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Zhang WF, Zhao XY, Chen H, Meng LH, Chen YX. Endogenous Endophthalmitis at a Tertiary Referral Center in China: A Retrospective Study Over Three Decades. Ocul Immunol Inflamm 2024; 32:803-812. [PMID: 37094073 DOI: 10.1080/09273948.2023.2198001] [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: 11/15/2022] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To investigate the etiology, pathogens, treatment, and prognosis of endogenous endophthalmitis (EE). METHODS Patients diagnosed with EE over three decades at Peking Union Medical College Hospital were retrospectively reviewed and analyzed. RESULTS A total of 97 eyes from 81 patients were included. Diabetes was the most common predisposing medical condition (34.6%). Klebsiella pneumoniae (31.3%) and Candida albicans (32.8%) were the most common pathogens. Liver abscess (20.6%) was the predominant cause EE due to liver abscess had a worse initial visual acuity (P < 0.05). Patients who initially underwent pars plana vitrectomy (PPV)+silicone oil tamponade underwent fewer total treatments (P < 0.05). In the past 10 years, the proportion of Gram-positive cocci, Gram-negative bacilli, and Candida showed an upward trend. Over the past 15 years, EE after liver abscess and immunosuppression has increased, while EE from genitourinary systems has decreased. CONCLUSION EE was a devastating intraocular disease with a poor visual prognosis. The initial condition and prognosis of EE after liver abscess were the worst. PPV+silicone oil tamponade as an initial treatment may reduce additional therapy.
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Affiliation(s)
- Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Huth A, Roth M, Viestenz A. [Endogenous Candida endophthalmitis]. DIE OPHTHALMOLOGIE 2024; 121:272-281. [PMID: 38252295 DOI: 10.1007/s00347-023-01978-3] [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: 12/19/2023] [Indexed: 01/23/2024]
Abstract
Endogenous Candida endophthalmitis is a rare but vision-threatening disease. In most cases, endogenous endophthalmitis caused by Candida species has a better prognosis than endogenous endophthalmitis caused by other fungal species or bacteria but the prognosis still depends heavily on the time required for diagnosis and subsequent treatment as well as the initial visual acuity. Suggestions for treatment algorithms have already been made in the past but binding guidelines in ophthalmology only exist sporadically due to the rarity of the disease. This review discusses the current knowledge on endogenous Candida endophthalmitis and draws conclusions from the current study situation.
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Affiliation(s)
- A Huth
- Universitätsklinik und Poliklinik für Augenheilkunde Halle (Saale), Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - M Roth
- Augenklinik Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - A Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde Halle (Saale), Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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Huth A, Viestenz A, Viestenz A, Heichel J, Gabel-Pfisterer A. [Endogenous Candida endophthalmitis: diagnostics and treatment options based on case studies]. DIE OPHTHALMOLOGIE 2024; 121:291-297. [PMID: 38252294 DOI: 10.1007/s00347-023-01977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as a whole organ but also the life of the patient due to its systemic cause. MATERIAL AND METHOD Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. RESULTS 8 patients with 14 eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent a pars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1 patient received parabulbar administration of a triamcinolone depot in both eyes, 7 patients received a dexamethasone depot in 11 eyes and all 8 patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2 logMar to 1.0 logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2 patients died from one of the underlying diseases after 3 and 25 months, respectively. CONCLUSION Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.
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Affiliation(s)
- A Huth
- Universitätsklinik und Poliklinik für Augenheilkunde Halle, Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - A Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde Halle, Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - A Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde Halle, Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - J Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde Halle, Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
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Lin ML, Hall AJ. Uveitis masquerade syndromes: An approach to diagnosis. Clin Exp Ophthalmol 2024; 52:91-105. [PMID: 37997019 DOI: 10.1111/ceo.14328] [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: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Uveitis masquerade syndromes are a diverse group of clinical entities which mimic conventional immune-mediated uveitis due to the presence of inflammatory signs but are resistant to anti-inflammatory therapy. Misdiagnosis hinders appropriate management in these conditions and may result in poor outcomes. This review discusses commonly encountered neoplastic and non-neoplastic disease processes that masquerade as intraocular inflammation with a focus on relevant clinical features and adjunctive investigations that are helpful in reaching a correct diagnosis.
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Affiliation(s)
- Ming Lee Lin
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Shen Y, Gong Y, Su L. Diagnostic Challenges in PD-1 Inhibitor Induced Panuveitis in a Teenage Girl with Chest Soft Tissue Sarcoma - A Case Report. Ocul Immunol Inflamm 2023; 31:2065-2068. [PMID: 37442377 DOI: 10.1080/09273948.2023.2233015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To report a case of programmed cell death receptor-1 (PD-1) inhibitor induced panuveitis. METHOD Observational case report of a 13-year-old Chinese girl presented as panuveitis. The clinical course, imaging performance, laboratory examination, differential diagnosis, treatment and prognosis were described. RESULT Patient presented with bilateral anterior granulomatous uveitis, vitritis, papillitis, and various creamy yellow nodular lesions in the mid-peripheral fundus. She had a history of biopsy proven alveolar soft tissue sarcoma on the chest wall and pulmonary metastasis, and a PD-1 inhibitor (sintilimab) was intravenously administered. Blood tests, magnetic resonance imaging of the cranium and the orbit, aqueous humor assay of inflammatory cytokines and microbial DNA were performed to distinguish infectious and non-infectious uveitis, choroidal metastases, and intravenous injection-related endophthalmitis. The oncologist evaluated that the sarcoma was stable and terminated sintilimab dosage. After sintilimab withdrawal, the blurred vision improved. Then, the patient received oral corticosteroids, resulted in resolution of the panuveitis. A diagnosis of PD-1 inhibitor induced panuveitis was made. CONCLUSION For patients taking PD-1 inhibitors, the major diagnostic challenge is to identify whether the cause of the uveitis is due to the antitumor treatment or not. It is suggested to be screened by eye care specialist and timely referral to uveitis specialist with any suspicion of intraocular inflammation for these patients.
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Affiliation(s)
- Yinchen Shen
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanyuan Gong
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Su
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Petrillo F, Sinoca M, Fea AM, Galdiero M, Maione A, Galdiero E, Guida M, Reibaldi M. Candida Biofilm Eye Infection: Main Aspects and Advance in Novel Agents as Potential Source of Treatment. Antibiotics (Basel) 2023; 12:1277. [PMID: 37627697 PMCID: PMC10451181 DOI: 10.3390/antibiotics12081277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Fungi represent a very important cause of microbial eye infections, especially in tropical and developing countries, as they could cause sight-threating disease, such as keratitis and ocular candidiasis, resulting in irreversible vision loss. Candida species are among the most frequent microorganisms associated with fungal infection. Although Candida albicans is still the most frequently detected organism among Candida subspecies, an important increase in non-albicans species has been reported. Mycotic infections often represent an important diagnostic-clinical problem due to the difficulties in performing the diagnosis and a therapeutic problem due to the limited availability of commercial drugs and the difficult penetration of antifungals into ocular tissues. The ability to form biofilms is another feature that makes Candida a dangerous pathogen. In this review, a summary of the state-of-the-art panorama about candida ocular pathology, diagnosis, and treatment has been conducted. Moreover, we also focused on new prospective natural compounds, including nanoparticles, micelles, and nanocarriers, as promising drug delivery systems to better cure ocular fungal and biofilm-related infections. The effect of the drug combination has also been examined from the perspective of increasing efficacy and improving the course of infections caused by Candida which are difficult to fight.
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Affiliation(s)
- Francesco Petrillo
- Department of Medical Sciences, Eye Clinic, Turin University, 10126 Turin, Italy; (F.P.); (A.M.F.); (M.R.)
| | - Marica Sinoca
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (M.G.)
| | - Antonio Maria Fea
- Department of Medical Sciences, Eye Clinic, Turin University, 10126 Turin, Italy; (F.P.); (A.M.F.); (M.R.)
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Angela Maione
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (M.G.)
| | - Emilia Galdiero
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (M.G.)
- NBFC—National Biodiversity Future Center, 90133 Palermo, Italy
| | - Marco Guida
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (M.G.)
- NBFC—National Biodiversity Future Center, 90133 Palermo, Italy
- Center for Studies on Bioinspired Agro-Environmental Technology (BAT Center), 80055 Portici, Italy
| | - Michele Reibaldi
- Department of Medical Sciences, Eye Clinic, Turin University, 10126 Turin, Italy; (F.P.); (A.M.F.); (M.R.)
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Teixeira FHF, Santos NS, de Carvalho Mendes Paiva A, Carvalho EM, Biancardi AL, Curi ALL. Optical coherence tomography findings in fungal uveitis. Int Ophthalmol 2023; 43:3023-3030. [PMID: 37004606 DOI: 10.1007/s10792-023-02696-0] [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: 07/11/2022] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The purpose of the study was to describe the vitreal, retinal, and choroidal features of eyes affected by endogenous endophthalmitis (EE) and evaluate the effects of systemic antifungal drug treatment and pars plana vitrectomy by using spectral domain optical coherence tomography (SD-OCT). METHODS Medical records and SD-OCT images of eyes diagnosed with EE at a single uveitis tertiary referral center in Brazil were acquired at the time of diagnosis, after 7 days of high-dose antifungal drug treatment, and at follow-up assessments performed 30 days after resolution. RESULTS Thirteen eyes were enrolled in the study. All patients showed hyperreflective round-shaped lesions on SD-OCT and pre-retinal aggregates. Five eyes responded to antifungal systemic oral drugs despite showing vitreous opacity. The response to treatment was observable on optical coherence tomography (OCT) images. CONCLUSION Fungal endophthalmitis showed typical features on SD-OCT, facilitating early diagnosis and treatment despite the absence of vitreous culture or biopsy. This study suggests that OCT images can be used to support diagnosis by physicians who do not have access to vitreoretinal surgery.
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Affiliation(s)
- Fernando Henrique Flores Teixeira
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil.
| | - Nathalia Silva Santos
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Alexandre de Carvalho Mendes Paiva
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Erika Moreira Carvalho
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Ana Luiza Biancardi
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - André Luiz Land Curi
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
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Gozzi F, Bertolini M, Gentile P, Verzellesi L, Trojani V, De Simone L, Bolletta E, Mastrofilippo V, Farnetti E, Nicoli D, Croci S, Belloni L, Zerbini A, Adani C, De Maria M, Kosmarikou A, Vecchi M, Invernizzi A, Ilariucci F, Zanelli M, Iori M, Cimino L. Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma. Diagnostics (Basel) 2023; 13:2451. [PMID: 37510195 PMCID: PMC10378347 DOI: 10.3390/diagnostics13142451] [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: 05/24/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) allows the explore not only the anterior chamber but also the front part of the vitreous cavity. Our cross-sectional single-centre study investigated whether AS-OCT can distinguish between vitreous involvement due to vitreoretinal lymphoma (VRL) and vitritis in uveitis. We studied AS-OCT images from 28 patients (11 with biopsy-proven VRL and 17 with differential diagnosis uveitis) using publicly available radiomics software written in MATLAB. Patients were divided into two balanced groups: training and testing. Overall, 3260/3705 (88%) AS-OCT images met our defined quality criteria, making them eligible for analysis. We studied five different sets of grey-level samplings (16, 32, 64, 128, and 256 levels), finding that 128 grey levels performed the best. We selected the five most effective radiomic features ranked by the ability to predict the class (VRL or uveitis). We built a classification model using the xgboost python function; through our model, 87% of eyes were correctly diagnosed as VRL or uveitis, regardless of exam technique or lens status. Areas under the receiver operating characteristic curves (AUC) in the 128 grey-level model were 0.95 [CI 0.94, 0.96] and 0.84 for training and testing datasets, respectively. This preliminary retrospective study highlights how AS-OCT can support ophthalmologists when there is clinical suspicion of VRL.
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Affiliation(s)
- Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Marco Bertolini
- Medical Physics Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Pietro Gentile
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Laura Verzellesi
- Medical Physics Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | | | - Enrico Farnetti
- Molecular Pathology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Davide Nicoli
- Molecular Pathology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Lucia Belloni
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Alessandro Zerbini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Chantal Adani
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Michele De Maria
- Ophthalmology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Areti Kosmarikou
- Ophthalmology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Marco Vecchi
- Ophthalmology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
- Faculty of Health and Medicine, Save Sight Institute, University of Sydney, Sydney, NSW 2000, Australia
| | | | - Magda Zanelli
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
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10
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Wang H, Chang Y, Zhang Y, Yang R, Shi H, Zhang M. Bilateral endogenous fungal endophthalmitis: A case report. Medicine (Baltimore) 2023; 102:e33585. [PMID: 37083776 PMCID: PMC10118318 DOI: 10.1097/md.0000000000033585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Endogenous fungal endophthalmitis is a challenging condition. There are no universally accepted diagnostic or management protocols. We share a case of endogenous fungal endophthalmitis who was successfully treated, focusing on the diagnostic and treatment procedures. PATIENT CONCERNS A 31-year-old female with a history of fungal vaginitis and tinea corporis presented with progressive visual decrease in both eyes after having an induced abortion. Her best corrected visual acuity at presentation was 20/1000 in her right eye and 20/250 in her left eye. Upon slit lamp examination, mild inflammatory reaction in the anterior chamber was found. Dilated fundus examination revealed a hazy view of the optic disc and posterior retina, and there was a whitish mass with "string and pearls" just in front of the macular region in each eye. DIAGNOSES Bilateral fungal endogenous endophthalmitis was diagnosed empirically, which was confirmed later by deoxyribonucleic acid sequencing and culture of intraocular fluid. INTERVENTIONS Oral itraconazole and intravitreal voriconazole were administered to the patient at first. The intraocular inflammation was partially responsive to the medication, yet the visual acuity persisted to deteriorate and the vitreous whitish masses became more prominent. Then vitrectomy procedures were carried out and oral itraconazle was switched to intravenous fluconazole. The antifungal treatment lasted for 8 weeks. OUTCOMES The intraocular inflammation alleviated and visual acuity improved after vitrectomy. At the 9-month follow-up visit, the patient's best corrected visual acuity was 20/40 in the right eye and 20/30 in the left eye. There was no intraocular inflammatary reaction, and retinal scar was noticed in each eye. LESSON Early and correct diagnosis, coupled with prompt and aggressive treatment, is crucial for cases of fungal endogenous endophthalmitis. Deoxyribonucleic acid sequencing techniques can contribute to early diagnosis, while vitrectomy may be necessary when antifungal medication is insufficient in controlling the condition.
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Affiliation(s)
- Hao Wang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Yongye Chang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Yifan Zhang
- School of Life Sciences and Food Engineering, Hebei University of Engineering, Hebei province, China
| | - Rong Yang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Huijun Shi
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Minglian Zhang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
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11
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Lüken S, Kurz M, Rommel F, Freitag JC, Ranjbar M, Tharun L, Perner S, Friedrich D, Rogacev M, Grisanti S, Kakkassery V. [PCR-confirmed late-onset Candida albicans endophthalmitis from a retinal biopsy]. DIE OPHTHALMOLOGIE 2022; 119:958-961. [PMID: 34661702 DOI: 10.1007/s00347-021-01510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 01/26/2023]
Affiliation(s)
- S Lüken
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - M Kurz
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - F Rommel
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - J C Freitag
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Ranjbar
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - L Tharun
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - S Perner
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.,Pathologie, Forschungszentrums Borstel, Leibniz Lungenzentrum, Borstel, Deutschland.,Deutsches Zentrum für Lungenforschung, Borstel, Deutschland
| | - D Friedrich
- Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - M Rogacev
- Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - S Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - V Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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12
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Fungal Endophthalmitis: A Comprehensive Review. J Fungi (Basel) 2021; 7:jof7110996. [PMID: 34829283 PMCID: PMC8623405 DOI: 10.3390/jof7110996] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/27/2022] Open
Abstract
Endophthalmitis is a serious ophthalmologic condition involving purulent inflammation of the intraocular spaces. The underlying etiology of infectious endophthalmitis is typically bacterial or fungal. The mechanism of entry into the eye is either exogenous, involving seeding of an infectious source from outside the eye (e.g., trauma or surgical complications), or endogenous, involving transit of an infectious source to the eye via the bloodstream. The most common organism for fungal endophthalmitis is Candida albicans. The most common clinical manifestation of fungal endophthalmitis is vision loss, but other signs of inflammation and infection are frequently present. Fungal endophthalmitis is a clinical diagnosis, which can be supported by vitreous, aqueous, or blood cultures. Treatment involves systemic and intravitreal antifungal medications as well as possible pars plana vitrectomy. In this review, we examine these essential elements of understanding fungal endophthalmitis as a clinically relevant entity, which threatens patients’ vision.
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13
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D’Angeli F, Guadagni F, Genovese C, Nicolosi D, Trovato Salinaro A, Spampinato M, Mannino G, Lo Furno D, Petronio Petronio G, Ronsisvalle S, Sipala F, Falzone L, Calabrese V. Anti-Candidal Activity of the Parasitic Plant Orobanche crenata Forssk. Antibiotics (Basel) 2021; 10:1373. [PMID: 34827311 PMCID: PMC8615231 DOI: 10.3390/antibiotics10111373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/12/2022] Open
Abstract
Candida albicans (C. albicans) and Candida glabrata (C. glabrata) are part of the human microbiome. However, they possess numerous virulence factors, which confer them the ability to cause both local and systemic infections. Candidiasis can involve multiple organs, including the eye. In the present study, we investigated the anti-candidal activity and the re-epithelizing effect of Orobanche crenata leaf extract (OCLE). By the microdilution method, we demonstrated an inhibitory effect of OCLE on both C. albicans and C. glabrata growth. By crystal violet and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, we showed the ability of OCLE to inhibit the biofilm formation and the viability of yeast cells, respectively. By germ tube and adhesion assays, we proved the capacity of OCLE to affect the morphological transition of C. albicans and the adhesion of both pathogens to human retinal pigment epithelial cells (ARPE-19), respectively. Besides, by MTT and wound healing assay, we evaluated the cytotoxic and re-epithelizing effects of OCLE on ARPE-19. Finally, the Folin-Ciocalteu and the ultra-performance liquid chromatography-tandem mass spectrometry revealed a high content of phenols and the presence of several bioactive molecules in the extract. Our results highlighted new properties of O. crenata, useful in the control of Candida infections.
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Affiliation(s)
- Floriana D’Angeli
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy; (F.D.); (F.G.)
| | - Fiorella Guadagni
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy; (F.D.); (F.G.)
- InterInstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Carlo Genovese
- Faculty of Medicine and Surgery, “Kore” University of Enna, Contrada Santa Panasia, 94100 Enna, Italy
- Nacture S.r.l, Spin-Off University of Catania, Via Santa Sofia 97, 95123 Catania, Italy;
| | - Daria Nicolosi
- Nacture S.r.l, Spin-Off University of Catania, Via Santa Sofia 97, 95123 Catania, Italy;
- Department of Drug and Health Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Angela Trovato Salinaro
- Department of Biomedical and Biotechnological Sciences, Section of Biochemistry, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.T.S.); (M.S.); (V.C.)
| | - Mariarita Spampinato
- Department of Biomedical and Biotechnological Sciences, Section of Biochemistry, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.T.S.); (M.S.); (V.C.)
| | - Giuliana Mannino
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (G.M.); (D.L.F.)
| | - Debora Lo Furno
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (G.M.); (D.L.F.)
| | - Giulio Petronio Petronio
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco de Sanctis 1, 86100 Campobasso, Italy;
| | - Simone Ronsisvalle
- Department of Drug and Health Sciences, Section of Medicinal Chemistry, University of Catania, 95125 Catania, Italy; (S.R.); (F.S.)
| | - Federica Sipala
- Department of Drug and Health Sciences, Section of Medicinal Chemistry, University of Catania, 95125 Catania, Italy; (S.R.); (F.S.)
| | - Luca Falzone
- Laboratory of Experimental Oncology, Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy;
| | - Vittorio Calabrese
- Department of Biomedical and Biotechnological Sciences, Section of Biochemistry, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.T.S.); (M.S.); (V.C.)
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14
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Efficacy and Pharmacokinetics of Fosmanogepix (APX001) in the Treatment of Candida Endophthalmitis and Hematogenous Meningoencephalitis in Nonneutropenic Rabbits. Antimicrob Agents Chemother 2021; 65:AAC.01795-20. [PMID: 33361304 DOI: 10.1128/aac.01795-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/12/2020] [Indexed: 12/22/2022] Open
Abstract
Candida endophthalmitis is a serious sight-threatening complication of candidemia that may occur before or during antifungal therapy. Hematogenous Candida meningoencephalitis (HCME) is also a serious manifestation of disseminated candidiasis in premature infants, immunosuppressed children, and immunocompromised adults. We evaluated the antifungal efficacy and pharmacokinetics of the prodrug fosmanogepix (APX001) in a rabbit model of endophthalmitis/HCME. Manogepix (APX001A), the active moiety of prodrug fosmanogepix, inhibits the fungal enzyme Gwt1 and is highly active in vitro and in vivo against Candida spp., Aspergillus spp., and other fungal pathogens. Plasma pharmacokinetics of manogepix after oral administration of fosmanogepix on day 6 at 25, 50, and 100 mg/kg resulted in maximum concentration of drug in plasma (C max) of 3.96 ± 0.41, 4.14 ± 1.1, and 11.5 ± 1.1 μg/ml, respectively, and area under the concentration-time curve from 0 to 12 h (AUC0-12) of 15.8 ± 3.1, 30.8 ± 5.0, 95.9 ± 14 μg·h/ml, respectively. Manogepix penetrated the aqueous humor, vitreous, and choroid with liquid-to-plasma ratios ranging from 0.19 to 0.52, 0.09 to 0.12, and 0.02 to 0.04, respectively. These concentrations correlated with a significant decrease in Candida albicans burden in vitreous (>101 to 103 log CFU/g) and choroid (>101 to 103 log CFU/g) (P ≤ 0.05 and P ≤ 0.001, respectively). The aqueous humor had no detectable C. albicans in treatment and control groups. The tissue/plasma concentration ratios of manogepix in meninges, cerebrum, cerebellum, and spinal cord were approximately 1:1, which correlated with a >102 to 104 decline of C. albicans in tissue versus control (P ≤ 0.05). Serum and cerebrospinal fluid (CSF) (1→3)-β-d-glucan levels demonstrated significant declines in response to fosmanogepix treatment. These findings provide an experimental foundation for fosmanogepix in treatment of Candida endophthalmitis and HCME and derisk the clinical trials of candidemia and invasive candidiasis.
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15
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Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020; 75:100797. [DOI: 10.1016/j.preteyeres.2019.100797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
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16
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Shirvani M, Hosseini S, Maalhagh M, Mohaghegh S. Endogenous Candida Endophthalmitis as a Rare Complication of Trans-Urethral Lithotripsy in a Healthy Woman: A Case Report. Turk J Ophthalmol 2019; 49:294-296. [PMID: 31650813 PMCID: PMC6823585 DOI: 10.4274/tjo.galenos.2019.02328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.
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Affiliation(s)
- Mohammad Shirvani
- Shiraz University of Medical Sciences, Department of Ophthalmology, Shiraz, Iran
| | - Shahla Hosseini
- Shiraz University of Medical Sciences, Department of Ophthalmology, Shiraz, Iran
| | - Mehrnoosh Maalhagh
- Shiraz University of Medical Sciences, Department of Ophthalmology, Shiraz, Iran
| | - Sahar Mohaghegh
- Shiraz University of Medical Sciences, Department of Ophthalmology, Shiraz, Iran
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17
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Case of cryptococcal choroiditis in adult with T-cell leukemia/lymphoma. J Infect Chemother 2018; 25:59-64. [PMID: 30057340 DOI: 10.1016/j.jiac.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/09/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022]
Abstract
A rare case of 70-year-old woman with adult T-cell leukemia/lymphoma who developed multifocal choroiditis from a dissemination of Cryptococcus neoformans is reported. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. Sequential optical coherence tomographic images disclosed the involvement of the choroid and the consecutive changes in its architecture during the course of treatment. The recognition of these ocular manifestations may be important for the rapid diagnosis of C. nerformans-disseminated diseases. Rapid diagnosis and prompt therapy with intravitreal injection as well as systemic fosfluconazole and liposomal amphotericin B led to clinical improvement of intraocular cryptococcosis.
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18
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Lei B, Jiang R, Gu R, Xu G, Song F, Zhou M. Endogenous Fungal Endophthalmitis Associated with Genitourinary Procedures. Ocul Immunol Inflamm 2018; 27:747-755. [PMID: 29993300 DOI: 10.1080/09273948.2018.1465100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose: To summarize the characteristics of endogenous fungal endophthalmitis (EFE) after genitourinary procedures. Methods: Medical records of patients diagnosed with EFE after genitourinary procedures from a single center during a 6-year period were reviewed. Results: Nineteen eyes of 15 patients were included. The interval time between procedure to symptom was 3.6 ± 3.6 weeks. As the initial treatment, 9/19 eyes underwent primary vitrectomy and 10/19 eyes underwent intravitreal antifungal injection . Candida albicans was the pathogen in 15 of 19 eyes. Systemic treatment with itraconazole was used in all patients. LogMAR best corrected visual acuity improved from 2.2 ± 0.9 to 0.9 ± 1.2 after treatment (p = 0.002) in 15 eyes that were followed-up for an average of 4.9 ± 2.1 years. Conclusion: Genitourinary procedure is a predisposing factor for EFE. Candida albicans is the predominant pathogen. Normative systemic and local antifungal treatments improved the final visual outcome.
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Affiliation(s)
- Boya Lei
- a Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, P. R . China
| | - Rui Jiang
- a Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, P. R . China.,b Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University , Shanghai, P. R . China.,c Key Laboratory of Myopia of State Health Ministry, Fudan University , Shanghai, P. R . China
| | - Ruiping Gu
- a Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, P. R . China
| | - Gezhi Xu
- a Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, P. R . China.,b Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University , Shanghai, P. R . China.,c Key Laboratory of Myopia of State Health Ministry, Fudan University , Shanghai, P. R . China
| | - Fang Song
- a Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, P. R . China
| | - Min Zhou
- a Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, P. R . China.,b Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University , Shanghai, P. R . China.,c Key Laboratory of Myopia of State Health Ministry, Fudan University , Shanghai, P. R . China
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19
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SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN ENDOGENOUS CANDIDA ENDOPHTHALMITIS AND THEIR CLINICAL RELEVANCE. Retina 2018; 38:1011-1018. [PMID: 28492430 DOI: 10.1097/iae.0000000000001630] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe vitreal, retinal, and choroidal features of eyes affected by Endogenous candida endophthalmitis (ECE) analyzed by spectral domain optical coherence tomography (SD-OCT) and to evaluate their clinical impact. METHODS Medical records and SD-OCT images from eyes diagnosed with ECE at four retina and uveitis tertiary referral centers were retrospectively evaluated. Spectral domain optical coherence tomography images were analyzed to evaluate the structural changes occurring in the vitreous, the retina, and the choroid in areas involved by ECE. Baseline and final best-corrected visual acuity were correlated with SD-OCT findings. RESULTS Fifteen eyes from nine patients were enrolled. Vitreous involvement (vitreous cells, posterior hyaloid thickening) was detected in 13/15 eyes. Peculiar hyper-reflective preretinal aggregates obscuring the underlying retina because of a shadowing effect ("rain-cloud" sign) were noticed in all eyes with vitreous involvement. Two patterns of retinal and choroidal findings were identified: the first (six eyes) confined within the inner retinal layers (Intraretinal Pattern), the second (nine eyes) involving both retina (full thickness) and choriocapillaris (Chorioretinal Pattern). None of the eyes showed both patterns. None of the eyes, regardless the pattern, showed choroidal thickening. Baseline best-corrected visual acuity was not associated with OCT pattern (P = 0.09). On the contrary, final best-corrected visual acuity was significantly higher in patients showing Intraretinal Pattern (∼20/25, 0.06 ± 0.08 LogMAR) than in subjects with Chorioretinal Pattern (∼20/50, 0.44 ± 0.30 LogMAR) (P = 0.01). CONCLUSION Endogenous candida endophthalmitis showed peculiar features on SD-OCT. Two distinct patterns of chorioretinal involvement influencing the final best-corrected visual acuity were identified. Spectral domain optical coherence tomography could be useful in the diagnosis, management, and outcome prediction in ECE.
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20
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Is routine ophthalmoscopy really necessary in candidemic patients? PLoS One 2017; 12:e0183485. [PMID: 29065121 PMCID: PMC5655487 DOI: 10.1371/journal.pone.0183485] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/05/2017] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to determine among patients with candidemia the real rate of ophthalmoscopy and the impact of performing ocular assessment on the outcome of the disease. We performed a post hoc analysis of a prospective, multicenter, population-based candidemia surveillance program implemented in Spain during 2010–2011 (CANDIPOP). Ophthalmoscopy was performed in only 168 of the 365 patients with candidemia (46%). Ocular lesions related to candidemia were found in only 13/168 patients (7.7%), of whom 1 reported ocular symptoms (incidence of symptomatic disease in the whole population, 0.27% [1/365]). Ophthalmological findings led to a change in antifungal therapy in only 5.9% of cases (10/168), and performance of the test was not related to a better outcome. Ocular candidiasis was not associated with a worse outcome and progressed favorably in all but 1 evaluable patient, who did not experience vision loss. The low frequency of ophthalmoscopy and ocular involvement and the asymptomatic nature of ocular candidiasis, with a favorable outcome in almost all cases, lead us to reconsider the need for systematic ophthalmoscopy in all candidemic patients.
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Yadav HM, Thomas B, Thampy C, Panaknti TK. Management of a case of Candida albicans endogenous endophthalmitis with intravitreal caspofungin. Indian J Ophthalmol 2017. [PMID: 28643723 PMCID: PMC5508469 DOI: 10.4103/ijo.ijo_781_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of Candida albicans endogenous endophthalmitis treated with intravitreal caspofungin. The patient was a known case of acute lymphoblastic leukemia on chemotherapy and presented to us with features suggestive of endogenous endophthalmitis. He was treated initially with intravenous (IV) caspofungin and intravitreal amphotericin B. Patients condition worsened after IV caspofungin was replaced by amphotericin B necessitating a core vitrectomy. The patient was given the option of off-label caspofungin intravitreal injection for which the patient consented. There was a gradual improvement in the clinical picture. The situation worsened after the injections were stopped necessitating a revitrectomy. The study demonstrates the clinical efficacy of intravitreal caspofungin for the first time in human eyes.
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Affiliation(s)
- Harshali Manish Yadav
- Department of Ophthalmology, Kerala Institute of Medical Science, P.B.No.1, Anayara P.O, Trivandrum, Kerala, India
| | - Boben Thomas
- Department of Cancer Care, Kerala Institute of Medical Science, P.B.No.1, Anayara P.O, Trivandrum, Kerala, India
| | - Cherian Thampy
- Department of Cancer Care, Kerala Institute of Medical Science, P.B.No.1, Anayara P.O, Trivandrum, Kerala, India
| | - Tandava Krishnan Panaknti
- Neoretina Eye Care Institute, Dr.P.Ramchander House, 5-9-83/B, Nampally, Hyderabad, Telangana, India
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Uyhazi KE, Kolomeyer AM, Gray IN, Traband A, Kohli AA, O'Brien JM, Maguire AM. Management of Presumed Endogenous Fungal Endophthalmitis in a Child With Acute Lymphoblastic Leukemia. J Pediatr Ophthalmol Strabismus 2017; 54:e42-e46. [PMID: 28665443 DOI: 10.3928/01913913-20170531-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/18/2017] [Indexed: 11/20/2022]
Abstract
The authors describe a case of presumed endogenous fungal endophthalmitis in an immunocompetent pediatric patient with acute lymphoblastic leukemia. A 15-year-old boy with a history of high-risk B-cell acute lymphoblastic leukemia status post-chemotherapy presented with acute changes in vision in his left eye. Fundus examination revealed a white bi-lobed chorioretinal lesion with overlying vitritis and associated subretinal fluid. Magnetic resonance imaging of the brain revealed small ring-enhancing lesions in the right parietal and left occipital lobes. Blood, cerebrospinal fluid, aqueous, and vitreous cultures were all negative. Bone marrow and vitreous cytology were negative for malignant cells. The patient was treated for presumed fungal endophthalmitis with systemic and intravitreal voriconazole, followed by pars plana vitrectomy with intravitreal voriconazole and amphotericin B injections. The chorioretinal lesion resolved and visual acuity recovered to 20/20. Chorioretinal infiltrates in a patient with leukemia may require treatment even in the absence of a definitive diagnostic test result. Intervention should be guided by risk analysis and clinical judgment. [J Pediatr Ophthalmol Strabismus. 2017;54:e42-e46.].
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23
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William A, Spitzer MS, Deuter C, Blumenstock G, Partsch M, Voykov B, Ziemssen F, Bartz-Schmidt KU, Doycheva D. Outcomes of Primary Transconjunctival 23-Gauge Vitrectomy in the Diagnosis and Treatment of Presumed Endogenous Fungal Endophthalmitis. Ocul Immunol Inflamm 2016; 25:239-245. [PMID: 26829468 DOI: 10.3109/09273948.2015.1115080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report the outcomes of primary transconjunctival 23-gauge (23-G) vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis (EFE). METHODS Retrospective analysis of patients with EFE who underwent diagnostic transconjunctival 23-G vitrectomy at a tertiary referral center. RESULTS Nineteen eyes of 15 patients with EFE were included in the study. Four patients had bilateral and 11 patients unilateral disease. Sixteen eyes of 15 patients underwent 23-G vitrectomy to confirm the diagnosis using vitreous culture, polymerase chain reaction, and histopathologic examinations. All affected eyes were treated with intravitreal amphotericin B 5 µg/0.1 mL. Fourteen patients received additional systemic antifungal therapy. Diagnostic 23-G vitrectomy confirmed the diagnosis of EFE in 75% of the eyes (12/16). Candida was found to be a causative agent in 62.5% and Aspergillus in 12.5% of the eyes. Retinal detachment was the most common complication (42% of eyes). CONCLUSIONS EFE can be easily confirmed using primary 23-G vitrectomy.
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Affiliation(s)
- Antony William
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
| | - Martin S Spitzer
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
| | - Christoph Deuter
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
| | - Gunnar Blumenstock
- b Department of Clinical Epidemiology and Applied Biometry , University of Tuebingen , Tuebingen , Germany
| | - Michael Partsch
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
| | - Bogomil Voykov
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
| | - Focke Ziemssen
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
| | | | - Deshka Doycheva
- a Centre for Ophthalmology , University of Tuebingen , Tuebingen , Germany
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24
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Magano R, Cortez J, Ramos E, Trindade L. Candida albicans osteomyelitis as a cause of chest pain and visual loss. BMJ Case Rep 2015; 2015:bcr-2015-211327. [PMID: 26475877 DOI: 10.1136/bcr-2015-211327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.
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Affiliation(s)
- Rita Magano
- Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal
| | - Joana Cortez
- Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal
| | | | - Luís Trindade
- Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal
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Intravitreal liposomal amphotericin B for treatment of endogenous candida endophthalmitis. Jpn J Ophthalmol 2015. [DOI: 10.1007/s10384-015-0397-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Prospero Ponce CM, Al Zubidi N, Beaver HA, Lee AG, Huey DA, Chavis PS. HIV and cannot see. Surv Ophthalmol 2014; 59:468-73. [DOI: 10.1016/j.survophthal.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/11/2013] [Indexed: 02/08/2023]
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Wang SH, Lee JJ, Chen YJ, Kuo HK. Endogenous candida endophthalmitis in South Taiwan: A 10-year retrospective study. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Etiological agents of fungal endophthalmitis: diagnosis and management. Int Ophthalmol 2013; 34:707-21. [PMID: 24081913 DOI: 10.1007/s10792-013-9854-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
Endophthalmitis caused by fungi is commonly diagnosed around the world in apparently healthy and immunocompromised individuals. An accurate clinical diagnosis for endophthalmitis confirmed by laboratory techniques is essential for early treatment with antifungal drugs, such as amphotericin B, imidazoles, and other antifungals. Here, we review endophthalmitis caused by fungi according to its classification into endogenous fungal endophthalmitis (EFE) and exogenous fungal endophthalmitis (EXFE). EFE is caused by endogenously acquired fungi, whereas the traumatic implantation of opportunistic fungal pathogens is the main feature of EXFE. We highlight the most important etiologies causing endophthalmitis and the steps required for a rapid diagnosis and management.
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Lebas M, De Lahitte GD, Fardeau C, Cassoux N, Terrada C, Le Hoang P, Bodaghi B. Bilateral fungal endophthalmitis masquerading as multifocal chorioretinitis. Retin Cases Brief Rep 2011; 5:279-83. [PMID: 25390413 DOI: 10.1097/icb.0b013e3181f66a18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Spontaneous healing of ocular Candida infection is extremely rare, and early clinical manifestations may be misleading. This report explicates how to make the appropriate diagnosis when facing atypical presentation of the disease. METHODS AND PATIENTS Case report. RESULTS A 36-year-old woman presented with bilateral chorioretinitis. Intravenous drug abuse was not suspected, and a diagnosis of multifocal chorioretinitis was made. Oral corticosteroid treatment was started. Three months later, all previously seen lesions had healed on the right eye but had increased on the left with development of severe endophthalmitis. Microbiologic analysis of scalp pustules yielded Candida albicans. She underwent vitrectomy, intravitreous amphotericin B injection, and systemic fluconazole treatment. The uveitis responded well to this treatment regiment, but subsequent development of macular edema and retinal detachment in the left eye limited the final visual acuity to 20/200. Visual acuity remained 20/20 on the right without any evidence of inflammation. CONCLUSION This case demonstrates a broad range of potential outcomes after Candida endophthalmitis in the same patient, from very rare healing without antifungal treatment in one eye to severe panuveitis in the other eye. The delayed diagnosis in this case led to the inappropriate treatment with corticosteroids alone and delayed antifungal treatment. Early differentiation of Candida chorioretinitis from multifocal chorioretinitis is critical to final visual outcome.
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Affiliation(s)
- Maud Lebas
- From the Hôpital de la Pitié Salpêtrière, Ophthalmology Department, Paris, France
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Abstract
Candida tropicalis is one of the more common Candida causing human disease in tropical countries; the frequency of invasive disease varies by geography causing 3--66% of candidaemia. C. tropicalis is taxonomically close to C. albicans and shares many pathogenic traits. C. tropicalis is particularly virulent in neutropenic hosts commonly with hematogenous seeding to peripheral organs. For candidaemia and invasive candidiasis amphotericin B or an echinocandin are recommended as first-line treatment, with extended-spectrum triazoles acceptable alternatives. Primary fluconazole resistance is uncommon but may be induced on exposure. Physicians in regions where C. tropicalis is common need to be mindful of this lesser-described pathogen.
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Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol 2010; 4:121-35. [PMID: 20390032 PMCID: PMC2850824 DOI: 10.2147/opth.s6461] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Indexed: 12/07/2022] Open
Abstract
Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.
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Affiliation(s)
- M Kernt
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
| | - A Kampik
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
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Gerstenblith AT, Shah CP. Candidachorioretinitis and endophthalmitis. EXPERT REVIEW OF OPHTHALMOLOGY 2009. [DOI: 10.1586/eop.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Intraocular inflammation, or uveitis, incorporates a diverse group of infectious and immune-mediated disorders. In addition, some conditions masquerade as uveitis. However, classifying uveitis according to anatomic location in adult and pediatric populations, and appreciating the effect of immune status and regional differences, refines the list of potential causes. In this way, a select few investigations can be performed, rather than a nondirected battery of tests.
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Cruciani M, Serpelloni G. Management of Candida infections in the adult intensive care unit. Expert Opin Pharmacother 2008; 9:175-91. [PMID: 18201143 DOI: 10.1517/14656566.9.2.175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The epidemiology of Candida infection in intensive care units (ICUs) and the management strategies for such infections in non-neutropenic intensive care patients are discussed in this review. Candida species are one of the leading causes of nosocomial bloodstream infections and a significant cause of morbidity in patients admitted to the ICU. Prophylactic, pre-emptive and empiric treatment strategies for Candida infections have been explored in ICU patients. Routine prophylaxis should not be administered to the whole population of ICU patients, because the concerns about the selection of azole-resistant Candida strains or the induction of resistance are justified. Treatment of fungal infections is now possible with newer antifungal agents, including newer azoles (e.g., voriconazole, posaconazole) and echinocandins (e.g., micafungin, anidulafungin). However, there is a critical need for improvement in diagnosis of invasive Candida infection in order to provide clinicians the opportunity to intervene earlier in the diseases course.
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Affiliation(s)
- Mario Cruciani
- Center of Preventive Medicine & HIV Out-Patient Clinic, V. Germania, 20-37135 Verona, Italy.
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Hussain B, Lynn W, Lightman SL. Metastatic endophthalmitis. Br J Hosp Med (Lond) 2007; 68:424-8. [PMID: 17847685 DOI: 10.12968/hmed.2007.68.8.24494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endophthalmitis carries a poor visual prognosis for patients and can be a potentially blinding condition that may result in loss of the eye. Early diagnosis and prompt treatment are imperative to save the eye. Delay in diagnosis affects visual prognosis and therefore doctors should be aware of the presenting features of endophthalmitis. Urgent ophthalmic referral is advised as soon as a diagnosis is suspected.
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