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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reports the results of an exploratory analysis among patients in the Endophthalmitis Vitrectomy Study to determine if there was a different response to treatment in diabetes and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients. Patients in this multicenter clinical trial were followed for 9 months after random assignment to either vitrectomy or tap/biopsy. Outcome measures included visual acuity assessed in standardized fashion. Fifty-eight of 420 study patients were diabetic. Diabetics presented with slightly worse vision and ocular media. Only 39% of diabetics compared with 55% of nondiabetics achieved 20/40 final vision. Both diabetic and nondiabetic patients who presented with vision of only light perception (LP) had better visual results with immediate vitrectomy. For those who presented with better than LP vision, diabetics achieved 20/40 more often with vitrectomy (57%) than with tap/biopsy (40%), but non diabetics did equally well with vitrectomy or tap/biopsy. In the diabetic group, small numbers did not allow adequate statistical power to test treatment difference. A new clinical trial is needed to determine if in fact there is a difference in response to treatment among diabetic and nondiabetic patients who present with better than LP vision.
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PMID:Diabetes and postcataract extraction endophthalmitis. 1201 82

In Taiwan, the incidence of pyogenic liver abscess caused by Klebsiella pneumoniae has been increasing over the past 2 decades. Although most of the patients have no concurrent biliary tract disease, diabetes mellitus is thought to be an important risk factor for the disease. The incidence of metastatic infections in K. pneumoniae liver abscess, such as endogenous endophthalmitis and other extrahepatic infections, is also higher than that in liver abscess caused by other microbes. Furthermore, the incidence of metastatic infections in K. pneumoniae liver abscess in Taiwan is higher than Western countries. The reasons why K. pneumoniae liver abscess is so common in Taiwan and why diabetes mellitus is a risk factor for the disease are not clear. In this study, blood isolates from 40 patients with K. pneumoniae liver abscess treated at the Taipei Veterans General Hospital from 1995 through 2000 were randomly selected for study. Pulsed-field gel electrophoresis, ribotyping, and serotyping were used for cluster analysis. A total of 15 strains were of serotype K1 and 25 strains were of a serotype other than K1. No major cluster or a closely related strain of K. pneumoniae was found. In conclusion, the results obtained from pulse-field gel electrophoresis and ribotyping of K. pneumoniae isolates do not suggest that liver abscess in Taiwan is primarily caused by a single genetically related strain.
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PMID:Klebsiella pneumoniae liver abscess in Taiwan is not caused by a clonal spread strain. 1209 40

Invasive bacterial and candidal infections are known to involve the retina, but the natural history of the retinal lesions and the utility of ophthalmologic consultation in the critical care setting as a diagnostic tool are not well understood. We 1) performed weekly funduscopic examinations on 77 medical and surgical patients in intensive care units (ICUs), 2) analyzed results of serial ocular examinations in 180 non-neutropenic patients with candidemia, and 3) reviewed the English literature on the association of retinal lesions with disseminated bacterial or candidal infection (DBCI). We found that 15 (19%) of the ICU patients had retinal lesions consistent with DBCI. Of these 15, 1 had clearly sepsis-related retinal lesions, while 13 (87%) had 1 or more systemic disease that could have explained their retinal findings (6 diabetic retinopathy; 2 human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) retinopathy; 2 hypertensive retinopathy; 1 hemolytic uremic syndrome, and 1 leukemia). Multivariate analysis revealed that systemic disease (odds ratio 8.37, 95% confidence intervals: 3.24-21.56) independently correlated with the presence of retinal lesions while DBCI, trauma, hyperalimentation, and transfusion of blood products were not independently predictive in any analysis. Twenty of the 180 (15%) candidemic patients had retinal lesions. Two (1%) had classic 3-dimensional white lesions with vitreal extension, and 5 (2.7%) had chorioretinal lesions without vitreal haziness. Notably, 10% of patients had superficial retinal hemorrhages and/or cotton wool spots that could have been due to either candidemia or a systemic disease (diabetes, hypertension, renal failure, closed head trauma). Concurrent bacteremia occurred in 3 of the 27 patients with eye lesions. Retinal lesions resolved in a mean of 33 days. None of the patients had symptoms at the time of the retinal finding. We found 3 studies that prospectively assessed retinal lesions in bacteremic patients. The frequency of retinal lesions in these series varied from 12% to 26%, with the most common lesions being cotton wool spots followed by superficial retinal hemorrhages. White-centered hemorrhages were seen in about 15% +/- 2 of bacteremic patients. Five studies prospectively evaluated candidemic patients for Candida endophthalmitis. These studies observed rates from 0% to 78% for lesions consistent with candidal endophthalmitis. Most studies performed recently found that nonspecific lesions such as cotton wool spots or superficial retinal hemorrhages occurred with a frequency of 11% to 20%. The availability of less toxic antifungal agents, more frequent use of empirical therapy, and the trend to early treatment may be altering the frequency of this complication. Observation of a classic 3-dimensional retina-based vitreal inflammatory process is virtually diagnostic of endogenous endophthalmitis due to Candida spp., but such lesions are relatively uncommon. Conversely, nonspecific lesions that could be due to bacterial or candidal endophthalmitis (cotton wool spots, retinal hemorrhages, and Roth spots) are seen frequently. These lesions are most often due to an underlying systemic disease rather than an infection. Serial examinations provide the best evidence that a given lesion is due to an intercurrent infection. The current low rate of vitreal extension of retinal process appears to be due to the high rate of empirical or therapeutic use of antifungal agents in high-risk patient groups. Ophthalmoscopy should be performed in patients with known candidemia. However, ophthalmoscopic examination seems to have little value in assisting with the discovery of occult disseminated candidiasis or bacterial infection.
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PMID:Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology. 1279 5

A 78-year-old woman developed a severe fibrinous anterior chamber reaction 1 day after uneventful clear corneal incision cataract extraction with intraocular lens implantation. There was no history of uveitis or diabetes, and the fibrin responded immediately to topical steroids. The patient was followed closely to rule out endophthalmitis. The only risk factor identified was the use of systemic aminocaproic acid as prophylaxis for bleeding in chronic leukemia.
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PMID:Excessive fibrin after cataract surgery associated with aminocaproic acid use. 1295 20

Endogenous Aspergillus endophthalmitis (AE) is a rare complication of invasive aspergillosis (IA) in transplant patients. In this report, we describe two patients with polycystic kidney disease, who developed AE with cerebral involvement after renal transplantation. Both patients received intense immunosuppression with methyl prednisolone and mycophenolate mofitil (MMF) because of persistent rejection, which rendered them diabetic and vulnerable to opportunistic infections. Endophthalmitis developed within six months of transplantation and was confirmed by microscopy and culture of the vitreous fluid. Patients were treated with combinations of different anti-fungal agents including liposomal amphotericin B, 5-flucytosine, itraconazole, voriconazole and terbinafine. In an electronic MEDLINE review, we found eight further cases of AE in renal transplant patients between 1959 and September 2002. Based on this review, we identified possible risk factors including CMV infection, diabetes mellitus and treatment for rejection with agents such as methyl prednisolone and MMF. In 70% of cases the histology, microscopy or culture of vitreous fluid confirmed the diagnosis. The outcome of AE in renal transplant patients was poor with 70-100% mortality. The review of reported cases and current practice guidelines suggests that vitrectomy and intravitreal amphoterecin B is the treatment of choice. In addition, new antifungal agents with good CSF and ocular penetration such as voriconalzole should be considered for the treatment of invasive cerebral/ocular aspergillosis.
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PMID:Aspergillus endophthalmitis: an unusual complication of disseminated infection in renal transplant patients. 1455 60

In anecdotal reports, septic metastatic lesions from a pyogenic liver abscess can result in endogenous endophthalmitis, an infection of intraocular contents. Recent reports suggest that this devastating complication is increasing in frequency. The initial presentation may be nonspecific and easily misdiagnosed by the surgical team. When the infecting organism is virulent, it tends to be rapidly progressive and often leads to permanent visual deterioration or blindness despite medical intervention. We conducted a study to determine the incidence of endophthalmitis associated with pyogenic liver abscess, to identify its associations, and to determine the outcome of treatment. A retrospective review of 289 patients with a clinical diagnosis of pyogenic liver abscess admitted between January 1995 and March 2001 revealed 10 patients (3.5%) with the complication of endogenous endophthalmitis. Among them, seven had a previous history of diabetes mellitus. The offending organism was Klebsiella pneumoniae in all cases. There was no mortality in this series. Final visual outcomes of our patients were as follows: Five had no light perception (two had undergone evisceration), one had light perception only, and four were able to visualize hand motion only. There is a trend toward a worse outcome when ocular symptoms are not diagnosed and treated within 24 hours of onset. Of the five patients who lost their eyesight completely, three were initially misdiagnosed, and referral to the ophthalmologist was delayed. Surgeons must be alert to the complication of endogenous endophthalmitis. Ocular symptoms in patients treated for pyogenic liver abscess must be referred early for an ophthalmologic consult. Increased awareness and a high index of suspicion are required for salvage of visual function.
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PMID:Ocular manifestations and complications of pyogenic liver abscess. 1461 92

Although there have been a few reported cases of Enterococcal endophthalmitis, this is an unusual case of endophthalmitis complicated with corneal ulcer caused by Enterococcus faecalis. A 67-year-old male patient with diabetes mellitus underwent secondary intraocular lens implantation. Post-operative recovery was uneventful until a wound rupture was noted 3 weeks after the operation. On day 12 after the repair of the wound, endophthalmitis accompanied by wound necrosis and a full-thickness corneal ulcer was detected. His vision was light perception, and Enterococcus faecalis was identified by culture in samples of conjunctival sac, anterior chamber and vitreous humor. After 3 rounds of intravitreal antibiotics injection, the vitreous opacity disappeared on ultrasonographic finding but corneal opacity and corneal neovascularization still remained.
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PMID:A case of Enterococcus faecalis endophthalmitis with corneal ulcer. 1563 32

We describe a 56-year-old woman with type 2 diabetes complicated by a Klebsiella pneumoniae perirenal abscess. The patient further developed incipient diabetic ketoacidosis, disseminated intravascular coagulation, and endogenous endophthalmitis. Occurrence of the latter as a metastatic infection from perirenal abscess caused by this organism is very rare, and we know of no previously reported patient with the additional occurrence of disseminated intravascular coagulation. Since prompt intravitreal antibiotic administration is needed, physicians should be aware of these rare but severe complications of K pneumoniae infection, especially in patients with poorly controlled diabetes.
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PMID:Endogenous endophthalmitis and disseminated intravascular coagulation complicating a Klebsiella pneumoniae perirenal abscess in a patient with type 2 diabetes. 1576 24

This retrospective report presents a series of patients with endogenous endophthalmitis treated over a 13-y period in a tertiary care centre in South Australia. 16 eyes of 13 patients (8 M, 5 F) with a mean age 62 y were included. Systemic predisposing risk factors were mainly diabetes mellitus (30.7%), chronic obstructive airway disease (23.1%) and end-stage renal disease (15.4%). Isolated organisms included fungal species in 11 eyes (7 eyes with Candida albicans and 4 with Aspergillus fumigatus), Gram-positive isolates in 4 eyes, and Pseudomonas aeruginosa in 1 eyes. Presenting visual acuity was 20/200 or lower in 8 patients (61.5%). Final visual improvement of more than 2 lines was noted in 5 patients, it was stable or worse in 6 patients and in 2 patients the eye was either enucleated or eviscerated. Systemic aspergillosis resulted in death of both patients. In conclusion, the clinical course and microbiological profile of pathogens in patients with endogenous endophthalmitis in our series are similar to other recent western reports. Candida species are the leading isolates, with an overall poor visual prognosis, especially in Aspergillus infections. Close monitoring of immune-compromised patients with systemic infections may enable early diagnosis and treatment and improve prognosis.
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PMID:Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia. 1584 50

We conducted a retrospective, hospital-based study of patients who were diagnosed with bacterial endophthalmitis on admission to the Department of Ophthalmology, Hiroshima University Hospital, between January 1999 and December 2003. Thirty eyes of 30 patients were identified. Of these patients, 19 eyes had postoperative endophthalmitis, 8 eyes had penetrating trauma and 3 eyes were infected from an endogenous source. All of the patients underwent immediate three-port pars plana vitrectomy. Vitreous specimens of diabetic patients demonstrated a significantly higher incidence of positive bacterial culture. Diabetic vitreous appeared to be a good medium for culture. Visual acuity of hand motion or less at the latest follow-up visit was associated with the presence of diabetes. Prompt treatment with vitrectomy and intra-vitreal antibiotics is crucial for patients with bacterial endophthalmitis, especially if they are diabetic.
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PMID:A five-year review of patients admitted with the diagnosis of bacterial endophthalmitis. 1599 97


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