An eighteen-year-old student from one of the South Asian countries reported with a sudden blurring of vision and redness in the right eye (OD) for which he sought a local ophthalmologist's opinion. The patient underwent a lensectomy along with vitrectomy, elsewhere for suspected endophthalmitis. The vitreous sample was suggestive of fungal infection. He received intravitreal injection of Amphotericin B along with vancomycin and ceftazidime at the time of first surgery elsewhere. After the operation, he had perception of light. Two days after the surgery, a repeat intravitreal injection of Amphotericin B and antibiotics were administered, following which his vision did not improve. He was then referred to our institute, where on examination, he was found to have no light perception. The intraocular contents could not be seen because of anterior chamber being full of exudates. Ultrasound revealed the presence of total retinal detachment with shallow choroidal detachment.
Prior to the onset of ocular complication the patient had a history of diarrhoea for 10 days. The patient was advised evisceration of the right eye. At this point, the patient had fever touching up to 101 F, cold, cough, and vomiting. Once the fever subsided, the evisceration was performed under general anaesthesia. Following the evisceration, patient had intermittent fever with high Alanine aminotransferase (ALT) levels. The patient was tested negative for HIV. Clinical examination ruled out the presence of pulmonary tuberculosis.
A bacterial and fungal culture was put up for eviscerated material and the sample was subjected to direct examination using KOH/Calcofluor for fungus and Gram-s stain for bacteria. A few septate fungal filaments were seen in the KOH/Calcofluor stain, and a few Gram-negative bacilli along with pus cells were seen in the Gram-stained smear. The blood sample was processed for bacterial and fungal culture using the BACTEC (Becton, Dickinson and Company) system. Clean catch mid stream urine was subjected to conventional semiquantitative method of isolation bacteria.
After three days of incubation, Salmonella typhi was isolated from the eviscerated material and blood specimen, whereas the urine culture was negative for pyogenic bacteria. The isolated organism, from both the specimen, was subjected to a nested PCR amplification using primers targeted against the 16S rRNA gene following the protocol described by us earlier. The first round of PCR amplified products was then subjected to a DNA sequencing to find the sequence homology among the isolates. The sequenced data was analysed using the BLAST search tool and were aligned using the MultAlin software. The DNA sequences of organisms isolated from the blood and eviscerated material confirmed Salmonella typhi with 98% identity. The Multalin picture of 16SrRNA of the isolates was identical as shown in Figure 1. The DNA extracts of the isolates were also subjected to a RAPD (Bangalore Genei Pvt. Ltd) analysis to determine their clonal origin which showed that they belonged to the same clone as shown in Figures 2(a) and 2(b). The patient was treated with systemic antibiotics based on the sensitivity report.