Sporothrix schenckii Endophthalmitis in a Patient With Human Immunodeficiency Virus Infection

Kurosawa, Akimitsu; Pollock, Stephen C.; Collins, Mary Pat; Kraff, Colman R.; Tso, Mark O.M.

doi:10.1001/archopht.1988.01060130402030

Cited by 65 publications

(22 citation statements)

References 11 publications

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“…Conjunctival rhinosporidiosis with associated scleral melting and staphyloma formation recently reported (54). (205). Organisms of uncertain taxonomic classification.…”

Section: Rhinosporidium Seeberisupporting

confidence: 41%

“…Vieira-Dias et al (410) reported the occurrence of concomitant ocular and cutaneous sporotrichosis, in which the fungus was isolated from skin lesions and the aqueous humor. Risk factors for endophthalmitis due to S. schenckii include AIDS (205) and trauma (427); however, this ocular infection may occur even in the absence trauma or systemic infection (52). Endophthalmitis due to S. schenckii usually presents initially as a granulomatous uveitis (52,205) which may be treated with corticosteroids, leading to progression of the lesion.…”

Section: Intraocular Mycoses (Excluding Endophthalmitis)mentioning

confidence: 39%

“…Risk factors for endophthalmitis due to S. schenckii include AIDS (205) and trauma (427); however, this ocular infection may occur even in the absence trauma or systemic infection (52). Endophthalmitis due to S. schenckii usually presents initially as a granulomatous uveitis (52,205) which may be treated with corticosteroids, leading to progression of the lesion. Improperly treated uveitic lesions may result in frank endophthalmitis (205) or scleral perforation (52).…”

Section: Intraocular Mycoses (Excluding Endophthalmitis)mentioning

confidence: 39%

“…In view of these toxic effects, treatment should be reserved for patients in whom a diagnosis of mycotic infection is reasonably well substantiated; patients receiving systemic amphotericin B for ophthalmic reasons should be comanaged with an internist, who will monitor the patient for toxicity (236). Intravenous amphotericin B continues to be the treatment of choice for invasive fungal infections of the orbit (164,213,323,349); it has also been used in the treatment of endophthalmitis due to dimorphic fungi (205,215,224,253,338,357) and lesions of the eyelids, conjunctiva, and cornea caused by P. brasiliensis (353). The efficacy of intravenous amphotericin B in endophthalmitis due to dimorphic fungi is difficult to evaluate since, in many of the reports cited, posttreatment cultures were negative but the affected eyeball had to be enucleated due to other complications.…”

Section: Polyenesmentioning

confidence: 42%

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Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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“…Conjunctival rhinosporidiosis with associated scleral melting and staphyloma formation recently reported (54). (205). Organisms of uncertain taxonomic classification.…”

Section: Rhinosporidium Seeberisupporting

confidence: 41%

Section: Intraocular Mycoses (Excluding Endophthalmitis)mentioning

confidence: 39%

Section: Intraocular Mycoses (Excluding Endophthalmitis)mentioning

confidence: 39%

Section: Polyenesmentioning

confidence: 42%

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Current Perspectives on Ophthalmic Mycoses

2003

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“…It is a protracted condition with poor outcomes, leading to total blindness in most cases. [24][25][26] Our patient's evolution was similar, with bilateral endophthalmitis despite surgical procedures and systemic antifungal therapy, thereby confirming previously reported severity of ocular sporotrichosis and poor prognosis for eyesight. Our patient's ocular infection probably originated from hematogenous spread, although no fungus was recovered from blood cultures.…”

Section: Discussionmentioning

confidence: 40%

Disseminated Sporothrix brasiliensis Infection with Endocardial and Ocular Involvement in an HIV-Infected Patient

Silva‐Vergara

Camargo²,

Silva³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. Disseminated sporotrichosis occurs in individuals with impaired cellular immunity, such as in cases of neoplasia, transplantation, diabetes, and especially, acquired immunodeficiency syndrome. This report presents a 32-year-old Brazilian human immunodeficiency virus (HIV)-infected patient who developed a protracted condition of disseminated sporotrichosis with endocarditis, bilateral endophthalmitis, and lymphatic involvement. He needed cardiac surgery to replace the mitral valve. Sporothrix brasiliensis isolates were recovered from cultures of subcutaneous nodules and mitral valve fragments. Species identification was based on classical and molecular methods. The patient received amphotericin B for 52 days and subsequently, oral itraconazole. He remains asymptomatic, and he is on maintenance therapy with itraconazole. Despite his positive clinical outcome, he developed bilateral blindness. To our knowledge, this case is the first report of endocarditis and endophthalmitis caused by S. brasiliensis.

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