Endogenous Endophthalmitis Associated With Intravenous Drug Abuse

Connell, Paul; O'Neill, Evelyn C; Islam, Amirul; Buttery, Robert; McCombe, Mark; Essex, Rohan W.; Roufail, Edward; Lash, Stephen; Wolffe, Bernard; Clark, Ben; Chiu, Daniel T.; Campbell, William; Allen, Penelope J

doi:10.1097/iae.0b013e3181dd6db6

Cited by 41 publications

(20 citation statements)

References 21 publications

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“…The clinical diagnosis of endogenous fungal endophthalmitis has been well described in previous case series and case reports [1,6,14,15]. While there have been descriptions of the differences between patients with yeast infection and patients with mold infection, no large head-to-head statistical comparisons of culture-proven cases have been previously reported [16].…”

Section: Discussionmentioning

confidence: 97%

Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections

Sridhar

Flynn

Kuriyan

et al. 2013

J Ophthal Inflamm Infect

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BackgroundThe purpose of the current study was to analyze risk factors, clinical features, and treatment outcomes in patients with endogenous fungal endophthalmitis with yeast and mold infections. For this retrospective consecutive case series, microbiologic and clinical records were reviewed to identify all patients with intraocular culture-proven endogenous fungal endophthalmitis treated at a single institution between January 1, 1990 and December 31, 2011.ResultsSixty-seven eyes of 53 patients were identified; 51 eyes of 39 patients had positive cultures for yeast and 16 eyes of 14 patients had positive cultures for molds. Patients with molds as a causative organism had significantly shorter duration of symptoms prior to diagnosis (molds 3.8 days, yeast 21.0 days, p = 0.002), were more likely to be receiving iatrogenic immunosuppression (molds 57.1%, yeast 7.7%, p = 0.001), have a history of whole-organ transplantation (molds 35.7%, yeast 2.6%, p = 0.001), and were more likely to have hypopyon at the time of diagnosis (molds 37.5%, yeast 6.0%, p = 0.001). Patients with endogenous endophthalmitis caused by molds had significantly worse visual acuity at the time of diagnosis (logMAR visual acuity molds 1.80, yeast 1.15, p = 0.008) and at final visit (logMAR visual acuity molds 1.97, yeast 1.05, p = 0.005) compared to those patients with yeast as a causative organism. There was no significant difference in the rate of retinal detachment between the two groups (mold 12.5%, yeast 30.6%, p = 0.201). Patients with cultures positive for mold were significantly more likely to undergo enucleation (molds 25.0%, yeast 0%, p < 0.001).ConclusionsSystemic risk factors for patients with endogenous fungal endophthalmitis caused by molds were iatrogenic immunosuppression and a history of whole-organ transplantation. Shorter duration of symptoms before diagnosis and higher rates of hypopyon occurred in mold cases. While endogenous fungal endophthalmitis is generally associated with poor visual acuity outcomes, infection with mold species was associated with worse visual acuity on presentation and on final follow-up than infection with yeast species. Enucleation rates were much higher in mold cases.

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Section: Discussionmentioning

confidence: 97%

Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections

Sridhar

Flynn

Kuriyan

et al. 2013

J Ophthal Inflamm Infect

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“…The most common cause of endogenous endophthalmitis in drug abusers is fungal [7]. Though we could not culture organisms from any of the samples, the rapidity of onset and progression favoured a bacterial etiology.…”

Section: Resultsmentioning

confidence: 99%

Intralesional antibiotic injection using 41G needle for the management of subretinal abscess in endogenous endophthalmitis

et al. 2016

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BackgroundPresence of subretinal abscess in endogenous endophthalmitis indicates a more severe form of infection. Available reports indicate variable response to standard treatment with systemic, intravitreal pharmacotherapy and vitreous surgery. There are no reports citing the possible role of intralesional antibiotic therapy in managing subretinal abscess.Case presentationA 30 year old lady presented with features of endogenous endophthalmitis and subretinal abscess. Presenting vision was finger counting close to face. Despite prompt initiation of systemic antibiotics and intravitreal injection, no response was noted. 25G pars plana vitrectomy was performed along with injection of vancomycin directly into the subretinal abscess, using a 41G needle. Postoperative course was uneventful and the abscess showed signs of rapid resolution. Visual acuity improved to 6/24.ConclusionIntralesional pharmacotherapy may be safe and effective in the treatment of subretinal abscess associated with endogenous endophthalmitis.

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“…Furthermore, the causative agent is identified in only 46% to 68.4% of patients. 2 Finally, as illustrated in our case series, treatment may be delayed due to postponement in seeking care, initial misdiagnoses, refusal or inability to follow through with treatment in a timely manner. Therefore, careful examination and high clinical suspicion are imperative to mitigate any delay in treatment.…”

mentioning

confidence: 83%

“…1 Intravenous drug users (IVDU) are a high-risk group for developing endogenous fungal endophthalmitis (EFE), with Candida albicans being the most commonly identified causative organism. 2 EFE is a potentially blinding disease in which the causative organism reaches the eye through hematogenous dissemination. The frequency of chorioretinitis and endophthalmitis in patients with documented fungemia ranges from 2–26% and 0–6%, respectively.…”

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confidence: 99%

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Retinal Neovascularization and Endogenous Fungal Endophthalmitis in Intravenous Drug Users

et al. 2014

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Endogenous Endophthalmitis Associated With Intravenous Drug Abuse

Abstract: Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

Cited by 41 publications

References 21 publications

Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections

Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections

Intralesional antibiotic injection using 41G needle for the management of subretinal abscess in endogenous endophthalmitis

Retinal Neovascularization and Endogenous Fungal Endophthalmitis in Intravenous Drug Users

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