Candida dubliniensis endophthalmitis: five cases over 15 years

Abstract

BackgroundRecent studies have shown that the recently identified organism Candida dubliniensis is less pathogenic than the more common Candida albicans. Due to its rare nature, C. dubliniensis has been previously reported as the causative organism in endophthalmitis in only three cases. We undertook a multicenter, retrospective, consecutive case series to describe the clinical features and outcomes of patients with culture-proven C. dubliniensis endophthalmitis. Medical records were reviewed for all patients with C. dubliniensis endophthalmitis on vitreous/aqueous cultures from June 1998 to June 2013 from all public hospitals throughout Queensland, Australia.ResultsSix eyes from five patients were identified - four males and one female aged from 21 to 55 years (mean 37 years). Four patients were intravenous drug users and four patients had hepatitis C. All five patients were treated with systemic antifungal therapy and intravitreal antifungal injections, and all required vitrectomy. Two eyes developed retinal detachment over the course of the endophthalmitis. Five eyes had visual outcomes of 20/60 or better, and one eye had a poor outcome with final visual acuity of hand movements only. There was no associated mortality, and no infected eyes required enucleation or evisceration.ConclusionsC. dubliniensis endophthalmitis is a rare condition which occurs mainly in intravenous drug users and can occur in both HIV-positive and HIV-negative patients. Unlike C. albicans endophthalmitis, C. dubliniensis endophthalmitis has reasonable visual outcomes and does not appear to be associated with high mortality.

Candida dubliniensis: A novel cause of fungal keratitis

“…in their study of the role of calcineurin in C. dubliniensis virulence actually created a mouse model of fungal keratitis where they demonstrated that C. albicans could cause infection in immunocompetent mouse corneas while C. dubliniensis could not and could only cause infection in the corneas of immunocompromised mice [ 12 ]. This is further supported by case series of endogenous endophthalmitis where visual outcomes have been shown to be better with C. dubliniensis as compared to C. albicans [ 5 ].…”

“…In the ophthalmology literature, C. dubliniensis was first described as a cause of fungal dacryocystitis [ 13 ] but has more recently been described as an emerging cause of endophthalmitis [ [2] , [3] , [4] , [5] , [6] , [7] ]. It has specifically been linked to several cases of endogenous endophthalmitis in IV drug users [ [3] , [4] , [5] , [6] ]. In fact, one such case was recently identified and treated at our institution by our retina colleagues.…”

“…The purpose of this case report is to describe a case of infectious keratitis due to Candida dubliniensis . This organism has been described most frequently in the ophthalmologic literature as a cause of endophthalmitis [ [2] , [3] , [4] , [5] , [6] , [7] ], but this is the first reported case of fungal keratitis to our knowledge.…”

Circumferential iris lesions in a male with cirrhosis caused by Candida dublinensis endophthalmitis

“…C. albicans has been the predominant species isolated and C. dubliniensis is a rare cause [5]. C. dublinensis had been generally considered less virulent than C. albicans as it is susceptible to environmental stressors and produces less hyphae in-vitro than C. albicans [6,7]. Disputing this are increasing reports on infections caused by C. dubliniensis that have hypothesized increased neutrophil migration, phagocytosis, cytokine release and ineffective interleukin-17A production by peripheral blood mononuclear cells as possible reasons [4,8].…”

“…Early diagnosis and rapid aggressive antifungal therapy are important to reduce ocular complications such as blindness. Diagnosis is often based on clinical findings documented by dilated eye exam and work up should be directed to identify the source [1,2,6]. The intraocular inflammation in fungal endophthalmitis tends to occur in “clumps” within the aqueous and/or vitreous (Fig.…”