Similarly, Ghoraba et al. For example, in keratitis-associated exogenous fungal endophthalmitis, risk factors include contact lens use, trauma with organic matter, and LASIK [17]. Endogenous Aspergillus endophthalmitis. 2017 May-Jun. Pain on extraocular movement without conjunctival Overview of Candida infections Delayed- versus acute-onset endophthalmitis after cataract surgery. Diagnostic and Management Strategies of Aspergillus Endophthalmitis: Current Insights. Results of the Endophthalmitis Vitrectomy Study. %PDF-1.6
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government site. 2012 Jan. 32(1):146-51. Report of a ten-year retrospective study. reported sustained vision loss in 23 of 44 (52.3%) eyes at final follow-up, including 16 of 44 (36.4%) with vision worse than 20/200 [8]. JACEP Open. The site is secure. Kitazawa K., Wakimasu K., Yoneda K., Iliakis B., Sotozono C., Kinoshita S. A case of fungal keratitis and endophthalmitis post penetrating keratoplasty resulting from fungal contamination of the donor cornea. Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: Causative organisms and possible prevention strategies. eye pain that keeps getting worse after surgery, an injection or injury to the eye. [QxMD MEDLINE Link]. Noninfectious (sterile) endophthalmitis may result. Physicians should have high clinical suspicion of endophthalmitis in the setting of a known mechanism for fungal penetration into the bloodstream, irrespective of a history of immunosuppression [7]. Fungal Endophthalmitis: A Comprehensive Review - PMC Endophthalmitis - diagnosis, symptoms and treatments - MaculaCenter.com Ocular manifestations of candidemia. 0000008773 00000 n
Durand ML, Miller JW, Young LH, eds. Also, in contrast to exogenous endophthalmitis, endogenous endophthalmitis is more closely associated with distinct medical risk factors, namely those which increase the likelihood of systemic infection such as immunocompromising conditions and diabetes mellitus [9,10,11,12,13,14]. Xie L., Zhong W., Shi W., Sun S. Spectrum of fungal keratitis in north China. white or yellow pus or discharge from the eyes. Sallam et al. The purpose of this study is to investigate the application of polymorphonuclear cell counts and smears in the early diagnosis of infectious endophthalmitis. Limited reports exist on treatment of other etiologies of fungal endophthalmitis. and transmitted securely. Wu AY, Oestreicher JH. The time course for endogenous endophthalmitis may differ from exogenous endophthalmitis: Chakrabarti et al. Incidence of acute endophthalmitis following penetrating keratoplasty: A systematic review. 1Disease Entity 1.1Etiology and Risk Factors 1.1.1Endogenous fungal endophthalmitis 1.1.1.1Risk factors for endogenous fungal endophthalmitis 1.1.2Exogenous endophthalmitis 1.2Prevalence and Incidence 1.3Pathophysiology 2Diagnosis In a drug sensitivity test, 14 Gram-positive cocci were all sensitive to vancomycin. Ocular trauma predisposed to infection in 54.4% of eyes, consistent with the figure of 42.1% reported by Joseph et al. sharing sensitive information, make sure youre on a federal MeSH Alves da Costa Pertuiset P.A., Logrono J.F. 11 Laniado-Laborin R., Cabrales-Vargas M.N. Endogenous endophthalmitis in the Korean population: A six-year retrospective study. The physical examination revealed significant periorbital edema and erythema involving both the upper and lower eyelids. [QxMD MEDLINE Link]. Effect of vitrectomy on epiretinal membranes after endogenous fungal endophthalmitis. McCannel CA. Incidence of acute endophthalmitis following penetrating keratoplasty: a systematic review. Br J Ophthalmol. conducted a retrospective analysis of 81 patients who developed endophthalmitis following cataract surgery from 2000 to 2005 and searched for sonographic characteristics predictive of developing a future ocular infection. More Endophthalmitis is an uncommon infection of the eyeball. Narang et al. Wade R.L., Chaudhari P., Natoli J.L., Taylor R.J., Nathanson B.H., Horn D.L. A study by Keyhani et al. Though sample sizes were low, Schiedler et al. [QxMD MEDLINE Link]. reported a case of successful inflammatory resolution of Candida ciferri post-operative endophthalmitis using intravitreal capsofungin in the setting of C. ciferri resistance to fluconazole, voriconazole, and amphotericin B [97]. Edwards J.E., Jr., Foos R.Y., Montgomerie J.Z., Guze L.B. This is not the procedure for patients with solely orbital cellulitis, as those patients can be managed at the initial presenting facility. Cultures are taken of eye fluids, and antibiotics are given as soon as possible. Exogenous endophthalmitis was first described in 1933 by Rychener, who divided it into the categories of contiguous spread from an external ocular infection, penetrating trauma, and intraocular surgery [15]. Intravitreal injections can be repeated in recalcitrant cases after 72 h. With respect to efficacy, limited data exist comprehensively examining treatment modalities. Weishaar P.D., Flynn H.W., Jr., Murray T.G., Davis J.L., Barr C.C., Gross J.G., Mein C.E., McLean W.C., Jr., Killian J.H. All the specimens were sent to the microbiology laboratory immediately. Furthermore, laboratory testing was notable for leukocytosis to 16,000 with 85% neutrophils. FOIA Figure 1A, Copyright (2008) with permission from Elsevier. Despite these guidelines, it is plausible, however, to continue to screen non-communicative patients with candidemia. Use to remove results with certain terms Endophthalmitis: A Guide to Diagnosis and Management deals comprehensively on all aspects of endophthalmitis management-the clinical and applied clinical aspects including the microbiology of the infecting organisms, pharmacokinetics of drugs used in management, investigations into cluster infection, and prophylaxis. studied 250 cases of patients admitted to a single hospital with open globe injuries during a three-year period and found that the frequency of endophthalmitis was 6.8%. Endogenous bacterial endophthalmitis after routine colonoscopy. In the last decade, there has been a two-fold increase in deaths secondary to drug dependence [53]. Aspiration of vitreous fluid was cultured and grew Klebsiella Introduction Bleb related infections (BRI) are a common problem and will be encountered by both comprehensive ophthalmologists and glaucoma specialists alike. 2020 Apr;212:34-42. doi: 10.1016/j.ajo.2019.11.026. Endophthalmitis Vitrectomy Study Group. Endogenous endophthalmitis: diagnosis, management, and prognosis 13 2012. [QxMD MEDLINE Link]. reviewed 56,839 cases of endogenous endophthalmitis hospitalizations in the United States and found that 13.7% had a history of drug dependence or use. 0000027817 00000 n
[QxMD MEDLINE Link]. Hypopyon is an accumulation of white blood cells in the anterior chamber of the eye and corneal infiltrate associated with infectious endophthalmitis. encoded search term (Endophthalmitis) and Endophthalmitis, Fast Five Quiz: Inherited Retinal Diseases, Fast Five Quiz: Management of Inherited Retinal Diseases, Inherited Retinal Diseases: Early Signs and Advances in Treatment, Fast Five Quiz: Diagnosis of Inherited Retinal Diseases, Steroid Implants Best for Improving Vision in Uveitis ME, Eye Damage Affects 26% of Those With Diabetes in the US, Biosimilar Comparable to Aflibercept in Neovascular AMD, What the Eyes Tell You: 15 Abnormalities of the Lens. Wan L., Cheng J., Zhang J., Chen N., Gao Y., Xie L.X. Silva R.A., Sridhar J., Miller D., Wykoff C.C., Flynn H.W., Jr. Exogenous fungal endophthalmitis: An analysis of isolates and susceptibilities to antifungal agents over a 20-year period (19902010). Gram-negative bacilli were the main bacteria isolated from post-traumatic endophthalmitis patients, including 3 Pseudomonas aeruginosa, 1 Klebsiella pneumoniae, and 1 Morganella morganii. Cui PZ, Chong E, Campbell TG. [QxMD MEDLINE Link]. 0000014172 00000 n
Choroidal origin of endogenous. The positive rate between microbiologic cultures and smears were compared using the 2 test. Clin Exp Ophthalmol. The inflammation can extend to surrounding tissues responsible for vision. 13 Antibiotics may be injected into the eye, given by vein (intravenously), or both. [QxMD MEDLINE Link]. Endogenous endophthalmitis: Diagnosis, management, and prognosis. studied 5083 cases of infectious keratitis over a 16-year period and found fungal positivity in 61 (1.2%) cases; of these, C. albicans (47.5%) was the most common [39]. Regarding the causative pathogens, Long et al. performed a systematic review of endogenous Candida endophthalmitis cases and found that patients with chorioretinitis respond well to antifungal monotherapy, but in cases of vitreous involvement, drug penetration of amphotericin B is limited and pharmacologic management is insufficient [80]. Laboratory diagnosis of infectious endophthalmitis - PMC Bacterial and Fungal Endophthalmitis. Occult retention of lens cortex or nucleus; Non-infectious hypopyon uveitis (Behcet's or rifabutin) Infectious posterior uveitis (syphilitic, tuberculous, toxoplasmosis, toxocariasis in children) the contents by NLM or the National Institutes of Health. Clinically, raised lesions indicate compromise of the blood-retinal barrier, necessitating the delivery of medications directly into the vitreous cavity with intravitreal injections [7]. 8600 Rockville Pike This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (. The diagnosis of endophthalmitis has traditionally been made by vitreous humor culture and is commonly missed on initial presentation. Endophthalmitis caused by gram-negative organisms tends to be more virulent and has a worse prognosis. 25 0 obj
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Binder MI, Chua J, Kaiser PK, Procop GW, Isada CM. [QxMD MEDLINE Link]. No high-powered studies have examined the relative incidence of bacterial versus fungal etiologies in exogenous endophthalmitis overall; data are generally limited to subclassifications of exogenous endophthalmitis, such as an overwhelming majority of bacterial sources in acute post-cataract surgery endophthalmitis (approaching 100% in the United States and Europe [1,2,17]) and a fungal majority (approximately 50% Aspergillus and Fusarium species) in keratitis-related exogenous endophthalmitis [2]. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Vitreous exudates with no red reflex (grade 5) were comparable in cases of endogenous fungal endophthalmitis (50%) compared to postoperative (58.5%) fungal endophthalmitis but less common than in post-traumatic (85.4%) fungal endophthalmitis. Two images (Figures 1A and 1B) illustrate the globe view of the affected eye in multiple planes. 2017 Jul. Its cause and incidence vary geographically. Additional hyperechoic debris were also present in the lens of the eye (Figure1). We do not control or have responsibility for the content of any third-party site. Coats M.L., Peyman G.A. [QxMD MEDLINE Link]. Vaziri K, Schwartz SG, Kishor K, Flynn HW Jr. Endophthalmitis: state of the art. and Weishaar et al., suggesting that visual outcomes are worse in Aspergillus-mediated endogenous endophthalmitis. N/|Cp(J%m$+i~iBJ5;|3%6z-iAS-$Vs$UBVjd.R_xL(\FrWO>uFJv&@87_Qa2:'!FDV*A]%%G,qkN0xP:snO}e2_9fA
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<. pointed out in their review of pharmacologic agents for the treatment of Candida endophthalmitis that only five of these patients had vitritis [80]. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. 153 (3):391-398.e2. found mean latent periods of clinical presentation for postoperative and post-traumatic fungal endophthalmitis to be 20 and 7 days, respectively, whereas endogenous fungal endophthalmitis had a mean latent period of 30 days [51]. Low rate of endophthalmitis in a large series of open globe injuries. 2015 Jan. 122 (1):25-30. 8600 Rockville Pike Publishers Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Received 2010 Dec 22; Accepted 2011 Jan 31. laboratory diagnosis, infectious endophthalmitis, IOL-related inflammation. Available at https://www.escrs.org/media/uljgvpn1/english_2018_updated.pdf. From an epidemiological standpoint, the risks of fungal endophthalmitis secondary to intravitreal injection are low. Alfaro DV, Roth D, Liggett PE. Keay L, Gower EW, Cassard SD, Tielsch JM, Schein OD. (B) Fundus autofluorescence showing large area of hypoautofluoroescence in the fovea and multiple areas of scattered punctate hyperautofluoresence lesions in areas of early retinal pigment epithelium loss. An official website of the United States government. The underlying etiology of infectious endophthalmitis is typically bacterial or fungal. Viruses can also cause extensive eye infections, but these are not usually classified as endophthalmitis. Wykoff CC, Flynn HW Jr, Miller D, Scott IU, Alfonso EC. trailer
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(A, B) Globe view of the affected eye in multiple planes. Etiological agents of fungal endophthalmitis: diagnosis and management 0000015012 00000 n
2000 Feb. 30 (2):306-12. Tabandeh H., Boscia F., Sborgia A., Ciraci L., Dayani P., Mariotti C., Furino C., Flynn H.W., Jr. Endophthalmitis associated with intravitreal injections: Office-based setting and operating room setting. [Guideline] Barry P, Cordovs L, Gardner S. ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery: Data, Dilemmas and Conclusions 2013. The purpose of the current review is to provide a comprehensive updated literature about the diagnosis and management of fungal endophthalmitis. It can occur following eye surgery or trauma. 0000019969 00000 n
Careers. found in 2013 that dense vitreous opacities, marked vitreous membranes, retinal detachment and choroidal detachments demonstrated a statistically significant association with worse visual acuity. J Cataract Refract Surg. One study which examined infectious causes of endophthalmitis after PKP found that in cases of culture-positivity, 30.7% of cases were fungal, of which the Candida species were the most common [28]. However, azole resistance, mainly to fluconazole, is a growing problem in clinical isolates of Candida species, limiting their effectiveness [78,79]. Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System In their study of 56,839 cases of endogenous endophthalmitis, Mir et al. Bjerrum S.S., la Cour M. 59 eyes with endogenous endophthalmitisCauses, outcomes and mortality in a Danish population between 2000 and 2016. Kernt M., Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Daniel J Egan, MD Associate Attending Physician, Associate Residency Director, Department of Emergency Medicine, St Luke's Roosevelt Hospital Center; Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons Wykoff et al. Bleb-related Endophthalmitis: Clinical Presentation, Isolates, Treatment and Visual Outcome of Culture-proven Cases. The https:// ensures that you are connecting to the Am J Ophthalmol. Secondary complications to fungal endophthalmitis are of clinical importance. 0000017546 00000 n
As a consequence, endogenous fungal endophthalmitis often is preceded by choroiditis or chorioretinitis (infection localized to the choroid or the choroid and retina), with minimal inflammation in the . Eur J Ophthalmol. Exogenous endophthalmitis refers to a condition in which the infectious source is external to the eye. 10.1002/emp2.12802 As a result of the decreased visual acuity, discharge, and chemosis greatly limiting direct physical examination of the eye, a bedside ocular ultrasound was performed to assess for intraocular extension of the infection as well as retinal or vitreal detachment. Thompson G.R., 3rd, Lewis J.S., 2nd Pharmacology and clinical use of voriconazole. 2012 May. Role of intravitreal dexamethasone in exogenous fungal endophthalmitis. Also, the presence of a choroidal mass involving the retina and projecting into in the vitreous the context of endophthalmitis is highly suggestive of a fungal pathology. Fungal endophthalmitis is a diagnostic challenge, which requires a rigorous history and comprehensive ophthalmic examination. Danielescu et al. Though high-powered studies have not been conducted, limited reports suggest that prolonged corticosteroid use and protracted hospital courses during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, or COVID-19) pandemic may yield an increase in endogenous fungal endophthalmitis cases. [Microbiological and infectious disease aspects of postoperative endophthalmitis]. Intraocular sampling (AH and VF) was performed under absolute aseptic conditions. The intraocular fluid is an optimal medium for infections to brew insidiously, as it is minimally inhabited by inflammatory cells and cytokines that typically respond to infection. Topical tetracaine drops were administered in bilateral eyes for comfort during intraocular pressures, which were measured bilaterally and elevated in the left eye to 35mm Hg whereas right eye pressure was 15mm Hg. Thomas B.J., Mehta N., Yonekawa Y., Sridhar J., Kuriyan A.E., Relhan N., Liang M.C., Woodward M.A., Witkin A.J., Shah C., et al. and transmitted securely. National Library of Medicine Bleb Associated Infections - EyeWiki Endophthalmitis means bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humors. Endophthalmitis is a potential sight-threatening condition that leads to blindness. [QxMD MEDLINE Link]. 5 Computed tomography (CT) orbits demonstrated a rim enhancing collection that extended along the anterior left globe and an abscess (Figure2). [QxMD MEDLINE Link]. Joseph J., Sridhar M.S., Murthy S., Sharma S. Clinical and microbiological profile of microsporidial keratoconjunctivitis in southern India. POCUS study was notable for extensive, well demarcated, hyperechoic, mobile debris within the posterior chamber. 17 (3):148-52. [QxMD MEDLINE Link]. Am J Ophthalmol. Similarly, William et al. In a group of 53 cases of postcataract surgery fungal endophthalmitis, Chakrabarti et al. [QxMD MEDLINE Link]. In contrast, intraocular infections due to viruses or parasites (eg, cytomegalovirus [CMV] retinitis, toxoplasma chorioretinitis) are usually considered types of infectious uveitis rather than endophthalmitis. Cultures may be taken from the aqueous humor (fluid inside the front of the eye, also called the aqueous) and the vitreous humor (the jellylike substance that fills the back of the eyeball, also called the vitreous) to determine which organisms are causing the infection and which drugs are most active against them. Pt 5. Clin Ophthalmol. 0000028982 00000 n
145(5):883-8. This rapid report indicates the existence of pathogens and their basic characterization to clinical doctors, and provides information for choosing a suitable antibiotic and therapeutic regimen. That study also found worsening eye lesions in the fluconazole arm. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNzk5NDMxLWRpZmZlcmVudGlhbA==. Multivariate analysis revealed risk factors for the development of fungal endophthalmitis to be topical steroid use (odds ratio [OR] = 6.35), previous corneal laceration suturing (OR = 5.05), large corneal ulcer size (OR = 4.43), hypopyon (OR = 11.05), and aphakia (OR = 15.45). In terms of efficacy, Dave et al. Durand M.L. Bethesda, MD 20894, Web Policies Faghihi H, Hajizadeh F, Esfahani MR, et al. 216 (3):124-125. Retina. The infectious endophthalmitis patients included 23 cases with postoperative endophthalmitis and 13 cases with post-traumatic endophthalmitis. Enter search terms to find related medical topics, multimedia and more. Bouza E, Cobo-Soriano R, Rodrguez-Crixems M, Muoz P, Surez-Leoz M, Corts C. A prospective search for ocular lesions in hospitalized patients with significant bacteremia. Peripheral fungal lesions may be asymptomatic and discovered with patients referral for ocular consultation based on positive blood culture or diagnosis of systemic fungal infection. Furthermore, the incidence of endogenous endophthalmitis associated with drug dependence or use has increased from 0.08 per 100,000 people in 2003 to 0.32 per 100,000 people in 2016 [53]. Of note, Sallam et al. Endogenous Endophthalmitis: yield of the diagnostic evaluation However, Wykoff et al. Spectrum of fungal keratitis in central China. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Endogenous endophthalmitis: 10-year experience at a tertiary referral centre. A hypopyon and anterior chamber fungal infiltrates are seen in the setting of a multifocal, feathery-edged corneal infiltrate. Inclusion in an NLM database does not imply endorsement of, or agreement with, Eur J Clin Microbiol Infect Dis. Importantly, early lesions may be flat in the choroid but progress by protruding into the vitreous cavity and may lead to the appearance of intravitreal puff ball abscesses [7]. This has led to absence of level 1 evidence to guide treatment. Anand et al. Due to an increased amount of blood flow directed to the choroidal space and ciliary body, endogenous endophthalmitis primarily affects these areas of the eye, beginning with the choroid and then progressing to secondary impact on the retina and vitreous spaces [4,48]. Photograph demonstrating Fusarium oxysporum endophthalmitis which developed 27 days after minor trauma with organic matter to the right eye. Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. and transmitted securely. Received 2021 Oct 5; Accepted 2021 Nov 15. In these cases, systemic regimen should be combined with intravitreal injection of amphotericin 510 g/0.1 mL or voriconazole 100 g/0.1 mL [86]. 2021 Mar;118(3):230-234. doi: 10.1007/s00347-020-01287-z. Endophthalmitis is a serious vision-threatening condition, and knowledge of its diagnosis, clinical presentation, and management is essential for both ophthalmologists and physicians dealing with infectious disease. Clin Infect Dis. Surgery may be needed to remove infected tissue from inside the eye, which may improve the chances of stopping the infection. Fukuoka T., Johnston D.A., Winslow C.A., de Groot M.J., Burt C., Hitchcock C.A., Filler S.G. Genetic basis for differential activities of fluconazole and voriconazole against. reported that, in their group of 12 patients with endogenous fungal endophthalmitis, 5 patients (41.7%) had uncontrolled diabetes and 2 (16.7%) had a history of intravenous drug use [52]. As a direct result of the POCUS findings, it was recognized early in the workup that the patient would likely require intravitreal antibiotics for endophthalmitis in addition to intravenous antibiotics. Before [QxMD MEDLINE Link]. An understanding of the physiochemical properties of these antifungals clarifies drug penetration. The most common clinical manifestation of fungal endophthalmitis is vision loss, but other signs of inflammation and infection are frequently present. the contents by NLM or the National Institutes of Health. Dave VP, Pathengay A, Schwartz SG, Flynn HW Jr. Endophthalmitis following pars plana vitrectomy: a literature review of incidence, causative organisms, and treatment outcomes. 1989 Dec. 96(12):1722-6. In the only randomized, prospective trial we found on our review comparing fluconazole and amphotericin B, Rex et al.