Sir,

We present a case of visual loss due to Rothia genus endophthalmitis following penetrating injury in a child.

Case report

An 11-year-old boy sustained a penetrating corneal injury in his right eye after walking into the edge of a door. The ocular perforation was not initially diagnosed at the local A&E department and he was brought to our Eye Casualty a week later with progressive right visual loss.

At presentation, visual acuity was perception of light in the right eye and 6/5 in the left eye. The iris was prolapsed through a paracentral corneal wound. There was hypopyon, posterior synechiae, and cataract. The patient underwent repair of the corneal laceration and lens aspiration the following day (Figure 1a). A vitrectomy with intravitreal injection of vancomycin, amikacin, and triamcinilone was performed a day later due to clinical evidence of endophthalmitis.

Figure 1
figure 1

(a) Sutured corneal perforation, organised exudate in the angle (arrow). (b) Fundus photograph of posterior pole showing fibrosed detached retina.

Full size image

Gram-positive rods were present in the vitreous aspirate and identified as Rothia on incubation (API Coyne bacterial identification system). The organism was sensitive to vancomycin. The penicillin MIC was 0.32 mg/l. In the reference laboratory (Centre for Infections, HPA Colindale) the isolate was tested by gas chromatography of cellular fatty acids and partial sequencing of 16S rRNA. The results suggested an unnamed species within the genus Rothia.

The patient was further managed with oral coamoxiclav and topical penicillin. Visual acuity deteriorated to no perception of light 6 weeks postoperatively due to the development of a total retinal detachment with severe proliferative vitreoretinopathy (Figure 1b).

Discussion

Rothia genus was proposed for a group of coccoid to diphtheroid to filamentous Gram-positive organisms isolated from the human oral cavity.1 Rothia dentocariosa has been linked with human disease such as endocarditis, mycotic aneurysms, osteomyelitis, septicaemia, pneumonia, and peritonitis.2, 3, 4, 5, 6, 7 Endophthalmitis has been reported in an adult following multiple surgeries. The visual outcome was poor.8 The diagnosis of Rothia genus infection is difficult as the organism can be confused with other bacteria. Penicillin is the antibiotic of choice, however, other agents such as aminoglycosides, vancomycin, cephalosporins may be effective. In our case, possible mode of transmission could be haematogenous spread or eye rubbing with dirty hands.