ProlongedCurvularia EndophthalmitisDue to Organism Sequestration

Abstract

urvularia is a dematiaceous or darkly pigmented fungus. Endophthalmitis due to Curvularia species is exceedingly rare, with only isolated case reports in the literature. [1][2][3][4][5][6] Large series of endogenous and exogenous fungal endophthalmitis in the United States do not mention Curvularia as a separate causative organism. [7][8][9][10] The present series of 6 cases of Curvularia endophthalmitis demonstrates the difficulty of timely and proper diagnosis and challenges in the eradication of the microorganism. MethodsAn institutional review board-approved retrospective review of the archives of the microbiology laboratory at Bascom Palmer Eye Institute from January 1, 1980, through September 30, 2013, identified all cultures positive for Curvularia. The substrate (blood agar, chocolate agar, Sabouraud agar, Lowenstein-Jensen agar, or thioglycolate broth) on which Curvularia grew IMPORTANCE Endophthalmitis caused by Curvularia is a rare condition seen after cataract surgery and trauma. The clinical course has not been described previously.OBJECTIVE To examine the clinical course of 6 postoperative and trauma-related cases of Curvularia endophthalmitis. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series. We reviewed the archives of the microbiology laboratory of Bascom Palmer Eye Institute, a tertiary referral hospital, from January 1, 1980, through September 30, 2013, to identify cases of Curvularia endophthalmitis. Data collected included demographic information, the cause of endophthalmitis, presenting features, treatment course, the number of recurrences, the area of organism sequestration, and final visual outcome. EXPOSURES Trauma and cataract surgery.MAIN OUTCOMES AND MEASURES Times from the inciting event to presentation of symptoms, diagnosis, and eradication; visual acuity; and identification of the area of sequestration. RESULTSWe identified 6 patients with Curvularia endophthalmitis, including 5 who underwent cataract surgery and 1 after trauma. The diagnosis was established rapidly in the trauma case. In the postoperative cases, the time from the surgery to first symptoms ranged from 2 to 5 months; from the surgery to correct diagnosis, 7 to 24 months; and from the surgery to eradication, 8 to 27 months. Despite aggressive antifungal therapy, eradication of the infection could be achieved only by identification and removal of the nidus of sequestration. The median follow-up was 29.5 months. CONCLUSIONS AND RELEVANCEIn cases of endophthalmitis caused by Curvularia, the diagnosis and treatment are often delayed, especially in postoperative cases. The eradication of the organism requires identification and removal of the nidi of sequestration.

Delayed fungal endophthalmitis secondary to Curvularia

“…This may be related to its delayed-onset, or lack of knowledge about the typical clinical presentations of this condition due to its rarity. However, in the previous cases of Curvularia -associated endophthalmitis, PCO or posterior capsular plaque was described in 4 out of 8 patients who had an inciting event of cataract surgery [8] , [10] . In our case, the PCO was also seen and may be an important sign to identify, or at least suspect, a diagnosis of endophthalmitis related to Curvularia .…”

“…To date, there are only eleven reported cases of endophthalmitis secondary to Curvularia. [6] , [7] , [8] , [9] , [10] Among those cases, eight patients had a preceding history of cataract surgery [6] , [8] , [9] , [10] , while four had a previous history of trauma [7] , [9] , [10] . Our case is unique due to its delayed and recalcitrant course.…”

“…Among all the cases with a preceding history of cataract surgery, the interval between surgery and initial symptom was between 1 and 5 months [6] , [8] , [9] , [10] . In our case, the interval from surgery to initial symptom was three years, an unusually delayed-onset postoperative endophthalmitis associated with Curvularia .…”

Curvularia lunata causing orbital cellulitis in a diabetic patient: An old fungus in a new territory

“…In addition, there is an increasing number of endophthalmitis and sinusitis cases caused by dematiaceous fungi. Curvularia has been reported in diabetic patients in recent studies; however, the case reports are very few in number [2][3][4]13]. Increasing reports of dematiaceous fungi in immunocompromised individuals emphasize the importance of early and prompt diagnosis of such cases since the treatment for each group (i.e., dematiaceous and aseptate fungi) is entirely different.…”

“…Curvularia lunata has been reported as the etiological agent of keratomycosis, sinusitis, onychomycosis, eumycetoma, pneumonia, endocarditis, dialysis-associated peritonitis, cerebral abscess, and disseminated fungal infections. This species has also been reported to account for ocular infections, such as conjunctivitis, dacryocystitis, and endophthalmitis [1][2][3][4].…”