Bilateral Aspergillus endophthalmitis in a patient with chronic lymphocytic leukaemia

Ocular aspergillosis: Obtaining a specimen is crucial for diagnosis. A report of three cases

Aspergillus species have been implicated in a wide variety of primary ocular conditions, characterized by either slow and asymptomatic infection, or rapid, uncontrollable progression and sometimes death. The study design is a case series including chronic asymptomatic dacryocystitis, dacryocystitis with dacryoliths and endogenous endophthalmitis. Due to this variable clinical presentation of aspergillosis a high level of suspicion must be maintained as fulminant aspergillosis may lead to a rapidly progressive infection which may result in death.

Endogenous filamentous fungal endophthalmitis--single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.

Epigenetics and chronic lymphocytic leukemia

The DNA methylation level in patients with chronic lymphocytic leukemia is generally lower than healthy individuals. Although DNA methylation is globally decreased, regional hypermethylation of gene promoters leads to gene silencing. Many of these genes have tumor suppressor phenotypes. Unlike mutations or deletions, hypermethylation is potentially reversible after inhibition with DNA methylation modulators. Myelodysplastic syndrome has been a model disease in which treatment of patients results in demethylation of specific genes. The story in patients with chronic lymphocytic leukemia is slowly unraveling as epigenetic modifications likely also play an important role. Ongoing clinical trials correlating clinical response to gene expression after treatment with DNA methylation inhibitors will ultimately allow us to better risk stratify and predict the subgroup of patients who will benefit from treatment with this class of drugs.

Primary Aspergillus and Fusarium keratitis in a Holstein cow

A 5-year-old female Holstein cow was examined for ocular discharge, periorbital swelling, an area of full-thickness corneal cellular infiltrate, fibrin, hypopyon, diffuse corneal edema, and miosis. The patient was diagnosed with a corneal stromal abscess and secondary anterior uveitis. Histopathology, mycotic culture, and polymerase chain reaction positive for Aspergillus and Fusarium DNA confirmed the presence of fungal infection. Response to therapy was adequate, and follow-up with the patient 1 year after diagnosis revealed a focal area of corneal fibrosis.