Endogenous filamentous fungal endophthalmitis - single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

Abstract

Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.

Fungal endophthalmitis associated with compounded products

“…Infections among case-patients were characterized by poor outcomes, including vision loss, as has been described for fungal endophthalmitis (5,9,10). Prolonged time to diagnosis probably contributed to these poor outcomes; diagnostic delay might be explained by the rarity of fungal endophthalmitis and the resulting unfamiliarity of some physicians with this diagnosis, the subacute nature of early infection, or the difficulty of distinguishing true infection from the occasionally observed postprocedural sterile inflammation (19).…”

“…Most infections are bacterial; fungal infections are rare (5)(6)(7). The clinical course of fungal endophthalmitis is frequently prolonged and is associated with poor outcomes; vision loss is not uncommon (5,(8)(9)(10). We describe 2 concurrent multistate outbreaks of fungal endophthalmitis associated with intraocular use of contaminated products labeled as sterile from a single compounding pharmacy.…”

Absence of Intraocular Infections after Hematopoietic Stem Cell Transplantation at a Single Center: The Experience with Current Preventive Regimens

“…From a recently conducted literature study such filamentous fungi have been related to poor vision outcomes and low survival rate. 18 Previously, McKelvie et al described 2 patients with disseminated post-SCT Scedosporium sp. endophthalmitis and fungemia, nonresponsive to antifungal therapy with amphotericin B and fluconazole, that resulted in death.…”

<p>Diagnostic and Management Strategies of Aspergillus Endophthalmitis: Current Insights</p>

“…3 Fungal endophthalmitis accounts for 8.6% to 18.6% of culture-positive cases and has increased over the last 20 years, probably because of a larger amount of immunodepressed individuals. [4][5][6] Aspergillus accounts for 56% to 74% of all cases of fungal endophthalmitis after cataract surgery. 4,7 The rate varies between 4% and 14% of fungal endophthalmitis following bulbar trauma.…”