Abstract
Background
Although many studies have been published on the risk factors and therapies for endogenous fungal endophthalmitis (EFE), only a few have been published on the relationship between the stage of EFE at the initial examination and the prognosis. Thus, the purpose of this study was to determine the relation between the stage of EFE at the initial examination and the prognosis.
Methods
A total of 103 eyes of 58 patients (40 men, 18 women) with EFE, examined over a 20-year period (1984–2004), were studied. The severity of the EFE at the initial examination was classified into four stages. In addition, the type of fungus, general status, initial and final visual acuity, findings of the anterior and posterior segments, latent fungal infection, duration from initial symptoms to initial visit, history of intravenous hyperalimentation (IVH), results of the Candida Detection System, and β-D-glucan levels were analyzed.
Results
More than 95% of the patients had some type of underlying disorder. Candida albicans was detected initially in the blood in 40 patients. The stage of the EFE advanced as the time from the initial symptoms to the beginning of therapy increased. The final visual acuity was significantly correlated with the stage of EFE at the initial examination. In 20 of 21 patients, blood β-D-glucan was positive, and 42 patients (90%) were receiving IVH.
Conclusions
Because the stage of EFE advanced with the time between the initial symptoms and the beginning of therapy, and because of the high correlation between the stage of EFE and the final visual acuity, it is very important that treatment be begun as soon as possible. Thus, in patients with visual symptoms and susceptible to opportunistic infections, an early consultation with an ophthalmologist is highly recommended.
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References
Barrie T (1987) The place of elective vitrectomy in the management of patients with Candida endophthalmitis. Graefes Arch Clin Exp Ophthalmol 225:107–113
Brod RD, Flynn HW Jr, Clarkson JG, Pflugfelder SC, Cullbertson WW, Miller D (1990) Endogenous Candida endophthalmitis: management without intravenous amphotericin B. Ophthalmology 97:666–672
Brooks RG (1989) Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch Intern Med 149:2226–2228
Donahue SP, Greven CM, Zuravleff JJ, Eller AW, Nguyen MH, Peacock JE Jr, Wagener MW, Yu VL (1994) Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology 101:1302–1309
Edwards JE Jr, Bodey GP, Bowden RA, Buchner T, de Pauw BE, Filler SG, Ghannoum MA, Glauser M, Herbrecht R, Kauffman CA, Kohno S, Martino P, Mori T, Pfaller MA, Rex JH, Rogers TR, Rubin RH, Solomkin J, Viscoli C, Walsh TJ, White M (1997) International conference for the development of a consensus on the management and prevention of severe candidal infections. Clin Infect Dis 25:43–59
Essman TF, Flynn JW Jr, Smiddy WE, Brod RD, Murray TG, Davis JL, Rubsamen PE (1997) Treatment outcomes in a 10–year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers 28:185–194
Fung JC, Donta ST, Tilton RC (1986) Candida detection system (CAND-TEC) to differentiate between Candida albicans colonization and disease. J Clin Microbiol 24:542–547
Hidaka A, Ninomiya H, Kobayashi Y, Tanaka M (1994) The studies on routine ophthalmological check up in a patient receiving intravenous hyperalimentation (IVH). Jpn J Clin Ophthalmol 48:950–951
Laatikainen L, Tuominen M, Von Dickhoff T (1992) Treatment of endogenous fungal endophthalmitis with systemic fluconazole with or without vitrectomy. Am J Ophthalmol 113:205–207
Obayashi T, Obayashi T, Yoshida M, Mori T, Goto H, Yasuda A, Iwasaki H, Teshima H, Kohno S, Horiuchi A, Ito A (1995) Plasma (1-->3)-beta-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 345:17–21
Parke DW II, Jpnes DB, Gentry LO (1982) Endogenous endophthalmitis among patients with candidemia. Ophthalmology 89:789–796
Pfaller MA, Houston A, Coffmann S (1996) Application of CHROMagar candida for rapid screening of clinical specimens for Candida albicans, Candida tropicalis, Candida krusei, and Candida (torulopsis) glabrata. J Clin Microbiol 34:58–61
Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758
Pittet D, Anaissie E, Solomkin JS (1996) When to start antifungal therapy in the non-neutropenic critically ill? In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 567–577
Price MF, Gentry LO (1986) Incidence and significance of candida antigen in low-risk and high-risk patient populations. Eur J Clin Microbiol 5:416–419
Schiedler V, Scott IU, Flynn HW Jr, Davis JL, Benz MS, Miller D (2004) Culture–proven endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 137:725–731
Schulman JA, Peyman GA (1992) Intravenous corticosteroids as an adjunct in the treatment of bacterial and fungal endophthalmitis. Retina 12:336–340
Tanaka M, Kobayashi Y, Takebayashi H, Kiyokawa M, Qui H (2001) Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12-year study of 79 eyes of 46 patients. Retina 21:203–209
Urbak SF, Degn T (1992) Fluconazole in the treatment of Candida albicans endophthalmitis. Acta Ophthalmol 70:528–529
Voss A, le Noble JL, Verduyn Lunel FM, Foundrain NA, Meis JF (1997) Candidemia in intensive care unit patients: risk factors for mortality. Infection 25:8–11
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Takebayashi, H., Mizota, A. & Tanaka, M. Relation between stage of endogenous fungal endophthalmitis and prognosis. Graefe's Arch Clin Exp Ophthalmo 244, 816–820 (2006). https://doi.org/10.1007/s00417-005-0182-5
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DOI: https://doi.org/10.1007/s00417-005-0182-5