Kuo HK, Wu PC, Kuo ML, Tsai HH, Liu CC, Chen CH: A 10-year comparison of endogenous endophthalmitis outcomes: an East Asian experience with Klebsiella pneumoniae infection. Retina 2004;24:383-390.
[PubMed]
https://doi.org/10.1097/00006982-200406000-00008
5.
Sheu SJ, Kung YH, Wu TT, Chang FP, Horng YH: Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess: 20-year experience in southern Taiwan. Retina 2011;31:2026-2031.
[PubMed]
https://doi.org/10.1097/IAE.0b013e31820d3f9e
6.
Rahimian J, Wilson T, Oram V, Holzman RS: Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis 2004;39:1654-1659.
[PubMed]
https://doi.org/10.1086/425616
7.
Mezhir JJ, Fong Y, Jacks LM, Getrajdman GI, Brody LA, Covey AM, Thornton RH, Jarnagin WR, Solomon SB, Brown KT: Current management of pyogenic liver abscess: surgery is now second-line treatment. J Am Coll Surg 2010;210:975-983.
[PubMed]
https://doi.org/10.1016/j.jamcollsurg.2010.03.004
8.
Pang TC, Fung T, Samra J, Hugh TJ, Smith RC: Pyogenic liver abscess: an audit of 10 years' experience. World J Gastroenterol 2011;17:1622-1630.
[PubMed]
9.
Okada AA, Johnson RP, Liles WC, D'Amico DJ, Sullivan Baker A: Endogenous bacterial endophthalmitis: report of a ten-year retrospective study. Ophthalmology 1994;101:832-838.
[PubMed]
https://doi.org/10.1016/S0161-6420(13)31255-X
10.
Foo NP, Chen KT, Lin HJ, Guo HR: Characteristics of pyogenic liver abscess patients with and without diabetes mellitus. Am J Gastroenterol 2010;105:328-335.
[PubMed]
https://doi.org/10.1038/ajg.2009.586
11.
Tsai FC, Huang YT, Chang LY, Wang JT: Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis 2008;14:1592-1600.
[PubMed]
https://doi.org/10.3201/eid1410.071254
12.
Chiu CH, Yeh KM, Siu LK, Fung CP, Lin JC, Chang FY: Impact of age on neutrophil phagocytic reaction with different capsular serotypes of Klebsiella pneumoniae. J Microbiol Immunol Infect 2011;44:333-337.
[PubMed]
https://doi.org/10.1016/j.jmii.2010.08.013
13.
Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B: Impaired leucocyte functions in diabetic patients. Diabet Med 1997;14:29-34.
[PubMed]
https://doi.org/10.1002/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V
14.
Wang HH, Tsai SH, Yu CY, Hsu HH, Liu CH, Lin JC, Huang GS, Cheng WT, Tung HJ, Chen CY, Chang WC: The association of haemoglobin a levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus. Eur Radiol 2014;24:980-989.
[PubMed]
https://doi.org/10.1007/s00330-014-3113-1
15.
Gyorffy EJ, Frey CF, Silva J Jr, McGahan J: Pyogenic liver abscess. Diagnostic and therapeutic strategies. Ann Surg 1987;206:699-705.
[PubMed]
https://doi.org/10.1097/00000658-198712000-00003
16.
Ferraioli G, Garlaschelli A, Zanaboni D, Gulizia R, Brunetti E, Tinozzi F, Cammà C, Filice C: Percutaneous and surgical treatment of pyogenic liver abscesses: observation over a 21-year period in 148 patients. Dig Liver Dis 2008;40:690-696.
[PubMed]
https://doi.org/10.1016/j.dld.2008.01.016
17.
Zhu X, Wang S, Jacob R, Fan Z, Zhang F, Ji G: A 10-year retrospective analysis of clinical profiles, laboratory characteristics and management of pyogenic liver abscesses in a Chinese hospital. Gut Liver 2011;5:221-227.
[PubMed]
https://doi.org/10.5009/gnl.2011.5.2.221
18.
Nah B, Kim Y, Moon H, Park K, Kim S, Lee Y, Yang H, Seo S, Kim M, Lee B, Kim N, Heon M: Recent changes of organism and treatment in pyogenic liver abscess. Clin Mol Hepatol 2000;9:275-283.
[PubMed]
19.
Chung DR, Lee HR, Lee SS, Kim SW, Chang HH, Jung SI, Oh MD, Ko KS, Kang CI, Peck KR: Evidence for clonal dissemination of the serotype K1 Klebsiella pneumoniae strain causing invasive liver abscesses in Korea. J Clin Microbiol 2008;46:4061-4063.
[PubMed]
https://doi.org/10.1128/JCM.01577-08
20.
Wong JS, Chan TK, Lee HM, Chee SP: Endogenous bacterial endophthalmitis: an East Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology 2000;107:1483-1491.
[PubMed]
https://doi.org/10.1016/S0161-6420(00)00216-5
21.
Chou FF, Kou HK: Endogenous endophthalmitis associated with pyogenic hepatic abscess. J Am Coll Surg 1996;182:33-36.
[PubMed]
© 2014 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2014
You do not currently have access to this content.