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Li Y, Qian Z, Chen H, Zhang S, Wang R, Yu S, Chen L, Wang L, Xu S, Tao Y. THE CLINICAL VALUE OF β-D-GLUCAN TESTING AND NEXT-GENERATION METAGENOMIC SEQUENCING FOR THE DIAGNOSIS OF FUNGAL ENDOPHTHALMITIS. Retina 2024; 44:1209-1216. [PMID: 38359396 DOI: 10.1097/iae.0000000000004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To explore the clinical value of β-D-glucan (BDG) testing and metagenomic next-generation sequencing (mNGS) for detecting the pathogens of fungal endophthalmitis (FE). METHODS This study included 32 cases (32 eyes) with FE and 20 cases (20 eyes) with intraocular inflammation caused by other etiologies. All patients underwent extraction of aqueous humor or vitreous fluid samples for BDG testing and mNGS. The diagnostic performance and total clinical concordance rate of BDG testing and mNGS for FE were evaluated and calculated based on the results of the clinical diagnosis. RESULTS Among the clinically diagnosed FE, the positivity rates of BDG testing and mNGS (90.63%) were both significantly higher ( P < 0.001) than that of microbial cultures (53.13%). There was 100% consistency in pathogen identification using mNGS and culture identification for culture-positive cases. The area under the curve was 0.927 for BDG testing and 0.853 for mNGS. When the two tests were combined, sensitivity (93.75%), specificity (100.00%), and total clinical concordance rate (96.15%) were all improved, compared with the single tests. CONCLUSION The positive rates of BDG test and mNGS were markedly higher than those of cultures in FE identification. The combination of these two tests showed improved performance when compared with individual tests.
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Affiliation(s)
- Yuxin Li
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Zhuyun Qian
- Key Laboratory Jointly Built By the National Institute for Viral Disease Control and Prevention of China Centre for Disease Control and Prevention & Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Huagui Chen
- Medical College, Hunan Normal Universlty, Changsha, China
- Department of Clinical Laboratory, Aier Eye Hospital, Changsha, Hunan Province, China
| | - Shuguang Zhang
- Department of Ophthalmology, Zhengzhou Second People's Hospital, Zhengzhou, Henan, China; and
| | - Ruifeng Wang
- Department of Ophthalmology, Zhengzhou Second People's Hospital, Zhengzhou, Henan, China; and
| | - Shuhuan Yu
- Key Laboratory Jointly Built By the National Institute for Viral Disease Control and Prevention of China Centre for Disease Control and Prevention & Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Li Chen
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Lu Wang
- Key Laboratory Jointly Built By the National Institute for Viral Disease Control and Prevention of China Centre for Disease Control and Prevention & Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Songtao Xu
- National Institute for Viral Disease Control and Prevention, China Centre for Disease Control and Prevention, Beijing, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
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Krohn J, Power ØA, Mylvaganam H, Askim AJ, Arnes JB, Blomberg B. Endogenous fungal endophthalmitis caused by Cladophialophora devriesii: report of a case and literature review. J Ophthalmic Inflamm Infect 2024; 14:25. [PMID: 38836962 PMCID: PMC11153416 DOI: 10.1186/s12348-024-00408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
PURPOSE To report a case of endogenous endophthalmitis caused by the dematiaceous fungus Cladophialophora devriesii. METHODS Observational case report and literature review. CASE PRESENTATION A 73-year-old female with a history of chronic obstructive pulmonary disease presented with a red and painful left eye. Examination revealed anterior segment inflammation and vitritis, indicative of endophthalmitis. She underwent core vitrectomy and intravitreal injection of vancomycin and amphotericin B. The vitreous sample showed inflammatory cells and fungal hyphae, and systemic amphotericin B and itraconazole were commenced for fungal endophthalmitis. Targeted amplification of the sample for bacterial DNA (V2-V3 region of 16 S rDNA) was negative, but fungal DNA targets (ITS1 and ITS2) were present, and their sequences were consistent with Cladophialophora devriesii. Phenotypic characterisation and sequencing of ITS1 and ITS2, carried out on cultured fungus from the sample, also revealed Cladophialophora devriesii. She received repeated intravitreal injections of voriconazole, and based on the antifungal susceptibility results, her systemic medication was changed to posaconazole. After 12 months, the eye showed no signs of inflammation, and posaconazole therapy was discontinued. After 3 months without antifungal medication, the inflammation recurred, and she was restarted on antifungal therapy for an additional 20 months. Another recurrence occurred 3 months after discontinuation of treatment, and a repeat vitreous sample confirmed the presence of Cladophialophora devriesii. She was started on isavuconazole, but developed seclusio pupillae and painful secondary glaucoma. Due to the duration and severity of the infection, the eye was enucleated. Histopathology revealed persistent fungal elements at the ciliary processes and the posterior lens surface. CONCLUSIONS This second reported case of endogenous endophthalmitis caused by Cladophialophora devriesii illustrates the role of vitreous sampling and molecular methods in diagnosis and treatment of fungal endophthalmitis. Despite early diagnosis and prolonged local and systemic antifungal therapy, it was not possible to achieve long-term control of the fungal infection.
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Affiliation(s)
- Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.
| | - Øystein A Power
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Andreas J Askim
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Jarle B Arnes
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Infectious Diseases Section, University of Bergen, Bergen, Norway
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Dawit AM. Unusual sight-threatening complication of scaled burn injury in a pediatric patient: A case report. Int J Surg Case Rep 2024; 119:109700. [PMID: 38714070 PMCID: PMC11096736 DOI: 10.1016/j.ijscr.2024.109700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION Acute ophthalmic complications in burn injury patients are rare. Despite their rarity however, when they do occur, they may result in permanent visual impairment and lifelong disability. Emphasizing the need for vigilance and prompt treatment initiation for a good outcome. CASE PRESENTATION A 3-year-old girl was referred to our burn unit after receiving 10 days of treatment at a peripheral hospital for scalding burn to her upper chest, face, and scalp. Remarkably, her eyelids were spared from the initial injury. Upon her third day under our care, she began displaying severe sensitivity to light, photophobia, irritability, excessive crying, and frequent itching of the eyes. Upon examination, bilateral conjunctival redness and inflammation, as well as whitish opacity of both corneas with pus in the anterior chambers were observed. Prompt consultation and treatment led to improvement of the symptoms. DISCUSSION This case report describes a rare case of bilateral endopthalmitis in a burn injury patient with no initial apparent injury to the eyes and emphasizes the importance of vigilance, prompt recognition of the scenario and treatment initiation. Risk factors identified in this patient included compromised immune system due to severe burn, prolonged hospitalization, IV antibiotic use and young age. Other more common risk factors associated with endopthalmitis like direct ocular injury and central line use were absent making the case unusual. CONCLUSION Despite their rarity severe ophthalmic complications like endopthalmitis can occur in burn injury patients even when least expected. Heightened vigilance, prompt evaluation, multidisciplinary team approach and early initiation of broad spectrum antibiotic treatment is crucial to prevent permanent visual loss and lifelong disability.
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Affiliation(s)
- Anteneh Meaza Dawit
- Addis Ababa University, College of Health Sciences, Department of Plastic and Reconstructive Surgery.
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Hasbi A, Mohd Nafeez MN, Tai E, Yaakub A, Shatriah I. Endogenous Endophthalmitis: A 10-Year Review of Cases on the East Coast of Malaysia. Cureus 2024; 16:e60132. [PMID: 38864048 PMCID: PMC11165441 DOI: 10.7759/cureus.60132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose Our study aimed to describe the clinical profile of endogenous endophthalmitis, focusing on patient demographics, infection sources, microbial profiles, clinical outcomes, and factors affecting the final visual outcome. Methods A retrospective review was performed on data from 68 eyes of 60 patients diagnosed with endogenous endophthalmitis and hospitalized in two tertiary hospitals on the East Coast of Peninsular Malaysia from January 2011 to December 2020. The analysis encompassed evaluating patient age, gender, laterality, risk factors, infection origins, presenting and final visual acuity, microbial results, treatment responses, and factors affecting final visual outcomes. Results The average age of the patient cohort was 54.9 ± 13.3 years. Females were more likely to have endogenous endophthalmitis than males (33, 55.0% vs. 27, 45.0%). Twenty-seven patients (45.0%) presented with endogenous endophthalmitis in the left eye, while 25 patients (41.7%) had it in the right eye, and eight patients (13.3%) had bilateral involvement. Most patients had underlying predisposing conditions, predominantly diabetes mellitus (53, 88.3%). Infection sources were identified in 42 patients (70.0%), out of which urinary tract infections account for the majority (11, 18.3%). Klebsiella species(14, 22.7%) were the leading pathogens and were significantly associated with liver abscess cases. In this series, the majority of patients had poor presenting and final visual acuity of worse than 3/60 (56, 82.4% and 53, 77.9%, respectively). Thirty-six eyes (52.9%) underwent vitrectomy, resulting in only four eyes (11.11%) achieving final visual acuity better than 6/12. Presenting visual acuity was identified as the factor contributing to the blind final visual outcome (r = 0.707, p < 0.001). Conclusion Females were found to be more commonly affected by endogenous endophthalmitis than males. Klebsiella species were the most commonly isolated microorganisms and were typically associated with liver abscesses. Urinary tract infection was the most common predisposing factor. A majority of the patients had poor presenting and final visual acuity, in which poor visual acuity is a significant indicator of blind visual outcomes.
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Affiliation(s)
- Amirul Hasbi
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, MYS
| | - Mohd Nazri Mohd Nafeez
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, MYS
| | - Evelyn Tai
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Azhany Yaakub
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Ismail Shatriah
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
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Ness T. [Bacterial endogenous endophthalmitis : Spectrum of pathogens and drug therapy]. DIE OPHTHALMOLOGIE 2024; 121:264-271. [PMID: 38438813 DOI: 10.1007/s00347-024-01995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
Endogenous endophthalmitis represents an ophthalmological emergency requiring immediate diagnostics and treatment. Pathogens should be detected using appropriate methods, such as the Freiburg endophthalmitis set. In bacterial endophthalmitis both Gram-positive and Gram-negative bacteria can be detected. Frequent underlying sources include endocarditis, gastrointestinal or urogenital surgery, indwelling venous catheters, liver abscesses, skin or soft tissue infections, meningitis or less commonly, intravenous drug abuse. The treatment consists of systemic and intraocular administration of antibiotics and vitrectomy. Systemic or intraocular corticosteroids can additionally be considered.
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Affiliation(s)
- Thomas Ness
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
- Albert-Ludwigs Universität Freiburg, Medizinische Fakultät, Freiburg, Deutschland.
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Azhari J, Tetelbom PS, Sallam AB. The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment. J Fungi (Basel) 2023; 9:1147. [PMID: 38132748 PMCID: PMC10744273 DOI: 10.3390/jof9121147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Endophthalmitis refers to inflammation involving internal ocular structures, including the anterior and posterior eye segments, associated with infectious agents, most commonly bacteria and fungi. This review focuses on endophthalmitis caused by fungi. Medical and surgical management are the two main treatment modalities for fungal endophthalmitis, with medical management utilizing systemic or intravitreal antifungals. The use of systemic or intravitreal corticosteroids as an adjuvant treatment to dampen the severity of inflammation is controversial. Based on the pathobiology of fungal endophthalmitis as well as the mechanism of action of corticosteroids, it was hypothesized that corticosteroids affected the immune response against fungal infection. In vitro studies mostly carried out during the 1980s showed that dexamethasone plays a role in the suppression of phagocytosis of yeasts and demonstrated the facilitation of yeast proliferation by dexamethasone. In vivo studies analysis was compromised entirely of retrospective studies describing steroid use in fungal endophthalmitis, with the outcomes of the patients in these studies varying greatly and often being anecdotally noted, thus difficult to discern any definitive results. Given the limited clinical data and the heterogeneity of the existing studies, additional experimentation human studies with clinical trials or observations over more extended periods analyzing the effect of systemic and intravitreal corticosteroids in fungal endophthalmitis are needed before definitive conclusions can be drawn.
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Affiliation(s)
| | | | - Ahmed B. Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (J.A.); (P.S.T.)
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Xie Y, Wang X, Ji Z, Li G, Zhang C. The Effectiveness and Safety of Intravitreal Injections of Voriconazole in the Treatment of Fungal Endophthalmitis: A Systematic Review. J Ocul Pharmacol Ther 2023. [PMID: 38011696 DOI: 10.1089/jop.2023.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: Fungus endophthalmitis is a rare and serious infection that is treated with systemic and topical antifungal drugs. There is no clear consensus on the treatment of fungal endophthalmitis with intravitreal injections (IVIs) of voriconazole. This systematic review aims to summarize the literature on IVIs of voriconazole for fungal endophthalmitis. Methods: We conducted a systematic review of the literature to determine the effectiveness and safety of IVIs of voriconazole in the treatment of fungal endophthalmitis. We searched databases such as PubMed and Embase using the following search terms "Endophthalmitis" AND "Intravitreal Injections" AND "Voriconazole" with date limits of January 1, 1900, to December 31, 2022. We included all reports on humans, which described clinical outcomes of IVIs of voriconazole in the treatment of fungal endophthalmitis, including randomized controlled trials (RCTs) and case series. A descriptive synthesis of the data was conducted with a pooling of data for interventions. Results: One RCT and 21 retrospective studies were analyzed in this review. In these reports, a wide range of heterogeneous treatment regimens was used, including IVI in combination with other drugs, systemic therapy in combination with other agents, and surgery. Combined with other treatments, intravitreal voriconazole results in a favorable anatomical and clinical cure that was well tolerated. Conclusions: Reports on IVIs of voriconazole for fungal endophthalmitis demonstrate a heterogeneous approach to treatment. Of these, IVIs of voriconazole in anatomical and clinical outcomes appeared to be highly effective, although more data on its safety are needed.
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Affiliation(s)
- Yue Xie
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zichao Ji
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guangyao Li
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Das T, Joseph J, Simunovic MP, Grzybowski A, Chen KJ, Dave VP, Sharma S, Staropoli P, Flynn H. Consensus and controversies in the science of endophthalmitis management: Basic research and clinical perspectives. Prog Retin Eye Res 2023; 97:101218. [PMID: 37838286 DOI: 10.1016/j.preteyeres.2023.101218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
Infectious endophthalmitis is a severe intraocular infection caused by bacteria, or less commonly by fungi. It can occur after penetrating eye procedures, trauma, or the spread of infection from contiguous structures or via emboli from distant organs. Because of the time-critical nature of the treatment, endophthalmitis is treated with the clinical diagnosis and modified by the microbiological report of the intraocular contents. The current strategy for managing endophthalmitis relies on pre-clinical literature, case series, and one large multi-center randomized clinical trial on post-cataract surgery endophthalmitis. Culture-susceptibility of the microorganisms from undiluted vitreous guides the definitive treatment in non-responsive cases. Strategies to reduce the incidence of endophthalmitis after penetrating eye procedures have been developed concurrently with refined means of treatment. Despite these advances, outcomes remain poor for many patients. Although consensus articles have been published on managing endophthalmitis, treatment patterns vary, and controversies remain. These include (1) the use of newer methods for early and precise microbiological diagnosis; (2) the choice of intravitreal antibiotics; (3) the need for systemic therapy; (4) early and complete vitrectomy. Here, we review the current consensus and address controversies in diagnosing and managing endophthalmitis. This review is intended to familiarize physicians and ophthalmologists with different aspects of endophthalmitis management to make informed decisions.
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Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V, Prasad Eye Institute, Hyderabad, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Matthew P Simunovic
- Save Sight Institute, University of Sydney, NSW, 2006, Australia; Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Patrick Staropoli
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Harry Flynn
- Bascom Palmer Eye Institute, Miami, FL, USA.
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Awh CC, Mammo DA, Bergstrom R, Baynes K, Srivastava SK. Fungal Endophthalmitis Secondary to Aspergillus terreus Exacerbated by Intravitreal Dexamethasone in a Patient With Sarcoidosis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:448-454. [PMID: 37706086 PMCID: PMC10496802 DOI: 10.1177/24741264231173207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Purpose: To report a case of Aspergillus terreus endophthalmitis associated with systemic immunosuppression and an intraocular steroid implant in a patient with sarcoidosis. Methods: A case report was evaluated and a literature review performed. Results: A patient with a history of pulmonary and ocular sarcoidosis presented with new-onset uveitis and was treated for presumed sarcoid flare with oral prednisone and an intravitreal dexamethasone implant before developing worsening vision. She was ultimately diagnosed with A terreus endophthalmitis. Despite both systemic and local antifungals, the visual acuity at the most recent follow-up was no light perception without pain or active inflammation. No definitive source of the fungal disease had been identified. Conclusions: Endophthalmitis resulting from A terreus is associated with poor outcomes. Given the ability of fungal endophthalmitis to mimic other causes of uveitis, one must maintain a high suspicion in patients with any degree of immunosuppression.
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Thompson KN, Alshaikhsalama AM, Wang AL. Evaluation of the Clinical Course of Endogenous Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:389-396. [PMID: 37706078 PMCID: PMC10496817 DOI: 10.1177/24741264231191344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Purpose: To evaluate the presentations, clinical course, treatments, and outcomes of endogenous endophthalmitis cases. Methods: Consecutive medical records from 2016 to 2021 of a county hospital and an academic, private hospital in Dallas, Texas were retrospectively reviewed. This study comprised 37 eyes of 31 patients with endogenous endophthalmitis. Collected data included demographic factors, identifiable risk factors, medical history, presenting symptoms, infectious data, complications, and best-corrected visual acuity (VA) throughout the clinical course. Results: Twenty-two eyes had bacterial endophthalmitis, 7 had fungal endophthalmitis, and 8 had infections that could not be classified. Of the bacterial cases, 5 eyes had panophthalmitis with associated cellulitis. The most common organisms were Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa. The most common presenting symptoms were decreased vision (70%), eye redness (41%), and eye pain (38%). Among all cases, there was no significant difference in the presenting logMAR VA (1.86) before treatment and the most recent logMAR VA (1.75; P = .70) after treatment. However, fungal infections demonstrated better logMAR VA than bacterial infections 6 months after diagnosis (mean logMAR VA, 0.93 vs 2.54, respectively; P = .016) and at most recent follow-up (mean logMAR VA, 0.76 vs 2.3, respectively; P = .004). There was also a strong correlation between presenting VA and most recent VA (r2 = 0.81; P < .01). Conclusions: Visual outcomes of endogenous endophthalmitis cases were poor. Our study found 2 components to be predictive of final VA: (1) whether the infecting organism was bacterial or fungal and (2) a patient's presenting VA.
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Affiliation(s)
| | | | - Angeline L. Wang
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Xie CA, Singh J, Tyagi M, Androudi S, Dave VP, Arora A, Gupta V, Agrawal R, Mi H, Sen A. Endogenous Endophthalmitis - A Major Review. Ocul Immunol Inflamm 2023; 31:1362-1385. [PMID: 36306406 DOI: 10.1080/09273948.2022.2126863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022]
Abstract
Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.
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Affiliation(s)
- Cen Amy Xie
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jayanti Singh
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
| | - Mudit Tyagi
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Vivek Pravin Dave
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Atul Arora
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Eye ACP programme, Duke NUS Medical School, Singapore
- Ocular Infections and AntiMicrobials Group, Singapore Eye Research Institute, Singapore
| | - Helen Mi
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Alok Sen
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
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Thangamathesvaran L, Canner JK, Scott AW, Woreta FA, Breazzano MP. National emergency department trends for endogenous endophthalmitis: an increasing public health challenge. Eye (Lond) 2023; 37:1123-1129. [PMID: 35487961 PMCID: PMC10102014 DOI: 10.1038/s41433-022-02080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVE To characterize incidence rates and identify risk factors for admission and mortality in patients with endogenous endophthalmitis (EE) in the United States (US). SUBJECTS/METHODS Patients with EE were identified using the Nationwide Emergency Department (NEDS) Database from 2006 to 2017 in this cross-sectional study. Subjects were required to have diagnoses of both endophthalmitis and septicaemia using contemporary International Classification of Diseases diagnosis codes. Incidence rates, mortality rates and demographics were evaluated. Risk factors for admission and mortality were identified using weighted logistic regression analysis. RESULTS A total of 6400 patients with EE were identified. Incidence increased from 0.10 (95% confidence interval [CI]: 0.07-0.12) per 100,000 in the US population in 2006 to 0.25 (95% CI: 0.21-0.30) in 2017 (p < 0.05). Most were female (55.4%), insured with Medicare (53.5%), were in the first income quartile earnings (29.3%) [bottom 25% income bracket], lived in the South (40.5%), and presented to metropolitan teaching hospitals (66.6%). Mortality increased from 8.6% (95% CI: 3.8-18.3%) in 2006 to 13.8% (95% CI: 9.7-19.2%) in 2017 (p = 0.94). Factors predicting admission included older age (odds ratio [OR] 32.59; [95% CI 2.95-359.78]) and intravenous drug use (OR 14.90 [95% CI: 1.67-133.16]). Factors associated with increased mortality included: human immunodeficiency virus infection/immune deficiencies (OR 2.58 [95% CI: 1.26-5.28]), heart failure (OR 2.12 [95% CI: 1.47-3.05]), and hepatic infections/cirrhosis (OR 1.89 [95% CI: 1.28-2.79]). Pneumonia and renal/urinary tract infections (UTI) were associated with both increased hospital admission [(pneumonia OR 9.64 (95% CI: 1.25-74.35, p = 0.030), renal/UTI OR 4.09 (95% CI: 1.77-9.48)] and mortality [(pneumonia OR 1.64 (95% CI: 1.17-2.29, p = 0.030), renal/UTI OR 1.87 (95% CI: 1.18-2.97)]. Patients with diabetes mellitus (DM) had decreased odds ratio for mortality (OR 0.49 [95% CI: 0.33-0.73]). CONCLUSION EE has increased in incidence throughout US. The two systemic factors that conferred both an increase in mortality and admission were pneumonia, and renal/UTI. Additional exploration of the potential protective association of DM with decreased mortality in this context is needed.
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Affiliation(s)
- Loka Thangamathesvaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adrienne W Scott
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA.
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA.
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Sahu ES, Lahoti K, Bhargava A, Subhedar V, Sahu A. Subretinal Aspergillus Abscess in Post COVID-19 Recovered Patients - An Emerging Problem. Ocul Immunol Inflamm 2023; 31:127-133. [PMID: 34784260 DOI: 10.1080/09273948.2021.1993271] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe endogenous endophthalmitis in the setting of Covid-19 pneumonia post recovery. METHODS Retrospective review of five patients of endogenous endophthalmitis following Covid-19 disease done. RESULTS All five cases had received systemic corticosteroid for a mean duration of 7 days during severe Covid-19 treatment. Decrease vision was presenting symptom between 1 and 31 days following Covid-19 recovery. All patients had presumed fungal endogenous endophthalmitis based on clinical profile. Four out of five patients subjected to pars plana vitrectomy had microbiologically proven aspergillus species endogenous endophthalmitis on vitreous fluid assessment; two cases each of aspergillus niger and aspergillus fumigates. Four eyes underwent pars plana vitrectomy with silicone oil injection had shown satisfactory anatomical outcome with control of the infection; however, no significant visual gain achieved. CONCLUSION We reported five cases of aspergillus endogenous endophthalmitis in Covid-19 recovered patients to document the likely presentation of this rising entity and avoid misdiagnosis.
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Affiliation(s)
- Ekta Singh Sahu
- Consultant Vitreo-Retina and Uvea Services, Retina Speciality Hospital, Indore, India
| | - Keshav Lahoti
- Consultant Vitreo-Retina and Uvea Services, Retina Speciality Hospital, Indore, India
| | - Arun Bhargava
- Director and Head of Retina Department, Retina Speciality Hospital, Indore, India
| | | | - Animesh Sahu
- Consultant Cataract and Oculoplasty Services, Retina Speciality Hospital, Indore, India
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14
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Levine H, Naranjo A, Martinez JD, Altamirano DS, Gayer S, O’Brien TP, Karp CL, Amescua G. Considerations for Corneal Surgery With Patients in the 10th Decade of Life. Cornea 2022; 41:1222-1231. [PMID: 34743105 PMCID: PMC9065212 DOI: 10.1097/ico.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the indications, ocular and systemic comorbidities, and surgical outcomes of corneal transplantation in patients older than 90 years. METHODS A retrospective review was conducted to identify individuals 90 years and older who underwent corneal transplantation surgery at the Bascom Palmer Eye Institute between January 2013 and October 2020. Outcomes included best-corrected visual acuity and graft survival over time. Paired t tests were used to compare visual acuity preoperatively versus postoperatively. Graft survival was evaluated with Kaplan-Meier curves. RESULTS Fifty-eight eyes of 52 consecutive individuals were included. The mean age of individuals was 92 ± 2 years; 26.9% were male; and 48.1% self-identified as non-Hispanic White and 38.5% as Hispanic. Postoperative follow-up was 14.7 ± 12.1 months. Of the 58 eyes, 44.8% (26/58) underwent penetrating keratoplasty, 46.6% (27/58) Descemet stripping automated endothelial keratoplasty, and 6.9% (4/58) keratoprosthesis. All surgeries were performed under monitored local anesthesia, without major complications. Surgical indications included pseudophakic bullous keratopathy (36.2%), glaucoma-associated corneal decompensation (27.6%), Fuchs endothelial dystrophy (25.9%), and perforated corneal ulceration (19.0%). The best-corrected visual acuity improved by 0.32 (95% confidence interval 0.14-0.50; P < 0.01) as early as 1 month postoperatively, and vision gains were sustained for at least 12 months. Graft survival probability at 12 months was 88%. CONCLUSIONS Corneal transplantation is a safe and successful procedure in restoring the visual acuity for patients older than 90 years after careful preoperative evaluation. Further research is needed to evaluate the impact of corneal transplantation on quality of life in patients in the 10th decade of life.
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Affiliation(s)
- Harry Levine
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Naranjo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jaime D. Martinez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diego S. Altamirano
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven Gayer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Anesthesia, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Terrence P. O’Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carol L. Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Iyer PG, Fan J, Diaz JD, Liu J, Lazzarini T, Fan KC, Miller D, Flynn HW. Recurrent, bilateral endogenous Candida endophthalmitis with multiple focal chorioretinal lesions: management with pars plana vitrectomy and focal endolaser. J Ophthalmic Inflamm Infect 2022; 12:24. [PMID: 35816251 PMCID: PMC9273793 DOI: 10.1186/s12348-022-00301-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Bilateral endogenous Candida endophthalmitis (ECE) treatment usually involves administering systemic and intravitreal antifungal medications. In advanced cases with vitreous seeding, pars plana vitrectomy (PPV) is considered. The use of focal endolaser treatment to chorioretinal lesions has not been reported. We present a case of bilateral recurrent ECE treated with PPV and endolaser to elevated focal lesions. CASE A 45-year-old diabetic male presented with decreased visual acuity in both eyes (20/50 right eye, 20/150 left eye) and was found to have bilateral ECE with moderate vitritis and chorioretinal lesions. The initial treatment consisted of multiple intravitreal voriconazole injections to both eyes as well as systemic antifungal therapy. Resolution of ECE occurred after three months, but one year later despite therapy recurred bilaterally. Patient underwent PPV with endolaser to the elevated chorioretinal lesions in both eyes. One year later, his vision improved to 20/40 in both eyes, focal lesions were flat and resolved along with the ECE. CONCLUSION Advanced or recurrent ECE that is refractive to intravitreal antifungal therapy may be treated with PPV. Endolaser therapy to the chorioretinal lesions is an additional local option that can resolve the activity of ECE.
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Affiliation(s)
- Prashanth G Iyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - J Daniel Diaz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - Thomas Lazzarini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - Darleen Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA.
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Lee CS, Desilets J, Fang W, Hinkle DM. The microbiological spectrum, antimicrobial resistance pattern, and visual outcomes of endogenous endophthalmitis in West Virginia 2009-2019. Int Ophthalmol 2022; 42:3153-3163. [PMID: 35606624 DOI: 10.1007/s10792-022-02315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the microbiological spectrum, antimicrobial resistance patterns, and visual outcomes in patients with endogenous endophthalmitis (EE). METHODS This was a retrospective study of 50 patients with culture-positive EE managed in a tertiary referral center between October 2009 and 2019. Clinical, microbiology analysis, and antimicrobial resistance were reviewed. A multivariable linear regression analysis was used for identifying risk factors associated with worse visual outcomes. RESULTS Fifty organisms were identified, 62% bacterial and 38% fungal. The most common bacterial organism was Staphylococcus aureus (75% methicillin resistant), and Candida was the most common fungal species. Multidrug resistance was observed in methicillin-resistant Staphylococcus aureus (MRSA) isolates against clindamycin, daptomycin, and fluoroquinolones. The distributions of the final visual acuity (VA) between the bacterial and fungal groups were significantly different, and the visual outcomes in the bacterial group tended to be worse (p = 0.01). The distributions of enucleation status were significantly higher in bacterial EE (35%) than fungal EE (5.3%) (p = 0.02). Results from the multivariable linear regression analysis revealed that older age was significantly associated with worse visual outcome (coef = 0.03; p = 0.02), while fungal infections were associated with better outcomes (coef = - 0.87; p = 0.01). Intravenous drug use (coef = 0.87; p = 0.054) was a marginally significant factor associated with worse visual outcomes. CONCLUSION There was a higher prevalence of bacterial organisms than fungal species among EE. Bacterial EE was associated with worse visual outcomes and higher enucleation rates than fungal EE. Multidrug resistance was prevalent among MRSA isolates. Older age and intravenous drug use may be factors associated with poor prognosis.
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Affiliation(s)
- Chang Sup Lee
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.,University of Southern California Roski Eye Institute, 1450 San Pablo St., Suite 4700, Los Angeles, CA, 90013, USA
| | - Jeffrey Desilets
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.,Ross Eye Institute, 1176 Main St., Buffalo, NY, USA
| | - Wei Fang
- WVU Health Sciences Center Erma Byrd Biomedical Research Center, 1 Medical Center Drive, West Virginia Clinical and Translational Science Institute, Morgantown, WV, 26506, USA
| | - David M Hinkle
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA. .,Tulane University School of Medicine, 131 S. Robertson Street., 12th floor, 8069, New Orleans, LA, 70112, USA.
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The Diagnosis and Treatment of Fungal Endophthalmitis: An Update. Diagnostics (Basel) 2022; 12:diagnostics12030679. [PMID: 35328231 PMCID: PMC8947249 DOI: 10.3390/diagnostics12030679] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. However, we must keep in mind that prevalence of fungal species varies with the geographical area. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR—the limited number of pathogens that can be simultaneously searched for—may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. We must not forget the potential of simpler tests (such as galactomannan and β-d-glucan) in orienting towards a diagnosis of FE. There are few reports about the use of newer antifungals in FE. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy.
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18
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Mirenayat MS, Heshmatnia J, Saghebi SR, Sheikhy K, Marjani M, Fakharian A, Jamaati H. Uncommon Complications of Lung Transplantation in a Referral Center. TANAFFOS 2022; 21:179-185. [PMID: 36879725 PMCID: PMC9985118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/17/2021] [Indexed: 03/08/2023]
Abstract
Background Many efforts were made to determine the uncommon clinical complications after lung transplantation and treatment options to tackle them; however, many of these rare complications have not been mentioned in recent publications. Evaluating and recording adverse effects after organ transplantation can significantly prevent post-transplant mortality. This study aimed to examine rejection factors by examining individuals undergoing lung transplantation surgery. Materials and Methods In a prospective longitudinal study, we followed up on complications of 60 lung recipients post lung-transplantation surgery for six years from 2010 to 2018. All complications were recorded in follow-up visits or hospital admissions during these years. Finally, the patients' information was categorized and evaluated by designing a questionnaire. Results From a total of 60 transplant recipients, from 2010 to 2018, 58 patients were initially enrolled in our study, but two were lost to follow-up. Uncommon complications witnessed in the post-transplantation period included endogenous endophthalmitis, herpetic keratitis, duodenal strongyloidiasis, intestinal cryptosporidiosis, myocardial infarction, diaphragm dysfunction, Chylothorax, thyroid nodule, and necrotizing pancreatitis. Conclusion Meticulous postoperative surveillance is crucial for managing lung transplant patients for early detection and treatment of common and uncommon complications. Therefore, it is necessary to establish procedures for assessing the patients' constancy until complete recovery.
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Affiliation(s)
- Maryam Sadat Mirenayat
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NIRTLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalal Heshmatnia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NIRTLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Saghebi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NIRTLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Sheikhy
- Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NIRTLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NIRTLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Das T, Agarwal M, Anand AR, Behera UC, Bhende M, Das AV, Dasgupta D, Dave VP, Gandhi J, Gunasekaran R, Joseph J, Kulkarni S, Lalitha P, Mahendrakar PA, Mitra S, Mohamed A, Muralidhar A, Nimeshika PL, Prashanthi GS, Sen A, Sharma S, Uday P. Fungal endophthalmitis: Analysis of 730 consecutive eyes from seven tertiary eye care centers in India. Ophthalmol Retina 2021; 6:243-251. [PMID: 34547530 DOI: 10.1016/j.oret.2021.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the clinical and microbiological features of a large cohort of culture-confirmed fungal endophthalmitis across India. DESIGN Cross-sectional hospital-based retrospective medical records review. PARTICIPANTS Seven large tertiary eye care centers from different regions of India. METHODS The patient data were pooled from the electronic/physical medical records of each participating center. Fellowship-trained vitreoretinal specialists clinically managed all patients, and in-house microbiology laboratories performed all microbiology work-ups. The clinical and microbiology procedures were broadly uniform across all participating centers. The essential treatment consisted of vitreous surgery and intravitreal and systemic therapy with antifungal agents. MAIN OUTCOME MEASURES Clinical outcome by the causative event and causative fungus. RESULTS In the 2005-2020 period, seven centers treated 3830 cases of culture-proven endophthalmitis, and 19.1% (n=730) were culture-confirmed fungal endophthalmitis. It included 46.9% postoperative (87.4% post-cataract surgery), 35.6% traumatic and 17.5% endogenous endophthalmitis. The fungi included 39.0% Aspergillus (high in central, east and south zones), 15.1% Candida (high in west zone), 15.9% Fusarium (high in north and west zone). The time to symptoms was between 1w-4w in more than a third of patients except in traumatic endophthalmitis. Less than half of patients had hypopyon on presentation. Presenting visual acuity (PVA) in most patients was <20/400. Nearly all patients needed a vitrectomy and an average of two intravitreal injections of antifungal agents. At least 10% of eyes needed therapeutic keratoplasty, and up to 7% of eyes were eviscerated. Following treatment, the final (best corrected) visual acuity (FVA) was > 20/400 in 30.5% (n= 222) eyes; > 20/40 in 7.9% (n=58) eyes; and 12% (n=88) eyes lost light perception. Post-hoc analysis showed significantly more males in traumatic than post-operative (p<0.0001) and endogenous (p = 0.001) endophthalmitis; higher isolation of Candida species in endogenous than post-operative (p = 0.004) and traumatic (p<0.0001) endophthalmitis, better PVA in eyes with Candida species infection (p<0.0001) and poorer FVA in eyes with Aspergillus species infection. CONCLUSIONS Fungal endophthalmitis is not uncommon in India. The inclusion of antifungal agents with antibiotics as the first empirical intravitreal therapy before microbiological confirmation could be considered when fungal infection is suspected.
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Affiliation(s)
- Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India.
| | - Manisha Agarwal
- Retina and Vitreous Department, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Appakkudal R Anand
- L & T Microbiology Research Centre, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Umesh C Behera
- Department of Retina and Vitreous, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai India
| | - Anthony Vipin Das
- Department of eyeSmart and EMR, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Debarati Dasgupta
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai India
| | - Vivek P Dave
- Srimati Kanuri Santhamma Center for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Jaishree Gandhi
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | | | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Sucheta Kulkarni
- Department of Retina and Vitreous, HV Desai Eye Hospital, Pune, India
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
| | - Priyanka A Mahendrakar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai India
| | - Sanchita Mitra
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Alankrita Muralidhar
- Retina and Vitreous Department, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Pillutla L Nimeshika
- Department of eyeSmart and EMR, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gumpalli S Prashanthi
- Department of eyeSmart and EMR, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Alok Sen
- Retina and Vitreous Department, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Savitri Sharma
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Prithviraj Uday
- Department of Retina and Vitreous, Aravind Eye Hospital, Madurai, India
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Guerriero S, Dammacco R, Albano V, Rizzo T, Cassano F, Boscia F, Alessio G. A 10-year-old immunocompetent girl with endogenous fungal endophthalmitis: Report of a case and review of the literature. Eur J Ophthalmol 2021; 32:89-94. [PMID: 34405721 DOI: 10.1177/11206721211037825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endogenous Endophthalmitis (EE) is a rare cause of blindness in the pediatric age group and this may account for the paucity of management guidelines in the literature. In this report, we describe our experience with a 10-year-old immunocompetent female who developed EE and became blind because of rapidly progressive and destructive inflammatory changes in her eye in spite of seemingly timely treatment.
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Affiliation(s)
- Silvana Guerriero
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Rosanna Dammacco
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Valeria Albano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Tiziana Rizzo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Flavio Cassano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Francesco Boscia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Institute of Ophthalmology, University of Bari, Bari, Italy
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21
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Spelta S, Di Zazzo A, Antonini M, Bonini S, Coassin M. Does Endogenous Endophthalmitis Need a More Aggressive Treatment? Ocul Immunol Inflamm 2021; 29:937-943. [PMID: 31951759 DOI: 10.1080/09273948.2019.1705497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Topic: To focus on endogenous endophthalmitis management, particularly etiology-based medical and surgical therapy.Methods: Literature search of published studies from July 1990 to February 2019 on endogenous endophthalmitis available on PubMed was made without any language constraints.Results: A total of 78 articles were retrieved from 728 initially analyzed and 62 studies were included. Although the superiority of vitrectomy over tap and inject techniques is controversial, the most recent publications favor an early surgical approach for endogenous endophthalmitis. Vitrectomy is useful in severe cases complicated by marked vitreous opacity, retinal detachment, poor initial visual acuity, and more virulent pathogens. Oral or intravenous antibiotics are also necessary to treat systemic infection. Vitrectomy is superior to blood cultures in diagnosing the etiology of infection.Conclusions: Endogenous endophthalmitis is an important cause of visual acuity impairment. Prompt treatment with appropriate use of pharmacological or surgical therapy is mandatory to preserve visual function.Abbreviations: IOP: intra-ocular pressure; AIDS: acquired immune deficiency syndrome; EVS: endophthalmitis vitrectomy study; CEVE: complete and early vitrectomy for endophthalmitis.
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Affiliation(s)
- Sara Spelta
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Antonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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22
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Silvarajoo S, Jan Bond C, Zunaina E. The Unrelenting Non-sporulating Hyphae. Cureus 2021; 13:e15176. [PMID: 34168934 PMCID: PMC8216498 DOI: 10.7759/cureus.15176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 42-year-old man presented with generalized redness in the left eye and painless blurring of vision for four days. He also had a fever and a large left leg abscess for four days prior to the onset of eye symptoms. Visual acuity of the left eye was hand movement with a positive relative afferent pupillary defect. Conjunctiva was injected with chemosis and mild corneal haziness centrally. There was a presence of whitish fibrin covering the pupil and presence of hypopyon with anterior chamber inflammatory cells. The fundoscopic view was obscured by the presence of fibrin in the pupillary area. B-scan ultrasound showed severe vitritis with multiple loculations. He was treated as left eye endogenous endophthalmitis secondary to left leg abscess. He was given multiple intravitreal antibiotic injections together with intravenous ceftazidime and gutt. moxifloxacin. The vitreous specimen did not yield any growth. Incision and drainage were done for the left leg abscess, and yellowish pus was aspirated with negative culture. Trans-pars plana vitrectomy was performed in view of poor clinical response. However, despite that, his left visual acuity dropped to non-perception of light (NPL). The vitreous specimen taken during vitrectomy finally showed non-sporulating fungal hyphae. He was started on oral fluconazole and topical amphotericin B. His left eye remains as NPL. However, his general eye condition improved.
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Affiliation(s)
| | - Chan Jan Bond
- Ophthalmology, International Specialist Eye Centre, Kuala Lumpur, MYS
| | - Embong Zunaina
- Ophthalmology, Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, MYS
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Dave VP, Pathengay A, Panchal B, Jindal A, Datta A, Sharma S, Pappuru RR, Joseph J, Jalali S, Das T. Clinical presentations, microbiology and management outcomes of culture-proven endogenous endophthalmitis in India. Indian J Ophthalmol 2021; 68:834-839. [PMID: 32317456 PMCID: PMC7350439 DOI: 10.4103/ijo.ijo_1091_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: To report the clinical presentation, microbiology, and management outcome of endogenous endophthalmitis in Indian patients. Methods: Retrospective chart review of culture-positive (vitreous/urine/blood) endogenous endophthalmitis cases treated in tertiary eye care facility in India was done. Results: The study included 173 eyes of 117 patients. Mean patient age was 25.41 ± 20.46 years (median 24 years). Pre-disposing systemic illness could not be elicited in 79 (67.63%) patients. Commonest predisposing systemic condition in patients where it could be detected (n = 79) was pyrexia of unknown origin (25/79 = 32.0%). Following treatment, 45 out of 173 (26.0%) eyes regained vision of ≥20/400. Commonest isolated organism from vitreous was Streptococcus pneumoniae (36 eyes, 20.8%) and fungi were isolated in 24 (13.8%) eyes, the commonest being Candida spp. (8/24, 33.33%). Favorable functional outcome was seen in 26% eyes and favorable anatomic outcome in 43% eyes. Those with an underlying systemic illness were older (P = 0.02), had greater urine culture positivity (P = 0.003), lesser vitreous culture positivity (0.001), greater gram negative etiology (P = 0.0006), and greater fungal etiology (P = 0.01) as compared to those cases without underlying systemic illness. Conclusion: Endogenous endophthalmitis in India often presents in young immunocompetent individuals without any underlying systemic illness and with negative blood or urine microbiologic work up. Underlying systemic illness leads to greater gram-negative and fungal etiology. Overall visual outcome is poor inspite of prompt management.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Animesh Jindal
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Agniv Datta
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Subhadra Jalali
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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24
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Budoff G, Zarbin MA, Bhagat N. Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes. JOURNAL OF VITREORETINAL DISEASES 2021; 5:135-141. [PMID: 37009077 PMCID: PMC9979060 DOI: 10.1177/2474126420951979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work describes the characteristics, treatment, and outcomes of endogenous endophthalmitis (EE) cases over 13 years at a tertiary care hospital. Methods: This retrospective case series included EE cases from 2006 to 2018. Eyes were categorized by cultured organism and initial treatment status. Results: Forty-five eyes of 38 patients were identified with EE. Mean age was 48 ± 12 years and approximately three-fourths were male. Mean visual acuity (VA) at presentation was logMAR 1.86 ± 0.83. More than 50% of patients had a history of intravenous drug use. In a quarter of patients, no systemic source of infection was identified; 90% of these patients had a history of intravenous drug use. Bilateral infections occurred in 18% of participants. Of positive cultures, 29%, 56%, and 13% were fungal, gram-positive, and gram-negative in etiology, respectively. Eyes with fungal infections had a better presenting VA and were more likely to have better than 20/100 final VA vs those with bacterial infections. All patients received IV antibiotics; additionally 29% of eyes underwent initial combined pars plana vitrectomy with intravitreal antibiotic injection while 51% of eyes initially received bedside intravitreal antibiotic injection. There was no significant difference in final VA with respect to initial mode of treatment. Conclusions: Initial treatment of intravitreal antibiotics with or without pars plana vitrectomy did not show any difference in the average final VA in eyes with EE. Eyes with fungal infections had more favorable visual outcomes than those with bacterial infections. Almost 1 in 5 EE eyes were enucleated.
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Affiliation(s)
- Greg Budoff
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
- Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
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25
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Kuo G, Yen CL, Lu YA, Chen CY, Sun MH, Lin Y, Tian YC, Hsu HH. Clinical and visual outcomes following endogenous endophthalmitis: 175 consecutive cases from a tertiary referral center in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:114-122. [PMID: 33610510 DOI: 10.1016/j.jmii.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/07/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND To elucidate the linkage between organisms and visual outcome in cases of endogenous endophthalmitis. METHODS Patients who presented with signs of endogenous endophthalmitis between January 2008 and December 2015 and underwent a vitreous tapping were enrolled. The patients' demographics and clinical findings were recorded. The outcomes include visual acuity and enucleation. RESULTS A total of 175 consecutive patients with endogenous endophthalmitis were enrolled. Forty-four percent of the patients had a known distal focus of infection. The most common focus was liver abscess (24.6%), and the major intravitreal isolate was Klebsiella pneumoniae (34.4%). In this series, 51.4% of the intravitreal cultures were positive. The visual acuity of fungal ophthalmitis were better than in bacterial ophthalmitis. Multivariate logistic regression showed that Gram negative vitreous isolates, compared with the negative vitreous culture, were associated with higher risk of enucleation (Odds ratio [OR]: 10.424, 95% confidence interval [95% CI]: 3.019-35.995). The use of intravitreal antibiotics, compared non-users, was associated with a reduced risk of enucleation (OR:0.084, 95% CI: 0.026-0.268). Trans pars plana vitrectomy was not associated with risk of enucleation (OR: 0.307, 95% CI: 0.035-2.693). The post-treatment VA was positively correlated with the presenting VA (r = 0.718, p = 0.0001). CONCLUSION Our study demonstrated that liver abscess is the most common source of endogenous endophthalmitis in Taiwan. The visual outcome is good when the presenting visual acuity is relatively well preserved and when the infecting organism is fungus. The use of intra-vitreal antibiotics reduces the risk of enucleation.
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Affiliation(s)
- George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yueh-An Lu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - YuJr Lin
- Center for Big Data Analytics and Statistics, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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26
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Corredores J, Hemo I, Jaouni T, Habot-Wilner Z, Kramer M, Shulman S, Jabaly-Habib H, Al-Talbishi A, Halpert M, Averbukh E, Levy J, Deitch-Harel I, Amer R. Endogenous fungal endophthalmitis: risk factors, clinical course, and visual outcome in 13 patients. Int J Ophthalmol 2021; 14:97-105. [PMID: 33469490 DOI: 10.18240/ijo.2021.01.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze the risk factors, ophthalmological features, treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis (EFE). METHODS Data retrieved from the medical files included age at presentation to the uveitis clinic, gender, ocular symptoms and their duration before presentation, history of fever, eye affected, anatomical diagnosis and laboratory evidence of fungal infection. Medical therapy recorded included systemic antifungal therapy and its duration, use of intravitreal antifungal agents and use of oral/intravitreal steroids. Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected. RESULTS Included were 13 patients (20 eyes, mean age 58y). Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation. In one patient, there was no history of previous intervention. Diagnostic vitrectomy was performed in 16 eyes (80%) and vitreous cultures were positive in 10 of the vitrectomized eyes (62.5%). In only 4 patients (31%), blood cultures were positive. All patients received systemic antifungal therapy. Sixteen eyes (80%) received intravitreal antifungal agent with voriconazole being the most commonly used. Visual acuity (VA) improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last follow-up (P=0.03). A trend of greater visual improvement was noted in favor of eyes treated with oral steroids (±intravitreal dexamethasone) than eyes that were not treated with steroids. The most common complication was maculopathy. Twelve eyes (60%) showed no ocular complications. CONCLUSION High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation. Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention. Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.
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Affiliation(s)
- Jamel Corredores
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel
| | - Itzhak Hemo
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel
| | - Tareq Jaouni
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel
| | - Zohar Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel.,Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | - Michal Kramer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel.,Division of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Shiri Shulman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel.,Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | - Haneen Jabaly-Habib
- Department of Ophthalmology, Poriya Medical Center, Tiberias 1528001, Israel
| | | | - Michael Halpert
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel
| | - Edward Averbukh
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel
| | - Iris Deitch-Harel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel.,Division of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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27
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Parambil N, Mani S, Shahi A, Ramesh R. Challenges in the diagnosis of early endogenous fungal endophthalmitis. KERALA JOURNAL OF OPHTHALMOLOGY 2021. [DOI: 10.4103/kjo.kjo_87_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020. J Ophthalmol 2020; 2020:8869590. [PMID: 33149945 PMCID: PMC7603614 DOI: 10.1155/2020/8869590] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.
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29
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Dimacali VG, Lim Bon Siong R. Infectious endophthalmitis at a Philippine tertiary hospital: a ten-year retrospective study. J Ophthalmic Inflamm Infect 2020; 10:19. [PMID: 32794069 PMCID: PMC7426345 DOI: 10.1186/s12348-020-00208-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Endophthalmitis is a sight-threatening disease characterized by marked progressive inflammation of the vitreous and/or aqueous humors. Limited information is currently available regarding endophthalmitis in the Philippines. This study aimed to provide long-term summary data on endophthalmitis cases seen at the largest tertiary referral hospital in the Philippines. Methods All endophthalmitis cases diagnosed at the Philippine General Hospital from January 1, 2007 to December 31, 2016 were retrieved and classified by etiology. Data pertaining to history, associated risk factors, isolated microorganisms, management, and final visual outcomes for each patient were reviewed. Results A total of 202 cases diagnosed within the audit period were included in the study. These were classified as post-traumatic (55.94%), endogenous (14.36%), acute post-operative (10.40%), keratitis-induced (6.93%), chronic post-operative (5.44%), bleb-associated (3.96%), and suture-associated (2.97%) endophthalmitis. Males comprised 71.29% of the population, while the largest age group affected was 0–10 years (24.75%). The culture-positive rate was 57.89%. The predominant etiology was Gram-positive bacteria (38.18%), followed by Gram-negative bacteria and mixed pathogens (21.82% each), and fungi (18.18%). The most common organisms were Streptococcus, Staphylococcus, Pseudomonas, Aspergillus, and Candida, accounting for 56.45% of isolates. Pars plana vitrectomy was done for 62.87% of patients, intravitreal and other antibiotic therapy in 23.27%, and primary enucleation/evisceration in 10.89%. The final outcomes and best corrected visual acuities were: anophthalmia 11.86%, no light perception/no dazzle 27.84%, light perception 8.76%, hand motions 24.23%, counting fingers 5.15%, 3/200 to 20/50 12.89%, and 20/40 to 20/20 9.28%. Conclusions There was a higher proportion of post-traumatic endophthalmitis cases compared to traditional estimates but consistent with studies from China and Thailand. The majority of these cases involved younger children as well as young to middle-aged males engaged in carpentry and construction work, implying a need for increased public health awareness and strengthening of childcare and workplace safety policies. Our microbiologic profile showed a lower proportion of Gram-positive infections and a higher proportion of mixed pathogen infections compared to other studies. There was also a higher proportion of fungi associated with post-operative and keratitis-induced endophthalmitis. The best outcomes were seen in acute post-operative and bleb-associated endophthalmitis, and the worst outcomes in endogenous and keratitis-induced endophthalmitis. Visual outcomes were poorer compared to other Western and Asian countries, with only 21.7% of patients improving from presentation.
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Affiliation(s)
- Victoria Grace Dimacali
- Department of Ophthalmology and Visual Sciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Ruben Lim Bon Siong
- Department of Ophthalmology and Visual Sciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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30
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Grzybowski A, Turczynowska M, Schwartz SG, Relhan N, Flynn HW. The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective. Ophthalmol Ther 2020; 9:485-498. [PMID: 32613591 PMCID: PMC7406615 DOI: 10.1007/s40123-020-00270-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background The optimal management of patients with endophthalmitis is challenging and includes both intravitreal and, in some cases, systemic antimicrobials. Systemic antimicrobials may be administered either intravenously or orally. In this article we review systemic antimicrobial options currently available for the treatment of types of endophthalmitis and the role of systemic antimicrobials (antibiotics and antifungals) in these treatments. Review While systemic antimicrobials are not universally utilized in the management of endophthalmitis, they may be helpful in some circumstances. The blood–retinal barrier affects the penetration of systemic medications into the posterior segment of the eye differently; for example, moxifloxacin and imipenem cross the blood–retinal barrier relatively easily while vancomycin and amikacin do not. However, inflammation, including endophthalmitis, may disrupt the blood–retinal barrier, enhancing the penetration of systemic agents into the eye. Conclusion Systemic antimicrobials may be particularly beneficial in patients with certain types of endophthalmitis; as such, they are standard treatment in the management of endogenous endophthalmitis (fungal and bacterial) and also widely used for prophylaxis and treatment of open-globe injuries. Although systemic antimicrobials are used in some patients with acute-onset postoperative endophthalmitis following cataract surgery, the literature generally does not support this practice. It is noted that there are currently no randomized clinical trials demonstrating a benefit of systemic antibiotics for any category of endophthalmitis.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| | - Magdalena Turczynowska
- Department of Ophthalmology, Stefan Żeromski Specialist Municipal Hospital, Cracow, Poland
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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31
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Candida Infections in Immunocompetent Hosts: Pathogenesis and Diagnosis. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00392-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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32
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Pillai GS, Remadevi KK, Anilkumar V, Radhakrishnan N, Rasheed R, Ravindran GC. Clinical profile and outcome of endogenous endophthalmitis at a quaternary referral centre in south India. Indian J Ophthalmol 2020; 68:827-833. [PMID: 32317455 PMCID: PMC7350495 DOI: 10.4103/ijo.ijo_948_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: The purpose of this study is to evaluate the clinical profile, visual, anatomical and survival outcome of patients with endogenous endophthalmitis. Methods: Retrospective chart review of consecutive cases with endogenous endophthalmitis presenting from 2009-2016. Results: In our study, 41 eyes of 34 patients were included. Most common co-morbidity associated with endogenous endophthalmitis was Diabetes Mellitus (70.7%) and most common infective foci was UTI (73.2%). Among the culture positive cases, fungi and bacteria were evenly distributed, 76.93% were Gram positive bacteria and 23.07% were Gram negative. Fungal endogenous endophthalmitis was more commonly seen in immunosuppressed state (72.7%) and bilateral cases (66.7%). The mean presenting vision (log MAR) of patients who died during the study were poor compared to those who survived (P = 0.014) Poor mean visual acuity at presentation was associated with more death (P = 0.014). Eyes with poor presenting vision, fungal isolates, culture positivity and immune suppression had poor visual and survival outcome. Poor visual outcome was observed more frequently in eyes with Aspergillus infection (85.7%) compared to Candida (75%) and bacteria (58.3%). Evisceration was done for 5 out of 41 eyes (12.2%). Vitrectomy rate was 53.7% in our study, with 40% of them showing overall improvement in vision. Conclusion: Endogenous endophthalmitis is a sight threatening condition associated with high mortality particularly when caused by Aspergillus spp. in immunocompromised patients. Contrary to the prior published reports of endogenous endophthalmitis outside India, we found an equal distribution of fungal and bacterial organisms among our cases, with predominance of Aspergillus among fungal isolates and Gram-positive organism among bacteria. Fungal infections, especially with Aspergillus spp., resulted in poor visual and survival outcome.
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Affiliation(s)
- Gopal S Pillai
- Department of Ophthalmology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | | | - V Anilkumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Natasha Radhakrishnan
- Department of Ophthalmology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Rehna Rasheed
- Department of Ophthalmology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Greeshma C Ravindran
- Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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The cereus matter of Bacillus endophthalmitis. Exp Eye Res 2020; 193:107959. [PMID: 32032628 DOI: 10.1016/j.exer.2020.107959] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/06/2020] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
Abstract
Bacillus cereus (B. cereus) endophthalmitis is a devastating intraocular infection primarily associated with post-traumatic injuries. The majority of these infections result in substantial vision loss, if not loss of the eye itself, within 12-48 h. Multifactorial mechanisms that lead to the innate intraocular inflammatory response during this disease include the combination of robust bacterial replication, migration of the organism throughout the eye, and toxin production by the organism. Therefore, the window of therapeutic intervention in B. cereus endophthalmitis is quite narrow compared to that of other pathogens which cause this disease. Understanding the interaction of bacterial and host factors is critical in understanding the disease and formulating more rational therapeutics for salvaging vision. In this review, we will discuss clinical and research findings related to B. cereus endophthalmitis in terms of the organism's virulence and inflammogenic potential, and strategies for improving of current therapeutic regimens for this blinding disease.
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Tsirouki T, Steffen J, Dastiridou A, Praidou A, Androudi S. Endophthalmitis in HIV Infection. Ocul Immunol Inflamm 2020; 28:1060-1065. [PMID: 31944150 DOI: 10.1080/09273948.2019.1699580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The role of HIV infection in exogenous and endogenous endophthalmitis has not been clarified. We aim to assess the potential role of HIV as a risk factor or a poor prognostic feature in this sight-threatening condition. Methods: Literature review. Review of evidence: Evidence for endophthalmitis in HIV patients is based on scarce retrospective case series and case reports. Infrequency of literature on this topic is owed to the diversity of the different types of endophthalmitis as well as the rarity of the coexistence of the two conditions. Conclusions: Endophthalmitis in HIV patients are a rare but potentially devastating condition. Many forms of endophthalmitis tend to occur in severely immunosuppressed HIV patients with low CD4 counts. Therefore, the early introduction of cART with full immune reconstitution is an essential part of the prevention of endophthalmitis in the HIV population.
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Affiliation(s)
- Theodora Tsirouki
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Jonel Steffen
- Division of Ophthalmology, University of Cape Town , Cape Town, South Africa
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Anna Praidou
- Department of Ophthalmology, Agios Dimitrios Hospital , Thessaloniki, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
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Das T. Endophthalmitis Management: Stain-Culture, Empirical Treatment, and Beyond. Asia Pac J Ophthalmol (Phila) 2020; 9:1-3. [PMID: 31990737 PMCID: PMC7004445 DOI: 10.1097/01.apo.0000617904.11979.ae] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
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Hasanreisoglu M, Mahajan S, Ozdemir HB, Ozdal PC, Halim MS, Hassan M, Nguyen QD. Fungal Endogenous Endophthalmitis during Pregnancy as a Complication of In-Vitro Fertilization. Ocul Immunol Inflamm 2019; 29:308-311. [PMID: 31664877 DOI: 10.1080/09273948.2019.1677917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a Candida endogenous endophthalmitis in a pregnant woman with a prior history of in-vitro fertilization (IVF).Methods: Case report.Results: 21-year-old healthy woman within the first trimester of her pregnancy of a successful IVF developed a focal retinitis and panuveitis. Ocular findings suggested fungal endophthalmitis. The patient was treated with pars plana vitrectomy and repeated intravitreal antifungal injections. No systemic therapy was given. Cultures showed Candida albicans. IVF procedure was the only identifiable risk factor for endogenous endophthalmitis.Conclusions: In-vitro fertilization appeared as a possible risk factor for endogenous endophthalmitis during pregnancy. In the absence of systemic fungal infection, local intravitreal antifungal injections seem to be effective options to treat endogenous candida endophthalmitis, especially in the first trimester.
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Affiliation(s)
- Murat Hasanreisoglu
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.,Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Sarakshi Mahajan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Huseyin Baran Ozdemir
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Pinar Cakar Ozdal
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - M Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Rota N, Danese C, Menchini F, Pignatto S, Peghin M, Bassetti M, Lanzetta P. Fungal Endogenous Endophthalmitis Secondary to Magnusiomyces capitatus. Case Rep Ophthalmol 2019; 10:292-298. [PMID: 31579116 PMCID: PMC6758721 DOI: 10.1159/000502412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/28/2019] [Indexed: 11/30/2022] Open
Abstract
We report the case of a 68-year-old immunocompetent patient with a dilatation of the ascending aorta, intraluminal vegetations, and pseudoaneurysmatic bulging who presented with unilateral fungal endogenous endophthalmitis 8 days after coronary angiogram. The isolated pathogen resulted to be Magnusiomyces capitatus, a filamentous, yeast-like fungus that can be commonly found in normal human microflora, with an immunosuppression-related pathogenicity. A literature research revealed a single case of ophthalmic infection – a keratitis – caused by this pathogen. Furthermore, we add a review of mycotic endophthalmitis related to aortic infection.
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Affiliation(s)
- Nestore Rota
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Carla Danese
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Francesca Menchini
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Silvia Pignatto
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Maddalena Peghin
- Department of Medicine - Infectious Diseases, University of Udine, Udine, Italy
| | - Matteo Bassetti
- Department of Medicine - Infectious Diseases, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
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Pathobiology of Aspergillus Fumigatus Endophthalmitis in Immunocompetent and Immunocompromised Mice. Microorganisms 2019; 7:microorganisms7090297. [PMID: 31466325 PMCID: PMC6780922 DOI: 10.3390/microorganisms7090297] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Despite Aspergillus being the leading cause of exogenous fungal endophthalmitis following traumatic injury to the eye, its pathogenesis is not fully understood. In the current study, we developed a murine model of Aspergillus fumigatus (AF) endophthalmitis and investigated the disease pathobiology. Endophthalmitis was induced by intravitreal injection of Aspergillus spores in immunocompetent and immunocompromised (neutropenic) C57BL/6 mice, and disease severity was assessed by eye exam, fungal burden estimation, and histological examination. Our data showed that AF infection caused a time-dependent increase in corneal haze, opacity, and hypopyon beginning at two days post-infection (DPI). The fungal burden in infected eyes of immunocompetent mice peaked at 2 DPI and declined over 9 DPI. AF-infected neuroretina exhibited induction of innate immune response via upregulation of Toll-like receptors (TLRs) and inflammatory mediators (TNFα, IL-1β, and IL6), and increased polymorphonuclear neutrophil (PMN) infiltration. Histological analysis revealed heavy cellular infiltrates in the vitreous cavity as well as disruption of normal retinal architecture and increased retinal cell death. Neutropenic mice exhibited severe disease pathology with the prolonged fungal burden and increased inflammatory mediators. Our study described the first immunocompetent murine model of exogenous AF endophthalmitis and demonstrated an important role of neutrophils in innate defense against fungal endophthalmitis.
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Jojo V, Gupta M, Sharma B, Singh P, Dhira N. Penicillium on the Iris! An Unusual Presentation and Cause of Postoperative Anterior Uveitis. Cureus 2019; 11:e5343. [PMID: 31602348 PMCID: PMC6779146 DOI: 10.7759/cureus.5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intraocular fungal infections may not present solely as postoperative anterior uveitis or as a focal anterior segment lesion. The present study describes a 50-year-old woman with well-controlled diabetes who presented with postoperative anterior uveitis three months after uncomplicated cataract surgery. A fuzzy lesion was observed on her iris. The patient underwent an anterior chamber wash and removal of the lesion, followed by intracameral treatment with voriconazole. Culture of the lesion showed that it was a species of Penicillium. The patient has remained stable after treatment. Three aspects of this case were unusual: a fungal lesion of unusual etiology and location, inflammation restricted to the anterior segment despite a fungal background, and the excellent response to treatment with a very favorable outcome.
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Affiliation(s)
- Vijaya Jojo
- Ophthalmology, Tata Main Hospital, Jamshedpur, IND
| | | | | | - Poonam Singh
- Ophthalmology, Tata Memorial Hospital, Jamshedpur, IND
| | - Nitin Dhira
- Ophthalmology, Jamshedpur Eye Hospital, Jamshedpur, IND
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Fan KC, Russell JF, Miller D, Flynn HW. In Vitro Susceptibilities of Vitreous
Candida
Endophthalmitis Isolates to Newer and Traditional Antifungal Agents. Ophthalmic Surg Lasers Imaging Retina 2019; 50:S13-S17. [DOI: 10.3928/23258160-20190108-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
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Modjtahedi BS, Finn AP, Barb SM, MacLachlan MJ, van Zyl T, Papakostas TD, Eliott D. Characteristics and Outcomes of Endogenous Endophthalmitis. ACTA ACUST UNITED AC 2019; 3:61-72. [DOI: 10.1016/j.oret.2018.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/18/2018] [Accepted: 08/29/2018] [Indexed: 12/28/2022]
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Valašková J, Sitárová J, Krásnik V. INTRAVITREAL THERAPY OF ENDOGENOUS ENDOPHTALMITIS DUE TO UROSEPSIS - A CASE REPORT. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2019; 75:277-282. [PMID: 32397730 DOI: 10.31348/2019/5/6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case report of 58-year-old man with endogenous endophtalmitis due to urosepsis and bronchitis. Patient was hospitalized in Department of Internal Medicine another hospital. He was sent to consiliar examination to our Ophtalmology Department with worsening vision and pain in left eye one day after onset. The diagnose endogenous endophtalmitis was set. Visual aquity was a hand movement on the first visit. Intravitreal therapy was realized promptly that day, a combination of two antibiotic drugs (ceftazidim 2mg/ 0.1 ml a vankomycin 1 mg/ 0.1 ml) and antifungal agent (amfotericin B 10 μg/ 0.1 ml). This therapy was applicated 3x totally, in two weeks. Humour from anterior chamber was taken during first intravitreal application and was negative. Blood culture was positive for staphylococcus aureus. Intravenous treatment with antibiotics (gentamycin 240 mg i.v. á 24hours a amoxicilin with clavulan acid 1.2 g i.v. á 8 hod) was set for two weeks then continued antibiotic (ciprofloxacin 500 mg á 12 hours) and antifungal therapy (itrakonazol 100 mg á 12 hod) per os two months. Visual aquity of the left eye was 20/100 after four weeks and 20/40 after two months. We would like to highlight advantage of multidisciplinary co-operation.
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Celiker H, Kazokoglu H. The role of pars plana vitrectomy in the management of fungal endogenous endophthalmitis. Eur J Ophthalmol 2018; 30:88-93. [DOI: 10.1177/1120672118815105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose: To identify the causative microorganism of fungal endogenous endophthalmitis in our tertiary referral uveitis center and review the therapeutic role of pars plana vitrectomy in patients with fungal endogenous endophthalmitis. Methods: Seven eyes of six cases were identified as fungal endogenous endophthalmitis through positive cultures of ocular fluids and clinical presentations. The final anatomical and functional results were evaluated. Results: Four women (66.7%) and two men (33.3%) underwent vitrectomy. Control of infection was achieved early on in all cases. Candida (71.4%) and Aspergillus (28.6%) species were identified as causative fungi in patients with fungal endogenous endophthalmitis. Two patients were reoperated due to reinfection and retinal detachment, respectively. Visual acuity improved in six eyes (85.7%) and worsened in one eye (14.3%). At the final examination, the retina was flat in all cases. No eye developed phthisis bulbi. Conclusion: Candida species are the most common causative organisms of fungal endogenous endophthalmitis in this study. Pars plana vitrectomy in fungal endogenous endophthalmitis may enhance the treatment of infection by removing fungal elements in the vitreous and aid in diagnosis. Vitrectomy may also be an important tool in the management of vision-threatening post-infectious sequelae such as retinal detachment and reinfections.
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Affiliation(s)
- Hande Celiker
- Department of Ophthalmology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Haluk Kazokoglu
- Department of Ophthalmology, School of Medicine, Marmara University, Istanbul, Turkey
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Endogenous endophthalmitis: a 9-year retrospective study at a tertiary referral hospital in Malaysia. J Ophthalmic Inflamm Infect 2018; 8:14. [PMID: 30306361 PMCID: PMC6179973 DOI: 10.1186/s12348-018-0158-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background The objective of this study was to determine the clinical presentation, systemic risk factors, source of infective microorganism, treatment outcomes, and prognostic indicators of endogenous endophthalmitis at a main tertiary referral hospital for uveitis in Malaysia. A retrospective review of medical records of 120 patients (143 eyes) with endogenous endophthalmitis over a period of 9 years between January 2007 and December 2015 was undertaken. Results Identifiable systemic risk factors were present in 79.2%, with the majority related to diabetes mellitus (60.0%). The most common source of bacteremia was urinary tract infection (17.5%). A positive culture from ocular fluid or other body fluids was obtained in 82 patients (68.9%), and the blood was the highest source among all culture-positive results (42.0%). Gram-negative organisms accounted 42 cases (50.6%) of which Klebsiella pneumonia was the most common organism isolated (32.5%). Sixty-nine eyes (48.6%) were managed medically, and 73 eyes (51.4%) underwent vitrectomy. Final visual acuity of counting fingers (CF) or better was achieved in 100 eyes (73.0%). Presenting visual acuity of CF or better was significantly associated with a better final acuity of CF or better (p = 0.001). Conclusions The visual prognosis of endogenous endophthalmitis is often poor, leading to blindness. As expected, gram-negative organisms specifically Klebsiella pneumonia were the most common organisms isolated. Urinary tract infection was the main source of infection. Poor presenting visual acuity was significantly associated with grave visual outcomes. A high index of suspicion, early diagnosis, and treatment are crucial to salvage useful vision.
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Ocular culture-proven endogenous endophthalmitis: a 5-year retrospective study of the microorganism spectrum at a tertiary referral center in Turkey. Int Ophthalmol 2018; 39:1743-1751. [DOI: 10.1007/s10792-018-0997-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/21/2018] [Indexed: 11/27/2022]
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46
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Russell JF, Scott NL, Hinkle JW, Yannuzzi NA, Miller D, Relhan N, Flynn HW. Endogenous Endophthalmitis: Has the Opioid Crisis Impacted the Rates and Severity of Intravenous Drug-Related Cases? ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2474126418788498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Endogenous endophthalmitis is an intraocular infection associated with systemic illness and/or intravenous drug use (IVDU). Rising national rates of IVDU may have impacted rates and outcomes of endogenous endophthalmitis. The purpose of the current study is to compare rates and treatment outcomes in endogenous endophthalmitis with and without a history of IVDU. Methods: This is a single-center retrospective consecutive case series of 21 eyes of 17 patients with a diagnosis of endogenous endophthalmitis from May 2014 to December 2016. Clinical characteristics and treatment outcomes were compared between IVDU and non-IVDU groups. Results: A history of IVDU was present in 3 of 17 patients (18%), whereas the other 82% had systemic comorbidities. There was no statistically significant difference in presenting visual acuity (VA) between the IVDU and non-IVDU groups (20/630 vs 20/500, P = .75). Pars plana vitrectomy was performed at some point in the clinical course of 80% of eyes (4/5) in the IVDU group and 56% of eyes (9/16) in the non-IVDU group. Staphylococcus or Candida were the predominant causative organisms isolated in the IVDU and non-IVDU groups. Statistical analyses revealed trends towards worse last VA in the non-IVDU group compared with the IVDU group (20/1000 vs 20/110, P = .10). Conclusions: Compared with historical data from the same institution, there has not been an increase in the rates of IVDU-associated endogenous endophthalmitis at this tertiary referral center. VA outcomes are often poor in both groups, but there may be a better prognosis for IVDU-associated endogenous endophthalmitis.
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Affiliation(s)
- Jonathan F. Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nathan L. Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - John W. Hinkle
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nicolas A. Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
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Abstract
PURPOSE To review the literature on beta-D-glucan (BDG) testing in fungal endophthalmitis. METHODS Review of primary literature using PubMed through April 2017 and presentation of an illustrative case report. A total of 231 articles were identified and 43 were ultimately chosen for review based on relevance and presence of ophthalmologic examination and objective data. RESULTS Beta-D-glucan is a major component of fungal cell walls. It is quantified using a calorimetry-based Fungitell assay based on modification of the limulus amebocyte lysate. Serum BDG levels are commonly used clinically in conjunction with other tests for early surveillance and diagnosis of invasive fungal infections. In the ophthalmic literature, elevated levels of BDG have been detected in vitreous fluid of patients undergoing vitrectomy for fungal endophthalmitis, tear fluid of patients with mycotic keratitis, and serum of a patient with bilateral endogenous subretinal abscesses. Elevated serum BDG levels appear to be highly associated with fungal endophthalmitis. Potential uses and considerations with regards to test limitations are discussed. CONCLUSION Beta-D-glucan testing may be used as an adjunct to support a diagnosis, initiate pharmacologic therapy or surgical intervention, and optimize overall clinical management in patients diagnosed with or under clinical suspicion for invasive fungal infections, including endophthalmitis. Additional clinical studies are necessary to fully characterize the utility of BDG testing in patients with fungal endophthalmitis.
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AlQahtani GMS, AlSayed AAD, Gangadharan S, Adhi MI. Fungal endophthalmitis in a case of granulomatosis with polyangitis. Saudi J Ophthalmol 2018; 32:261-265. [PMID: 30224896 PMCID: PMC6137701 DOI: 10.1016/j.sjopt.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022] Open
Abstract
A 70-year-old immuno-compromised man, due to multiple comorbidities, particularly granulomatosis with polyangitis (GPA) and its related treatment, presented with generalized weakness, odynophagia and loss of taste sensation. After a complete evaluation, a diagnosis of right frontal lobe brain abscess was made. The patient then developed headache and sudden painful loss of vision in the right eye. Clinical examination revealed anterior chamber cells and flare, vitreous haze and cells, and hemorrhagic chorioretinitis with severe vasculitis in the right eye. Culture from the drained pus of the frontal brain abscess came positive for Aspergillus fumigatus. Incidental echocardiogram showed large vegetation in the mitral valve. Pars plana vitrectomy was done and a specimen was sent for culture that came positive for Aspergillus fumigatus. Although all the necessary medical and surgical interventions were timely carried out in the affected right eye, the patient’s vision worsened due to retinal damage.
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Affiliation(s)
| | - Alaa Adher D AlSayed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shiji Gangadharan
- Department of Surgery-Division of Ophthalmology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammad Idrees Adhi
- Department of Surgery-Division of Ophthalmology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Maling S, King C, Davies N. A British Ophthalmological Surveillance Unit Study on metastatic endogenous endophthalmitis. Eye (Lond) 2018; 32:743-748. [PMID: 29328066 DOI: 10.1038/eye.2017.284] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/16/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeEndogenous endophthalmitis (EE) is a rare but serious ocular infection caused by the seeding of bacteria into the eye from a source elsewhere in the body. Studies suggest that EE accounts for 2 to 8% of all endophthalmitis.MethodsA prospective observational study was conducted using the British Ophthalmological Surveillance Unit reporting system. Questionnaires were sent to reporting Ophthalmologists in the UK to assess incidence, underlying aetiology, eye findings, management, and final outcomes in endogenous endophthalmitis over a 12-month period within the British Isles.ResultsSixty two cases reported with 48 initial questionnaires returned and 25 6-month follow-up questionnaires returned. The median age of patients affected was 57 years with youngest aged 2 years and oldest aged 85 years. Twenty three were male and 24 were female. The median visual acuity in the affected eye was 3 logMAR (range -0.1 to 5). Blood cultures were taken in 36 patients, 58% of which were positive. Vitreous biopsy was taken in 35 patients, 23% of which were culture positive. The visual function as assessed by visual acuity had significantly improved at 6 months with a median acuity of 0.18 logMAR (P=0.003).ConclusionsThe survey demonstrates the severe nature of endogenous endophthalmitis in patients with active infection or with risk factors for infection. Our study has demonstrated that at least half of the patients who were treated had significant vision improvement.
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Affiliation(s)
- S Maling
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - C King
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - N Davies
- Chelsea and Westminster Hospital, London, UK
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50
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Lee M, Choi EY, Lee SC, Kim M. A Case of Fungal Endophthalmitis after Having Received Extraction of Wisdom Tooth in Healthy Woman. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.3.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Minwoo Lee
- The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Choi
- The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chul Lee
- The Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kim
- The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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