背景:导致眼部受累的败血症主要表现为眼内炎或全眼炎。相反,没有眼内受累的败血症,称为血源性眼眶蜂窝织炎(HOC),仅累及眼眶,是一种极为罕见的败血病并发症和一种罕见的眼眶蜂窝织炎。
方法:本研究描述了4例伴有眼眶受累且无眼内感染的败血症男性患者。他们是22(案例1),15(案例2),79(案例3),30岁(案例4),平均年龄29.75岁.除病例2外,所有患者均免疫功能低下。病例1和3有类固醇使用史,而病例4处于化疗后骨髓抑制期。病例1中的败血症是社区获得性的,病例3和4是医院获得的,病例2继发于痤疮挤压。病例1、2和3的血培养为白色念珠菌阳性,耐甲氧西林金黄色葡萄球菌,和肺炎克雷伯菌,分别。案例4有阴性文化;然而,下一代测序报告存在粪肠球菌和米根霉.病例1有右眼受累,两只眼睛都参与了另外三例。根据钱德勒的分类,病例1为2型,病例2为2型(OD)和4型(OS),病例3和4为1型眼眶感染。所有患者都有眼睑红斑,病例1和2视力轻度下降,突增,和疼痛和受限的眼球运动。住院时间为13至43天(平均,24天)。根据药物敏感性和下一代测序结果,所有患者均接受全身抗生素治疗。结合多学科治疗,导致眼部和全身体征和症状完全恢复;未进行眼部手术干预。眼外肌肉麻痹是最后一个症状。
结论:HOC主要见于高比例医院获得性感染和病原体培养阳性的免疫受损个体。使用针对病原体的全身性抗生素进行感染控制可确保良好的预后。
BACKGROUND: Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily,
septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of
septicemia and a rare type of orbital cellulitis.
METHODS: Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (
case 1), 15 (
case 2), 79 (
case 3), and 30 (
case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase.
Septicemia in
case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and
case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler\'s classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve.
CONCLUSIONS: HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.