Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Treatments

Khambati, Alisha; Wright, Robert E.; Das, Susmita; Pasula, Shirisha; Sepúlveda, Alejandro; Hernandez, Francis; Kanwar, Mamta; Chandrasekar, Pranatharthi H.; Kumar, Ashok

doi:10.3390/jof8070656

Cited by 7 publications

(8 citation statements)

References 150 publications

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“…The combination of these factors adds to the visual loss in FE cases. In this retrospective study, the presence of corneal infiltrate, which was noted in 54 (58.70%) eyes, was significantly associated with a poorer visual outcome, which was consistent with the findings of other studies [ 16 , 23 ].…”

Section: Discussionsupporting

confidence: 92%

“…Currently, there is no Level One evidence to guide FE management [ 1 ], and published data are limited in their spectrum of fungal species and disease management, particularly in China [ 13 , 14 , 15 ]. However, due to its overlapping clinical signs and symptoms with other endophthalmitis patterns and time-consuming etiological diagnosis, FE poses a challenge for its treatment [ 16 , 17 ]. This study aimed to understand the clinical characteristics of FE over a decade at a tertiary referral center in Shanghai, China, to help clinicians understand changes in the clinical presentation and disease management of FE cases.…”

Section: Introductionmentioning

confidence: 99%

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Fungal Endophthalmitis: Clinical Characteristics, Pathogens, and Factors Affecting Visual Outcome

Li,

Chen,

Zhang

et al. 2024

Antibiotics

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Aims: The aims of this study are to investigate the etiology, microbiological spectrum, and risk factors associated with visual outcomes of fungal endophthalmitis (FE) in a tertiary eye specialty hospital in Shanghai, China. Methods: This was a retrospective, single-center case series. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. Logistic regression was used to analyze the factors related to visual outcomes. Results: This study involved 102 eyes of 92 patients with FE, including 63 males (66.3%). The mean age was 44.4 ± 19.8 years. The most common etiology of FE was trauma (56.5%). The predominant fungal species isolated were Aspergillus spp. (31/93, 33.3%). Pars plana vitrectomy (PPV) and intravitreal antifungal agents was performed initially in 86 (84.3%) and 83 (81.4%) eyes, respectively. Only 35 (34.3%) eyes achieved final best corrected visual acuity (BCVA) of 20/400 or better. Ten (9.8%) eyes had a final BCVA of light perception or worse, and five (4.9%) had to be enucleated. The factors determining better visual outcomes included initial visual acuity better than finger-counting (FC) (odds ratio (OR) 5.811, p = 0.036), the absence of corneal infiltrate (OR 10.131, p = 0.002), and Candida species infection (OR 6.325, p = 0.011). Conclusions: Early diagnosis of FE and a timely vitrectomy, combined with an intravitreal injection of an antifungal drug, can mitigate the devastating results of intraocular fungal infection. Not being infected by Aspergillus spp., an initial BCVA that was no worse than FC, and the absence of corneal involvement were related to better visual prognosis.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Fungal Endophthalmitis: Clinical Characteristics, Pathogens, and Factors Affecting Visual Outcome

Li,

Chen,

Zhang

et al. 2024

Antibiotics

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“…Exogenous endophthalmitis usually occurs after trauma, intraocular surgery, or following corneal infections. Endophthalmitis without an antecedent intraocular surgery or trauma is termed endogenous and is largely associated with an immunocompromised state such as that induced by HIV infection, malignancy, following long-term immunosuppressive treatment, and is due to hematogenous dissemination from a systemic focus of infection [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Common fungi include Candida spp, Aspergillus spp., and Mucormycosis spp. Aspergillus is a highly prevalent saprophyte fungus, with infections commonly involving the lungs and sinuses [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Endogenous Intraocular Aspergillus Infection Associated With Systemic Vasculitis

Mehta¹,

Soni²

2023

Cureus

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We report the systemic, ocular, and investigational findings of a 51-year-old male patient with large-vessel vasculitis and presumed ocular Aspergillus infection. He presented with persistent fever with left-sided weakness of the upper and lower limb for the past 15 days accompanied by profound visual loss in the left eye. A neurological examination revealed a left-sided ataxic hemiparesis with a significant reduction of power in both upper and lower limbs with dysarthria. He underwent neuroimaging which revealed a fresh non-hemorrhagic infarct in the left thalamocapsular and left parieto-occipital regions, suggestive of a stroke. A positron emission tomography/computed tomography scan revealed a diffuse low-grade uptake (standardized uptake value = 3.6) associated with a circumferential wall thickening involving the ascending aorta, arch of the aorta, and descending and abdominal aorta, suggestive of active large-vessel vasculitis. On examination, his visual acuity was 6/9 unaided in the right eye and perception of light with inaccurate projection in the left. A dilated fundus examination revealed multiple hemorrhages, cotton-wool spots, and areas of retinal thickening associated with a hard exudate in the right eye. A similar picture was seen in the left eye with the additional findings of a large (1 DD x 1 DD) subretinal whitish-yellowish mass with surrounding superficial retinal hemorrhages in the superior quadrant. A B-scan through the subretinal revealed non-visualization of the retinal pigment epithelium-Bruchs membrane layer with a large subretinal mass with a basal hyporeflective area and hyperreflective areas superiorly, suggesting a choroidal Aspergillus infection with infiltration of the overlying retina but without vitreous seeding. He was treated with antiepileptics, oral and injectable blood thinners, oral antihypertensives, and oral antidiabetic medication. Intravenous methylprednisolone 1 g once daily was administered for five days, followed by oral prednisolone in tapering doses. In view of the ocular findings and the presumed diagnosis of ocular aspergillus, oral voriconazole 400 mg daily was added. At the last follow-up, the subretinal mass had completely resolved with a residual area of pigmentary degeneration with loss of retinal layer differentiation on the B-scan. There was also a marked reduction in the hemorrhages and cotton-wool spots in either eye, suggesting a marked improvement of the retinal vasculitis. A larger dataset would be needed to confirm a potential causative role for systemic fungal infections in large-vessel vasculitis.

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“…In terms of the etiology of the disease, bacterial and fungal endophthalmitis are distinguished [ 3 , 4 , 5 ]. Bacterial endophthalmitis, caused by Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus, Enterococcus, and Gram-negative bacilli, is the most common [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Thermosensitive Intravitreal In Situ Implant of Cefuroxime Based on Poloxamer 407 and Hyaluronic Acid

Bakhrushina,

Dubova,

Nikonenko

et al. 2023

Gels

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The main method of treatment and prevention of endophthalmitis is a combination of intravitreal and topical administration of antibiotics, such as cefuroxime moxifloxacin or vancomycin. However, this method is ineffective due to the rapid elimination of the drug. This problem can be solved with the help of intravitreal in situ injection systems, which are injected with a syringe into the vitreous body and provide prolonged action of the drug at the focus of inflammation. Under the influence of temperature, the liquid drug undergoes a phase transition and turns into a gel after injection. This ensures its prolonged action. The study aimed to develop an intravitreal in situ cefuroxime delivery system for the treatment of endophthalmitis based on a thermosensitive biodegradable composition of poloxamer 407 and hyaluronic acid. A combination of poloxamer Kolliphor® P407, Kolliphor® P188, and PrincipHYAL® hyaluronic acids of different molecular weights was used as a delivery system. The potency of cefuroxime solid dispersion with polyvinylpyrrolidone-10000, polyethylene glycol-400, and polyethylene glycol-1500 in a 1:2 ratio was studied for prolonged action compared to cefuroxime substance. The experimental formulations were studied for the parameters of gelation temperature in a long-term test (4 months), pH, and release of cefuroxime using dialysis bags. To study the distribution parameter in the vitreous body, an in vitro model (1/13) was developed, which was a hollow agar sphere filled with 1% (w/v) polyacrylate gel. For the superior formulations, a HET-CAM test (chorioallantoic membrane test) was performed to determine the absence of irritant effects. According to the study results, a formulation containing a solid dispersion of cefuroxime:PEG-400 (1:2), the matrix of which contained 18% (w/v) Kolliphor® P407 poloxamer, 3% (w/v) Kolliphor® P188 poloxamer, and 0.5% (w/v) hyaluronic acid (1400–1800), was selected. This sample had an average gelation temperature of 34.6 °C, pH 6.7 ± 0.5, and a pronounced prolonged effect. Only 7.6% was released in 3 h of the experiment, whereas about 38% of cefuroxime was released in 72 h. No irritant effect on the chorioallantoic membrane was observed for any formulations studied.

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Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Treatments

Cited by 7 publications

References 150 publications

Fungal Endophthalmitis: Clinical Characteristics, Pathogens, and Factors Affecting Visual Outcome

Fungal Endophthalmitis: Clinical Characteristics, Pathogens, and Factors Affecting Visual Outcome

Endogenous Intraocular Aspergillus Infection Associated With Systemic Vasculitis

Thermosensitive Intravitreal In Situ Implant of Cefuroxime Based on Poloxamer 407 and Hyaluronic Acid

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