Reliability of vitreous histological detection of pathogenic fungi in the diagnosis of fungal endophthalmitis

Liu, K; Fěng, Fang; Li, H

doi:10.1038/eye.2014.278

Cited by 13 publications

(8 citation statements)

References 13 publications

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“…Thus, direct microscopic examination, culture, and histopathologic examination are useful methods for diagnosing fungal endophthalmitis. 17 Examinations of smears of the aqueous fluid or vitreous body are convenient and rapid with high positive rates that can significantly facilitate the diagnosis and treatment of fungal endophthalmitis. In this study, the positive rate for microscopic smear examinations was 78.4%.…”

Section: Discussionmentioning

confidence: 99%

Endophthalmitis associated with fungal keratitis and penetrating injuries in North China

Liu

Zhang

Yin

et al. 2019

European Journal of Ophthalmology

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Purpose: To report the laboratory findings, management strategies, and visual outcomes of culture-proven exogenous fungal endophthalmitis in North China. Methods: The microbiological and treatment records of patients with culture-positive exogenous fungal endophthalmitis who visited the Affiliated Hospital of Qingdao University from January 2012 to December 2016 were reviewed. Results: A total of 39 eyes (39 patients) were identified over a 5-year period. Exogenous fungal endophthalmitis was associated with penetrating trauma in 22 eyes (56.4%), fungal keratitis in 15 eyes (38.5%), and intraocular surgery in 2 eyes (5.1%). Hyphae were found in 29 of 37 smear samples (78.4%) by direct microscopic examination. Fungal pathogens cultured from 39 samples were identified as 10 genera and 15 species. Filamentous fungi (molds) accounted for 94.9% (37 samples), including Fusarium (19, 48.7%) and Aspergillus (11, 28.2%). Most keratitis cases were caused by Fusarium (11 of 15; 73.3 %). Aspergillus was isolated from nine penetrating ocular trauma cases (9 of 22; 40.9%). Three eyes receiving evisceration had fungal and bacteria coinfection (3 of 39, 7.7%) with Aspergillus and Bacillus. At least, one surgical intervention was performed in all 39 eyes and 28 (71.8%) eyes underwent two or more procedures, including surgeries and intraocular injections. Twenty-nine patients received intraocular antifungal therapy with amphotericin B and/or voriconazole. Visual acuity at discharge from the hospital was significantly better than the initial visual acuity ( p < 0.001). Final vision of 20/400 or better was achieved in 22 (56.4%) eyes. Conclusions: This study highlighted the differences between clinical categories of exogenous fungal endophthalmitis. Trauma was the major etiological factor. Molds were the most common pathogens, with Fusarium ranking first, followed by Aspergillus. Fungal and bacterial coinfection mostly occurred after metal penetrating trauma, and Bacillus was the primary bacterial pathogen. Coinfection may be one reason of evisceration. Immediate intravitreal antifungal therapy combined with vitrectomy was effective for exogenous fungal endophthalmitis. Amphotericin B and voriconazole were commonly used antifungal agents.

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Section: Discussionmentioning

confidence: 99%

Endophthalmitis associated with fungal keratitis and penetrating injuries in North China

Liu

Zhang

Yin

et al. 2019

European Journal of Ophthalmology

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“…The prognosis of Rhodotorula endogenous endophthalmitis stands in contrast to the better prognoses seen in other eye infections such as scleritis and keratitis caused by this rare yeast [ 6 , 7 ]. Although vitreous culture is the gold standard for the diagnosis of fungal endogenous endophthalmitis, its sensitivity varies greatly, with values reported as low as 40% [ 8 ]. Our case underlines the importance of resampling and retreating eyes with suspected endogenous endophthalmitis as microbes may be sequestered and inaccessible in an abscess.…”

Section: Discussionmentioning

confidence: 99%

RhodotorulaEndogenous Endophthalmitis: A Novel Harbinger of the Injection Drug Epidemic in the United States

Luong

Kalpakian

Jaeger

et al. 2017

Case Reports in Infectious Diseases

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Endogenous endophthalmitis is a rare but feared infectious ocular complication of injection drug use (IDU). The recent opioid epidemic in the United States threatens to increase the incidence of this disease. We report the first case of endogenous endophthalmitis in the United States caused by the emerging fungal pathogen Rhodotorula in an injection drug user which led to no light perception vision (NLP). Worldwide experience with Rhodotorula endogenous endophthalmitis is limited, but existing cases suggest infection by this particular fungal genus has a grim prognosis.

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“…The ability to identify fungal growth with positive cultures has been reported to be between 25-70%. 24 Although not used in the current study, polymerase chain reaction could increase early detection of fungal infections. 22 Furthermore, it was not possible to demonstrate a difference in clinical outcomes between patients treated with voriconazole compared to amphotericin B in the current study.…”

Section: Discussionmentioning

confidence: 99%

Persistently Vitreous Culture–Positive Exogenous Fungal Endophthalmitis

Leung

Kuriyan

Flynn

et al. 2016

American Journal of Ophthalmology

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Purpose To report the clinical settings, microbiological isolates, and best corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis. Design Retrospective, consecutive, case series. Methods Setting Tertiary referral center. Patient population 16 eyes of 16 patients with at least two consecutive positive vitreous cultures between 1981-2015. Interventions Intravitreal antifungal injections, pars plana vitrectomy (PPV) Main Outcome Measure Clinical settings, microbiologic isolates, BCVA Results The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ≈20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (≈20/1400, P=0.83). The 9 patients (56%) who had IOL and capsular bag removals had better final BCVAs than those who did not (P=0.011). The BCVAs were similar in eyes with yeast and mold (P=0.37). The visual acuity at the last follow-up was ≥20/40 in 13% (2/16), ≥20/400 in 50% (8/16), and no light perception in 25% (4/16). Conclusions Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.

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Reliability of vitreous histological detection of pathogenic fungi in the diagnosis of fungal endophthalmitis

Cited by 13 publications

References 13 publications

Endophthalmitis associated with fungal keratitis and penetrating injuries in North China

Endophthalmitis associated with fungal keratitis and penetrating injuries in North China

RhodotorulaEndogenous Endophthalmitis: A Novel Harbinger of the Injection Drug Epidemic in the United States

Persistently Vitreous Culture–Positive Exogenous Fungal Endophthalmitis

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