Twelve hours after a farm injury causing a ruptured globe contaminated with soil, a patient develops fulminant panophthalmitis with hypopyon and rapid progression despite antibiotics. Which organism is classically responsible and associated with the worst visual prognosis?

• A Streptococcus pneumoniae
• B Coagulase-negative Staphylococcus
• C Haemophilus influenzae
• D Bacillus cereus ✓

Explanation

Bacillus cereus is a motile gram-positive rod found in soil and vegetation, and post-traumatic endophthalmitis from soil-contaminated open globes is its classic setting. It produces an explosive panophthalmitis within hours, with toxins causing rapid retinal necrosis, so the eye is frequently lost even with prompt intravitreal therapy. Coagulase-negative staphylococci cause indolent postoperative endophthalmitis, not fulminant post-traumatic infection.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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