Candida endophthalmitis in heroin addicts

Hogeweg, M; Jong, P.T.V.M. de

doi:10.1007/bf00140463

Cited by 24 publications

(4 citation statements)

References 19 publications

(20 reference statements)

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“…In severe cases the systemic antimycotics can be combined with vitrectomy and intraocular antimycotics. Early diagnosis and treatment give the best results (Hogeweg & Jong 1983).…”

Section: Discussionmentioning

confidence: 99%

Endogenous Candida endophthalmitis

Håskjold¹,

Lippe²

1987

Acta Ophthalmologica

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Two cases of endogenous endophthalmitis as a complication to spontaneous abortion, truly caused by candida albicans are presented. One patient received no antimycotic treatment. Endophthalmitis resulted in amaurosis in the affected eye, which had to be enucleated. The second patient was treated with intravenously administered amphotericin B and flucytocine, and was cured. The importance of early diagnosis and treatment is stressed.

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“…In severe cases the systemic antimycotics can be combined with vitrectomy and intraocular antimycotics. Early diagnosis and treatment give the best results (Hogeweg & Jong 1983).…”

Section: Discussionmentioning

confidence: 99%

Endogenous Candida endophthalmitis

Håskjold¹,

Lippe²

1987

Acta Ophthalmologica

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“…Aetiological pathogens in these reports include Fusarium [188,191], Acremonium [188,[191][192][193], Aspergillus [188] and Candida [188,[193][194][195][196][197][198][199]. Doses utilised ranged from 5 to 10 µg at one time.…”

Section: Intravitreous Injectionmentioning

confidence: 99%

“…In addition to intravitreous therapy, various other local and systemic therapies have also been utilised concurrently, including intravenous amphotericin B [191,192], topical natamycin [191], oral flucytosine and ketoconazole [193,195] and fluconazole [191,192,194]. Intravitreal injections have been most successfully utilised in conjunction with surgery [193,[195][196][197][198][199].…”

Section: Intravitreous Injectionmentioning

confidence: 99%

Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.

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“…Patients have been successfully treated with: systemic antifungal therapy alone 7,16,17 intravitreal amphotericin B alone 15,18,19,20 , or vitrectomy with or without intravitreal amphotericin B and with or without systemic antifungal agents [21][22][23] .…”

Section: Treatment Of Endogenous Fungal Endophthalmitismentioning

confidence: 99%

The eye in systemic sepsis

2002

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-Metastatic or endogenous endophthalmitis (EE) is a serious consequence of systemic sepsis. It is defined as intraocular infection resulting from haematogenous spread of organisms in which the initial focus of infection is at a site distal to the eye. A red/sore eye in a patient with a known septic focus needs urgent attention as EE can be a major cause of visual loss. Early diagnosis and treatment are associated with better visual outcome. This article focuses on the two main causes of EE, namely bacterial and fungal infections, and also briefly mentions dissemination of cytomegalovirus to the eye in immunocompromised patients. Although conscious patients may notice an ocular problem, unconscious or very sick patients may not; vigilance by medical staff in looking for early signs of this is extremely important.KEY WORDS: candida, ciprofloxacin, cytomegalovirus (CMV), endophthalmitis, floaters, hypopyon, red eye, retinal infiltrates, retinitis, septicaemia Endogenous fungal endophthalmitisFungal sepsis is identified most frequently in hospitalised patients who are seriously ill. Endogenous fungal endophthalmitis (EFE) occurs in 28-45% of patients with candidaemia 1,2,3 and is the most common form of endogenous endophthalmitis (EE) 4 . Patients usually present with floaters and decreased vision, unilateral or bilateral. Onset is often insidious; in its early stages EFE can be asymptomatic 2 , but if left untreated can have devastating consequences for visual function. Therefore, regular screening of high risk cases is undertaken in many centres 5,6 . High risk characteristics include those listed in Table 1. CandidiasisCandida albicans is the most common pathogen causing EFE and in some series is the causative agent in 85-99% of all cases 6,9 . Non-albicans candida spp are important as aetiological agents 10 because fungaemia with these species is associated with a higher incidence of endophthalmitis than with C. albicans 11 . Other causes of EFE in descending order of importance are Aspergillus fumigatus, cocciodioides, cryptococcus, fusarium, histoplasmosis and paecilomyces 4 .Diagnosis of ocular candidiasis. The clinical diagnosis of ocular candidiasis is largely made on the ocular appearance 8 . The organism typically causes inflammation in the choroid and retina, with subsequent spread into the vitreous cavity 8 . The ophthalmoscopic appearance is of one or more creamy-white, usually round and sometimes elevated retinal lesions, often sited in the posterior pole of the eye (Fig 1). They may vary in size from small pinpoint lesions to two-disc diameter in width 8 . If the vitreous is involved, multiple clumps may form ('puff balls') (Fig 2). Thread-like strands may connect these, producing a so-called 'string of pearls' appearance. Ocular lesions can indicate otherwise occult deep tissue fungal infection and are useful indicators of systemic candidiasis 12,13 . Although autopsy studies have demonstrated a high incidence (78%) of ocular involvement in patients with candidaemia 12 , the eye can be the ...

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Candida endophthalmitis in heroin addicts

Cited by 24 publications

References 19 publications

Endogenous Candida endophthalmitis

Endogenous Candida endophthalmitis

Novel modes of antifungal drug administration

The eye in systemic sepsis

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