Late-onset Orbital Cellulitis with Abscess Formation Caused by Klebsiella Pneumoniae

Jing Li, Jianmin Ma, Xin Ge

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.

DOI: 10.4236/ojoph.2012.23019                

Abstract

Klebsiella pneumoniae is a facultative anaerobic gram-negative, non-motile, capsulated, gas-producing rod found widely in nature and often associated with urinary and respiratory infections in humans. Orbital cellulitis with abscess formation caused by K. pneumoniae is rare. Here, we present a case of K. pneumonia-inducing orbital cellulitis with abscess formation in a patient who had undergone an orbital wall fracture prosthesis with hydroxyapatite implantation due to orbital trauma 9 years ago. The patient was treated successfully with antibiotics and surgery.

Keywords

Orbital Cellulitis; Abscess; Klebsiella Pneumoniae

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	E. Rezaei, H. Safari, M. Naderinasab, et al., “Common pathogens in burn wound and changes in their drug sensitivity,” Burns, Vol. 37, No. 5, 2011, pp. 804-806. doi:10.1016/j.burns.2011.01.019
[2]	M. I. Ahmed, “Prevalence of nosocomial wound infection among postoperative patients and antibiotics patterns at teaching hospital in Sudan,” North American Journal of Medical Sciences, Vol. 4, No. 1, 2012, pp. 29-34. doi:10.4103/1947-2714.92900
[3]	A. K. Seth, M. R. Geringer, A. N. Gurjala, et al., “Understanding the host inflammatory response to wound infection: An in vivo study of Klebsiella pneumoniae in a rabbit ear wound model,” Wound Repair and Regeneration, Vol. 20, No. 2, 2012, pp. 214-225. doi:10.1111/j.1524-475X.2012.00764.x
[4]	S. Ghafourian, Z. Bin Sekawi, N. Sadeghifard, et al., “The prevalence of ESBLs producing Klebsiella pneumoniae isolates in some major hospitals, Iran,” Open Microbiology Journal, Vol. 5, 2011, pp. 91-95. doi:10.2174/1874285801105010091
[5]	Z. Ghorashi, N. Nezami, H. Hoseinpour-Feizi, et al., “Arthritis, osteomyelitis, septicemia and meningitis caused by Klebsiella in a low-birth-weight newborn: a case report,” Journal of Medical Case Reports, Vol. 5, 2011, pp. 241.
[6]	S. Schelenz, K. Bramham and D. Goldsmith, “Septic arthritis due to extended spectrum beta lactamase producing Klebsiella pneumoniae,” Joint Bone Spine, Vol. 74, No. 3, 2007, pp. 275-278. doi:10.1016/j.jbspin.2006.08.007
[7]	L. C. Chew, “Septic monoarthritis and osteomyelitis in an elderly man following Klebsiella pneumoniae genitourinary infection: case report,” Annals of the Academy of Medicine Singapore, Vol. 35, No. 2, 2006, pp. 100-103.
[8]	J. E. Kohler, M. P. Hutchens, P. M. Sadow, et al., “Klebsiella Pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the western hemisphere,” Surgical Infections, Vol. 8, No. 2, 2007, pp. 227-232. doi:10.1089/sur.2006.007
[9]	N. Y. Lee, W. H. Huang, K. C. Tsui, et al., “Carbapenem therapy for bacteremia due to extended-spectrum (beta)-lactamase-producing Escherichia coli or Klebsiella pneumoniae,” Diagnostic Microbiology and Infectious Disease, Vol. 70, No. 1, 2011, pp. 150-153. doi:10.1016/j.diagmicrobio.2010.12.008
[10]	A. Stucki, M. Cottagnoud, F. Acosta, et al., “Efficacy of doripenem against Escherichia coli and Klebsiella pneumoniae in experimental meningitis,” Journal of Antimicrobial Chemotherapy, Vol. 67, No. 3, 2012, pp. 661-665. doi:10.1093/jac/dkr482
[11]	W. N. Chang, C. H. Lu, C. R. Huang, et al., “Clinical characteristics of post-neurosurgical Klebsiella pneumoniae meningitis in adults and a clinical comparison to the spontaneous form in a Taiwanese population,” Journal of Clinical Neuroscience, Vol. 17, No. 3, 2010, pp. 334-338. doi:10.1016/j.jocn.2009.06.019
[12]	D. A. Rosen, J. S. Pinkner, J. N. Walker, et al., “Molecular variations in Klebsiella pneu-moniae and Escherichia coli FimH affect function and pathogenesis in the urinary tract,” Infection and Immunity, Vol. 76, No. 7, 2008, pp. 3346-3356. doi:10.1128/IAI.00340-08
[13]	S. Zarei-Ghanavati, M.R. Sedaghat and A. Ghavami-Shahri, “Acute Klebsiella pneumoniae interface keratitis after deep anterior lamellar keratoplasty,” Japanese Journal of Ophthalmology, Vol. 55, No. 1, 2011, pp. 74-76. doi:10.1007/s10384-010-0836-7
[14]	T. Aung and T. K. Chan, “Nosocomial Klebsiella pneumoniae conjunctivitis resulting in infectious keratitis and bilateral corneal perforation,” Cornea, Vol. 17, No. 5, 1998, pp. 558-561. doi:10.1097/00003226-199809000-00015
[15]	A. H. Kashani and D. Eliott, “Bilateral Klebsiella pneumoniae (K1 serotype) endogenous endophthalmitis as the presenting sign of disseminated infection,” Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye, Vol. 42, 2011, pp. e12-14.
[16]	L. P. Ang, H. M. Lee, K. G. Au Eong, et al., “Endogenous Klebsiella endophthalmitis,” Eye, Vol. 14, No. 6, 2000, pp. 855-860. doi:10.1038/eye.2000.236
[17]	Y. J. Chen, H. K. Kuo, P. C. Wu, et al., “A 10-year comparison of endogenous endophthalmitis outcomes: an East Asian experience with Klebsiella pneumoniae infection,” Retina, Vol. 24, No. 3, 2004, pp. 383-390. doi:10.1097/00006982-200406000-00008
[18]	S. J. Yang, S. Y. Park, Y. J. Lee, et al., “Klebsiella pneumoniae orbital cellulitis with extensive vascular occlusions in a patient with type 2 diabetes,” Korean Journal of Internal Medicine, Vol. 25, No. 1, 2010, pp. 114-117. doi:10.3904/kjim.2010.25.1.114
[19]	I. A. Chaudhry, F. A. Shamsi, E. Elzaridi, et al., “Inpatient preseptal cellulitis: experience from a tertiary eye care centre,” British Journal of Ophthalmology, Vol. 92, No. 10, 2008, pp. 1337-1341. doi:10.1136/bjo.2007.128975
[20]	C. T. Lin and Y.Y. Tsai, “Klebsiella pneumoniae orbital cellulitis,” Chinese Medical Journal (Taipei), Vol. 64, No. 9, 2001, pp. 551-554.
[21]	A. Hauser and S. Fogarasi, “Periorbital and orbital cellulitis,” Pediatrics in Review, Vol. 31, No. 6, 2010, pp. 242-249.
[22]	M. Coskun, O. IIhan, U. Keskin, et al., “Central retinal artery occlusion secondary to orbital cellulitis and abscess following dacryocystitis,” European Journal of Ophthalmology, Vol. 21, No. 5, 2011, pp. 649-652. doi:10.5301/EJO.2011.6493
[23]	K. Starska, M. Lukomski and D. Starska-Dawidowskda, “Preseptal orbital abscess as a post-traumatic late complication--review of the literature and case report,” Otolaryngologia polska. The Polish otolaryngology, Vol. 61, No. 3, 2007, pp. 331-334. doi:10.1016/S0030-6657(07)70438-9
[24]	S. Rumelt and P. A. Rubin, “Potential sources for orbital cellulitis,” International Ophthalmology Clinics, Vol. 36, No. 3, 1996, pp. 207-221. doi:10.1097/00004397-199603630-00019
[25]	P. Laloyaux, D. Vanpee and J. B. Gillet, “Orbital cellulitis with abscess formation caused by frontal sinusitis,” Journal of Emergency Medicine, Vol. 18, No. 2, 2000, pp. 253-254. doi:10.1016/S0736-4679(99)00204-8
[26]	G. J. Ben Simon, S. Bush, D. Selva, et al., “Orbital cellulitis: a rare complication after orbital blowout fracture,” Ophthalmology, Vol. 112, No. 11, 2005, pp. 2030-2034. doi:10.1016/j.ophtha.2005.06.012
[27]	S. P. Bord and J. Linden, “Trauma to the globe and orbit,” Emergency Medicine Clinics of North America, Vol. 26, No. 1, 2008, pp. 97-123. doi:10.1016/j.emc.2007.11.006
[28]	I. Brook, “Microbiology of sinusitis,” Proceedings of the American Thoracic Society, Vol. 8, No. 1, 2011, pp. 90-100. doi:/10.1513/pats.201006-038RN
[29]	V. Kumar and D. Saunders, “Orbital cellulitis after phacoemulsification and intraocular lens implantation,” Journal of Cataract and Refractive Surgery, Vol. 30, No. 4, 2004, pp. 918-920. doi:10.1016/j.jcrs.2003.11.026
[30]	S. Y. Liang, G. Moloney, B. A. O’Donnell, et al., “Orbital cellulitis as a postoperative complication of sub-Tenon anaesthesia in cataract surgery,” Clinical and Experimental Ophthalmology, Vol. 34, No. 9, 2006, pp. 897-899. doi:10.1111/j.1442-9071.2006.01361.x
[31]	V. Juthani, C. I. Zoumalan, R. D. Lisman, et al., “Successful management of methicillin-resistant Staphylococcus aureus orbital cellulitis after blepharoplasty,” Plastic and reconstructive surgery, Vol. 126, No. 6, 2010, pp. 305e-307e. doi:10.1097/PRS.0b013e3181f63f67
[32]	E. Hoyama, V. Li-mawararut, I, Leibovitch, et al., “Blinding orbital cellulitis: a complication of strabismus surgery,” Ophthalmic Plastic and Reconstructive Surgery, Vol. 22, No. 6, 2006, pp. 472-473. doi:10.1097/01.iop.0000245486.61228.8d
[33]	A. Basheikh and R. Superstein, “A child with bilateral orbital cellulitis one day after strabismus surgery,” Journal of AAPOS, Vol. 13, No. 5, 2009, pp. 488-490. doi:10.1016/j.jaapos.2009.05.016
[34]	M. P. Hatton and M. L. Durand, “Orbital cellulitis with abscess formation following surgical treatment of canaliculitis,” Ophthalmic Plastic and Reconstructive Surgery, Vol. 24, No. 4, 2008, pp. 314-316. doi:10.1097/IOP.0b013e31817e9be7
[35]	M. M. Marcet, J. J. Woog, A. R. Bellows, et al., “Orbital complications after aqueous drainage device procedures, ” Ophthalmic Plastic and Reconstructive Surgery, Vol. 21, No. 1, 2005, pp. 67-69. doi:10.1097/01.IOP.0000150351.91768.16