title: Group A streptococcal endophthalmitis complicating a sore throat in a 2-year-old child.
abstract: A previously well 2-year-old presented to her general practitioner after 5 days of fever, lethargy, sore throat and a slightly red eye. A viral infection was diagnosed. Two days later, she re-presented with a swollen right eyelid and a moderately red eye. Oral amoxicillin and chloramphenicol eye drops were prescribed. The next day, marked periorbital swelling developed. She was admitted to hospital and parenteral ceftriaxone was started. Examination under anaesthetic showed injected globe diffuse corneal clouding and peripheral corneal opacities; ultrasound and CT suggested endophthalmitis. On transfer to a tertiary centre, intraocular vancomycin and subconjunctival cefuroxime were given. Aqueous fluid samples were positive for group A Streptococcus (GAS) by PCR, so parenteral clindamycin was added. GAS endophthalmitis was confirmed 1 day later from the positive intraocular fluid culture results. Visual evoked potentials revealed complete loss of vision. The eye was removed to limit potential spread. She made a good recovery postoperatively and was discharged on oral antibiotics.
authors: Department of Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, London, London, UK.
authors: Felicity
authors: F
authors: Fitzgerald
authors: Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors: Kathryn
authors: K
authors: Harris
authors: Department of Ophthalmology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors: Robert
authors: R
authors: Henderson
authors: Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors: Clive
authors: C
authors: Edelsten
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D009877:Endophthalmitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D054517:Orbital Cellulitis / Q000175:diagnosis; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D016133:Polymerase Chain Reaction / Q000379:methods; D011859:Radiography; D013290:Streptococcal Infections / Q000188:drug therapy / Q000473:pathology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome; D014463:Ultrasonography; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D014640:Vancomycin