Fungal Infection

  • Un Chul ParkEmail author
Part of the Retina Atlas book series (RA)


Fungi are eukaryotic organisms which have different ribosome, nuclear structure, and cellular wall composition from bacteria. They are usually divided into yeasts and molds. Yeasts are typically round or oval and reproduce by budding. They include Candida, Cryptococcus, Blastomyces, and Coccidioides species. Molds are composed of tubular structures called hyphae and grow by branching in a longitudinal extension. They include Aspergillus and the agents of mucormycosis. There are also dimorphic fungi, which grow in the host as yeasts but in vitro as molds, and they include Histoplasma and Blastomyces. Fungi are ubiquitous in nature, but only a limited number of fungal species causes human infection, especially in eye in the form of fungal retinitis and endophthalmitis. The most common organisms that cause fungal infection are the Candida species, followed by Aspergillus species.


  1. Anand A, Madhavan H, Neelam V, et al. Use of polymerase chain reaction in the diagnosis of fungal endophthalmitis. Ophthalmology. 2001;108:326–30.CrossRefGoogle Scholar
  2. Bakri SJ, Sears JE, Procop GW, et al. Excellent visual outcome following Aspergillus flavus endogenous endophthalmitis-farmer’s lung disease. Int Ophthalmol. 2010;30:99–101.CrossRefGoogle Scholar
  3. Brooks RG. Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch Intern Med. 1989;149:2226–8.CrossRefGoogle Scholar
  4. Chakrabarti A, Shivaprakash MR, Singh R, et al. Fungal endophthalmitis—fourteen years’ experience from a center in India. Retina. 2008;28:1400–7.CrossRefGoogle Scholar
  5. Chee YE, Eliott D. The role of vitrectomy in the management of fungal endophthalmitis. Semin Ophthalmol. 2017;32:29–35.CrossRefGoogle Scholar
  6. Cohen PR, Grossman ME, Silvers DN. Disseminated histoplasmosis and human immunodeficiency virus infection. Int J Dermatol. 1991;30:614–22.CrossRefGoogle Scholar
  7. Donahue SP, Greven CM, Zuravleff JJ, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology. 1994;101:1302–9.CrossRefGoogle Scholar
  8. Edwards JE Jr, Foos RY, Montgomerie JZ, et al. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis. Medicine. 1974;53:47–75.CrossRefGoogle Scholar
  9. Galarreta DJ, Tuft SJ, Ramsay A, et al. Fungal keratitis in London: microbiological and clinical evaluation. Cornea. 2007;26:1082–6.CrossRefGoogle Scholar
  10. Henderly DE, Liggett PE, Rao NA. Cryptococcal chorioretinitis and endophthalmitis. Retina. 1987;7:75–9.CrossRefGoogle Scholar
  11. Jampol LM, Dyckman S, Maniates V, et al. Retinal and choroidal infarction from Aspergillus: clinical diagnosis and clinicopathologic correlations. Trans Am Ophthalmol Soc. 1988;86:422–40.PubMedPubMedCentralGoogle Scholar
  12. Martinez-Vazquez C, Fernandez-Ulloa J, Bordon J, et al. Candida albicans endophthalmitis in brown heroin addicts: response to early vitrectomy preceded and followed by antifungal therapy. Clin Infect Dis. 1998;27:1130–3.CrossRefGoogle Scholar
  13. Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis: epidemiology, diagnosis and management in immunocompromised patients. Drugs. 2007;67:1567–601.CrossRefGoogle Scholar
  14. Moloney TP, Park J. Microbiological isolates and antibiotic sensitivities in culture-proven endophthalmitis: a 15-year review. Br J Ophthalmol. 2014;98:1492–7.CrossRefGoogle Scholar
  15. Narndran N, Balasubramaniam B, Johnson E, et al. Five-year retrospective review of guideline-based management of fungal endopthalmitis. Acta Ophthalmol. 2008;86:525–32.CrossRefGoogle Scholar
  16. Okhravi N, Adamson P, Mant R, et al. Polymerase chain reaction and restriction fragment length polymorphism mediated detection and speciation of Candida spp causing intraocular infection. Invest Ophthalmol Vis Sci. 1998;39:859–66.PubMedGoogle Scholar
  17. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35.CrossRefGoogle Scholar
  18. Pappas PG, Kauffman CA, Andes DR, et al. Executive summary: clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:409–17.CrossRefGoogle Scholar
  19. Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmology. 1982;89:789–96.CrossRefGoogle Scholar
  20. Rao NA, Hidayat AA. Endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared with aspergillosis. Am J Ophthalmol. 2001;132:244–51.CrossRefGoogle Scholar
  21. Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994;331:1325–30.CrossRefGoogle Scholar
  22. Riddel J, Comer GM, Kauffman CA. Treatment of endogenous fungal endophthalmitis: focus on new antifungal agents. Clin Infect Dis. 2011;52:648–53.CrossRefGoogle Scholar
  23. Sallam A, Lynn W, McCluskey P, et al. Endogenous Candida endophthalmitis. Expert Rev Anti Infect Ther. 2006;4:675–85.CrossRefGoogle Scholar
  24. Schmid S, Martenet AC, Oelz O. Candida endophthalmitis: clinical presentation, treatment and outcome in 23 patients. Infection. 1991;19:21–4.CrossRefGoogle Scholar
  25. Shah CP, McKey J, Spirn MJ, et al. Ocular candidiasis: a review. Br J Ophthalmol. 2008;92:466–8.CrossRefGoogle Scholar
  26. Shulman J, de la Cruz EL, Latkany P, et al. Cryptococcal chorioretinitis with immune reconstitution inflammatory syndrome. Ocul Immunol Inflamm. 2009;17:314–5.CrossRefGoogle Scholar
  27. Sugita S, Ogawa M, Shimizu N, et al. Use of a comprehensive polymerase chain reaction system for diagnosis of ocular infectious diseases. Ophthalmology. 2013;120:1761–8.CrossRefGoogle Scholar
  28. Tanaka M, Kobayashi Y, Takebayashi H, et al. 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. 2001;21:203–9.CrossRefGoogle Scholar
  29. Thompson GR 3rd, Cadena J, Patterson TF. Overview of antifungal agents. Clin Chest Med. 2009;30:203–15.CrossRefGoogle Scholar
  30. Walma D, Schlaegel TFJ. Presumed ocular histoplasmosis. Am J Ophthalmol. 1964;57:107–10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of Ophthalmology, College of MedicineSeoul National UniversitySeoulRepublic of Korea
  2. 2.Department of OphthalmologySeoul National University HospitalSeoulRepublic of Korea

Personalised recommendations