Fungal endophthalmitis caused by Paecilomyces variotii following cataract surgery: a presumed operating room air‐conditioning system contamination

Abstract

ABSTRACT.Purpose: To report a case of delayed fungal endophthalmitis by Paecilomyces variotii following uncomplicated cataract surgery. To our knowledge this is the first reported case of postoperative endophthalmitis by this species. Methods: We report the longterm clinical follow-up of an 83-year-old female who underwent uncomplicated sutureless, small-incision cataract surgery. She developed recurring uveitis 4 months after surgery. Vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens were performed. Fungi were studied by histopathology and culture. Results: At histopathological examination, the fungi were found to be closely related with the capsular bag. A few mononuclear inflammatory cells were encountered. At culture, Paecilomyces variotii, a common ubiquitous non-pathogenic saprophyte, was identified. Despite systemic, intravitreal and topical antifungal therapy after vitrectomy the uveitis recurred several times, but no fungal organisms were isolated from the repeat intraocular specimen. At 18 months postoperatively the subject's visual acuity was finger counting at 2 metres. At the time of surgery the operating room air-conditioning system was undergoing repairs. Cases of fungal endophthalmitis after contamination from air-conditioning ventilation systems have been reported before, but none of the cases reported have been caused by P. variotii. Conclusion: P. variotii, a non-pathogenic environmental saprophyte, may be disastrous if introduced into the eye. International recommendations on the environmental control of the operating room air-conditioning ventilation system should be strictly followed. No intraoperative surgery should be undertaken while the air-conditioning system is undergoing repairs or service.

Bacterial and fungal endophthalmitis in Upper Egypt: related species and risk factors

“…Postoperative fungal infection may be caused by discharge of spores from contaminated air conditioning units. The findings of many authors are in agreement with our findings where the filters of such units may be act as a nidus for the growth of fungi [9,25,26] . In this respect, and a trial to solve that problem originating from air fungal spores, the frequent change of air filters is very necessary to reduce airborne spores of Aspergillus species.…”

Fungal contamination of air conditioning units in operating theatres in India

“…A case of fungal endophthalmitis due to a presumably contaminated AC unit has been reported recently from Finland. 13 The rate of fungal isolation was highest at the initial evaluation. At that time, none of the hospitals were following a maintenance programme for AC units.…”

Identification ofPaecilomyces variotiiin Clinical Samples and Settings

“…Immunosuppression is the critical risk factor for infection; and cases of pneumonia (7), sinusitis (13,34,50), endophthalmitis (25,49), otitis media (12), wound infection in a transplant recipient (26), cutaneous hyalohyphomycoses (3,29), onychomycosis (2), osteomyelitis in a patient with granulomatous disorder (10), and dialysis-related peritonitis (38) have all been reported to be caused by this fungus. This species can be considered extremotolerant and is able to grow at high temperatures, on decaying wood, and on creosote treated wooden utility poles (E. de Meyere et al, unpublished data).…”