Study of ocular candidiasis during nine-year period

Tanaka, Hiroki; Ishida, Kyoko; Yamada, Wataru; Nishida, Takashi; Mochizuki, Kiyofumi; Kawakami, Hideaki

doi:10.1016/j.jiac.2015.12.001

Cited by 6 publications

(8 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, systemically ill patients with sustained fungemia demonstrate a much higher rate of bilateral infection. 14,23,24 There are limited clinical studies on the role of antifungals and vitrectomy in the treatment of EFE secondary to IVDA. In our series, the duration of systemic therapy did not correlate with a need for surgical intervention or final VA.…”

Section: Discussionmentioning

confidence: 99%

An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England

2017

View full text Add to dashboard Cite

IMPORTANCE Intravenous drug abuse (IVDA) is a known risk factor for endogenous fungal endophthalmitis (EFE), a severe intraocular infection caused by hematogenous seeding of mycotic organisms to the eye. Reporting significant increases in heroin-related deaths since 2014, the New England region is in the midst of an opioid crisis that has led to a substantial increase in patients at risk for this vision-threatening disease.OBJECTIVE To present an update on characteristics, management, and visual outcomes in patients with EFE. DESIGN, SETTING, AND PARTICIPANTS Medical records review was initiated on July 1, 2016, evaluating all patients with EFE referred to New England Eye Center at Tufts Medical Center, a tertiary care ophthalmology practice distributed throughout Massachusetts, from May 1, 2014, to May 1, 2016. Patients with a history of IVDA and culture-proven or clinical evidence of fungal endophthalmitis were included. EXPOSURES Intravenous drug use. MAIN OUTCOMES AND MEASURES Patient demographics, comorbidities, presenting symptoms and vision, vitreoretinal findings, treatment regimens, culture data, and final visual acuities.RESULTS Ten patients (5 women) with IVDA-related EFE were identified between May 1, 2014, and May 1, 2016-an increase from 3 patients treated from May 2012 to April 2014. The mean (SD) patient age was 34 (11) years (range, 24-60 years). Presenting visual acuities ranged from 20/25 to hand motion. The most common presenting symptoms were floaters (n = 8), reduced vision (n = 6), and pain (n = 5). Initial treatment included systemic antifungals in all patients and intravitreal antifungals in 9 eyes. Five patients required pars plana vitrectomy for worsening vitritis. The most commonly isolated pathogen was Candida albicans in 20% of the patients. Final visual acuity ranged from 20/40 to 20/300. CONCLUSIONS AND RELEVANCEThe data provided in this report suggest that EFE represents severe end organ damage associated with IVDA and portends poor visual outcomes. Health care professionals must maintain a high suspicion for EFE, as patients are typically ambulatory on presentation without systemic signs of infection.

show abstract

Section: Discussionmentioning

confidence: 99%

An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England

2017

View full text Add to dashboard Cite

show abstract

“…The onset of candidemia was defined as the day the initial positive blood sample was drawn, which subsequently formed a culture positive for Candida spp. To classify ocular candidiasis, we referred to criteria established in previous studies [ 10 , 11 , 12 , 13 ]. Proven ocular candidiasis was defined as ocular lesions combined with a positive histology or a culture of vitreous aspirate.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors and Clinical Characteristics of Patients with Ocular Candidiasis

Sakamoto

Gotoh

Hashimoto

et al. 2022

JoF

View full text Add to dashboard Cite

Ocular candidiasis is a critical and challenging complication of candidemia. The purpose of this study was to investigate the appropriate timing for ophthalmologic examinations, risk factors for complications of ocular lesions, and their association with mortality. This retrospective cohort study applied, using multiple logistic regression analysis and Cox regression models, to cases of candidemia (age ≥ 18 years) for patients who underwent ophthalmologic consultation. Of the 108 candidemia patients who underwent ophthalmologic examination, 27 (25%) contracted patients had ocular candidiasis, and 7 experienced the more severe condition of endophthalmitis, which included subjective ocular symptoms. In most cases, the initial ophthalmologic examination was performed within one week of the onset of candidiasis with a diagnosis of ocular candidiasis, but in three cases, the findings became apparent only after a second examination within 7–14 days after onset of candidiasis. The independent risk factor extracted for the development of ocular candidiasis was the isolation of C. albicans (OR, 4.85; 95% CI, 1.58–14.90), unremoved CVC (OR, 10.40; 95% CI, 1.74–62.16), and a high βDG value (>108.2 pg/mL) (HR, 2.83; 95% CI = 1.24–6.27). Continuous ophthalmologic examination is recommended in cases of candidemia with the above risk factors with an initial examination within 7 days of onset and a second examination 7–14 days after onset.

show abstract

“…We used the criteria described below to classify the ocular findings in accordance with previous studies [15,17]. Proven endophthalmitis was defined as ocular lesions with positive cultures of vitreous humor.…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Ocular candidiasis (OC) is an important disseminated complication of candidemia. The incidence of OC in patients with candidemia reported in previous studies is quite variable, ranging from 2.9% to 44.7% [10][11][12][13][14][15][16][17][18][19]. To date, several studies have reported risk factors for the development of OC, such as hemodialysis, parenteral hyperalimentation, immunosuppression, and C. albicans involvement [11,13,20].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Sakai

Matsumiya

Kusuhara

et al. 2021

J Ophthal Inflamm Infect

View full text Add to dashboard Cite

Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

show abstract

Study of ocular candidiasis during nine-year period

Cited by 6 publications

References 30 publications

An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England

An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England

Risk Factors and Clinical Characteristics of Patients with Ocular Candidiasis

Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Contact Info

Product

Resources

About