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1.
Turk J Ophthalmol ; 49(5): 294-296, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650813

RESUMO

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.


Assuntos
Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/terapia , Endoftalmite/terapia , Infecções Oculares Fúngicas/terapia , Litotripsia/efeitos adversos , Vitrectomia/métodos , Adulto , Candida albicans/genética , Candidíase/etiologia , Candidíase/microbiologia , DNA Fúngico/análise , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Tomografia por Emissão de Pósitrons , Cálculos Ureterais/terapia , Acuidade Visual
2.
Indian J Ophthalmol ; 67(9): 1483-1484, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436207

RESUMO

A 43-year-old male presented with left eye foveal retinits causing an acute visual loss following influenza virus type A infection (H1N1 infection or Swine flu). Considering viral (influenza) etiology, a prompt treatment with oral corticosteroids was started. But an initial poor response prompted an immediate diagnostic vitrectomy, which revealed Candida albicans. The retinitis healed with scar formation following anti-fungal therapy. This case highlights that even in the setting of an acute retinitis in an immunocompetent patient with recent history of viral systemic illness, a high index of suspicion of a fungal (rather than viral) infection should be kept in mind.


Assuntos
Antifúngicos/uso terapêutico , Infecções Oculares Fúngicas/etiologia , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Retina/patologia , Retinite/etiologia , Vitrectomia/métodos , Adulto , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Retinite/diagnóstico , Retinite/terapia , Tomografia de Coerência Óptica
3.
Ophthalmol Retina ; 3(2): 133-139, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31014761

RESUMO

PURPOSE: To report the 5-year outcome of an outbreak of Bipolaris hawaiiensis fungal endophthalmitis caused by contamination of intravitreal triamcinolone from Franck's Compounding Pharmacy in Ocala, Florida. DESIGN: Retrospective case series. PARTICIPANTS: Twenty-three patients (n = 25 eyes). METHODS: Data was collected from the practice of a single retina specialist in Los Angeles (K.W.S) and a retina practice in New York City. Intravitreal injections of triamcinolone obtained from a single lot were subsequently found to be contaminated with Bipolaris hawaiiensis. MAIN OUTCOME MEASURES: Visual acuity; presence of vitreous cells, anterior chamber cells, or both; and detection of fungi or fungal elements in samples obtained by vitreous needle aspiration or vitreous biopsy. RESULTS: Fungal endophthalmitis developed in 92% (23/25) of eyes. Despite aggressive local and systemic long-term therapy, severe visual loss resulted in the majority of treated eyes and the enucleated eyes showed evidence of hyphae. CONCLUSIONS: These reported cases of Bipolaris hawaiiensis endophthalmitis provide important messages for clinicians and regulatory agencies. First, patients treated with high-dose, long-term, orally administered voriconazole appeared to achieve better outcomes in treatment of Bipolaris endophthalmitis. Second, treated eyes may still show signs of deterioration, indicating the potential survival of causative organisms or fibrosis encapsulating the ciliary body, leading to hypotony. Third, several parallels can be drawn between this outbreak and the fungal meningitis outbreak after Exserohilum rostratum contamination of methylprednisolone by the New England Compounding Center.


Assuntos
Contaminação de Medicamentos , Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Injeções Intravítreas/efeitos adversos , Triancinolona Acetonida/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Composição de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
4.
Klin Monbl Augenheilkd ; 236(4): 358-365, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30616287

RESUMO

BACKGROUND: Infectious keratitis is a serious corneal disease and may lead to permanent visual deterioration if not treated rapidly and effectively. In order to determine possible changes in the spectrum of pathogens over time, we evaluated the pathogenic organisms of keratitis at a university hospital in Switzerland, comparing two time periods within a decade. METHODS: In this retrospective study, 417 patients with the clinical diagnosis of bacterial or fungal keratitis in 2006/07 and 2015/16 were enrolled. In an additional analysis, all cases of fungal keratitis between 2006 and 2016 were evaluated. Collected parameters were age, gender, side, use of contact lenses, systemic, neurological and ocular diseases, trauma, previous surgery, and systemic and topical therapy before presentation. In each patient, microbiological results of corneal smears such as growth and antibiotic resistance were analysed. RESULTS: A total of 163 and 254 eyes were included in 2006/07 and 2015/16, respectively. In 2006/07, a culture of smears revealed a bacterial cause in 70 eyes (42.9%) and a fungal cause in 4 eyes (2.5%), whereas in 2015/16, bacterial growth was found in 115 eyes (45.3%) and fungal growth in 6 eyes (2.4%). The most common bacteria in 2006/07 and 2015/16 were coagulase-negative Staphylococci (44.3 vs. 49.6%), Pseudomonas aeruginosa (18.6 vs. 13.9%), Staphylococcus aureus (10 vs. 16.5%), Corynebacterium spp. (8.6 vs. 5.2%), and Moraxella spp. (7.1 vs. 9.6%). Candida parapsilosis was the most common fungal isolate in both groups (25 vs. 33.3%). Between 2006 and 2016, fungal keratitis was found in 37 eyes (Candida spp. n = 11, Fusarium spp. n = 11, Aspergillus spp. n = 5, others n = 10). All patients with Fusarium spp. keratitis had a history of wearing contact lenses. CONCLUSION: The most commonly isolated bacterial organisms were Staphylococci and Pseudomonas spp., whereas fungal keratitis was mainly due to Candida spp. or Fusarium spp. No relevant variation in causative pathogens was observed between the two time periods.


Assuntos
Infecções Oculares Fúngicas , Ceratite , Bactérias , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/terapia , Hospitais Universitários , Humanos , Ceratite/diagnóstico , Ceratite/etiologia , Ceratite/terapia , Estudos Retrospectivos , Suíça
5.
Int Ophthalmol ; 39(6): 1299-1305, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29752592

RESUMO

PURPOSE: To study the incidence of endophthalmitis after pars plana vitrectomy, its causative organisms, and visual acuity outcomes. PATIENTS AND METHODS: In this retrospective, comparative study, the medical records of patients with acute-onset postoperative endophthalmitis after pars plana vitrectomy at Farabi Eye Hospital, Tehran, Iran, during a 12-year period between January 2004 and November 2015 were reviewed. To compare the endophthalmitis patients with other cases who underwent pars plana vitrectomy at the same day and also the same operating room, a control group was developed by gathering the data from surgical records. RESULTS: In the present study, the incidence rate of pos- vitrectomy endophthalmitis was 0.04% (16/39783). The organisms identified in aqueous or vitreous cultures (culture positive 44%) included Streptococcus pneumoniae (two patients, 12.5%), Pseudomonas aeruginosa (two patients, 12.5%), fungi (two patients, 12.5%), and Streptococcus viridans (one patient, 6.25%). Visual acuity after treatment for endophthalmitis ranged from light perception (7 eyes) to hand motion (1 eye), and evisceration was performed in 8 eyes (50%). When comparing the cases (patients developing endophthalmitis) and controls (patients with no complications operated in the same day and place of operation with the case group), only not using tamponade showed a statistically significant relation with the occurrence of endophthalmitis (p = 0.034). CONCLUSION: Our results indicated low incidence of endophthalmitis after pars plana vitrectomy comparable to previous studies which resulted in poor visual acuity. It seems that not using tamponade might increase the risk of endophthalmitis among these patients.


Assuntos
Endoftalmite/epidemiologia , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Fúngicas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Vitrectomia/efeitos adversos , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Adulto Jovem
6.
Ocul Immunol Inflamm ; 27(2): 251-256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29040009

RESUMO

PURPOSE: To illustrate the rate of endogenous endophthalmitis associated with fungemia and evaluate the importance of screening in a public city hospital. METHODS: A retrospective review was performed on all inpatient ophthalmology consults for fungemia from 2010 to 2015. Clinical histories, ocular examinations, and microbial cultures were reviewed. RESULTS: Of 95 patients (mean age 51.6 years, 75% male) with fungemia, 9/95 (9.5%) demonstrated intraocular involvement. Of these nine patients, two were unable to participate in the ophthalmic exam due to intubation, while the remaining seven reported no changes in their vision. Two patients had their antifungal medications adjusted to optimize intraocular penetration and one patient progressed to develop vitreous involvement but died before further escalation of care occurred. CONCLUSION: All involved individuals in this study were either non-communicative or without visual complaints. This suggests that routine screening should still be recommended, especially in a public hospital setting.


Assuntos
Candida/isolamento & purificação , Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Fungemia/complicações , Encaminhamento e Consulta , Centros de Atenção Terciária/estatística & dados numéricos , População Urbana , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Endoftalmite/epidemiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Seguimentos , Fungemia/microbiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
7.
Ocul Immunol Inflamm ; 27(5): 747-755, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29993300

RESUMO

Purpose: To summarize the characteristics of endogenous fungal endophthalmitis (EFE) after genitourinary procedures. Methods: Medical records of patients diagnosed with EFE after genitourinary procedures from a single center during a 6-year period were reviewed. Results: Nineteen eyes of 15 patients were included. The interval time between procedure to symptom was 3.6 ± 3.6 weeks. As the initial treatment, 9/19 eyes underwent primary vitrectomy and 10/19 eyes underwent intravitreal antifungal injection . Candida albicans was the pathogen in 15 of 19 eyes. Systemic treatment with itraconazole was used in all patients. LogMAR best corrected visual acuity improved from 2.2 ± 0.9 to 0.9 ± 1.2 after treatment (p = 0.002) in 15 eyes that were followed-up for an average of 4.9 ± 2.1 years. Conclusion: Genitourinary procedure is a predisposing factor for EFE. Candida albicans is the predominant pathogen. Normative systemic and local antifungal treatments improved the final visual outcome.


Assuntos
Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Doenças Urogenitais Femininas/cirurgia , Doenças Urogenitais Masculinas/cirurgia , Adulto , Idoso , Antifúngicos/uso terapêutico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
BMC Infect Dis ; 18(1): 671, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563477

RESUMO

BACKGROUND: This study reports a case of Unilateral Endogenous Fungal Endophthalmitis After Esophageal Cancer Surgery. CASE PRESENTATION: One patient presented with a month-long loss of vision in his left eye, he had surgery for esophageal cancer 2 months earlier. The patient underwent cataract surgery (by phacoemulsification) in the left eye combined with 25-gauge vitrectomy and silicone oil tamponade. The microbiological culture pointed to infection with Candida albicans. At 3-month follow-up, the unaided visual acuity of left eye was 0.02 and corrected visual acuity was 0.2. In addition, there was no recurrence of the endophthalmitis within 1 year of the surgery. CONCLUSION: The early diagnosis of endogenous fungal endophthalmitis is difficult, and the disease is very likely to be misdiagnosed as uveitis. It is therefore critical to improve awareness of this condition and to reduce the incidence of its misdiagnosis.


Assuntos
Candidíase/etiologia , Endoftalmite/etiologia , Neoplasias Esofágicas/cirurgia , Infecções Oculares Fúngicas/etiologia , Complicações Pós-Operatórias/patologia , Candida albicans/isolamento & purificação , Candidíase/patologia , Endoftalmite/microbiologia , Endoftalmite/patologia , Infecções Oculares Fúngicas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Visão Monocular , Acuidade Visual , Vitrectomia
9.
Indian J Pathol Microbiol ; 61(4): 607-609, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30303164

RESUMO

The fungus Purpureocillium lilacinum previously known as Paceliomyces lilacinus is an emerging pathogen that can cause severe human infections including devastating oculomycosis. Treatment with traditional antifungals often fails, and the organism shows variable susceptibility to novel triazoles. We hereby report a case of keratomycosis caused by Pur. lilacinum in an immunocompetent male patient following trauma. The patient was successfully treated with voriconazole. The drug shows good activity against Pur. lilacinum and could be a promising therapeutic alternative to treat infections caused by this fungus, which generally shows resistance to conventional antifungal agents including novel triazoles.


Assuntos
Infecções Oculares Fúngicas/etiologia , Paecilomyces/isolamento & purificação , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Paecilomyces/efeitos dos fármacos , Voriconazol/uso terapêutico
10.
Cornea ; 37(12): 1555-1560, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30234680

RESUMO

PURPOSE: Microbial keratitis (MK) is a major cause of corneal blindness worldwide. Variations in season and temperature can affect MK incidence due to specific causative organisms; however, few studies have examined these factors in the UK. METHODS: Retrospective review of all corneal scrapes from patients with MK presenting to Manchester Royal Eye Hospital, UK, between January 2004 and December 2015. Manchester's monthly temperature data were obtained from Met Office UK. Analysis was performed using logistic regression. RESULTS: From 4229 corneal scrapes, 1539 organisms grew (90.6% bacteria, 7.1% fungi, and 2.3% Acanthamoebae sp.). Gram-positive bacteria grew with increasing temperature [odds ratio (OR) 1.62, 95% CI: 1.11-2.39, P = 0.014], and fungi grew with decreasing temperature (OR 0.29, 95% CI: 0.16-0.51, P < 0.001). Moraxella sp. grew with decreasing temperature (OR 0.91, 95% CI: 0.86-0.96, P = 0.001). Compared with winter, overall culture positivity was significantly less likely in summer (OR 0.57, 95% CI: 0.38-0.87, P = 0.008) and spring (OR 0.65, 95% CI: 0.43-0.99, P = 0.045). Gram-negative bacteria were more likely in summer (OR 1.48, 95% CI: 1.06-2.09, P = 0.022) and autumn (OR 1.75, 95% CI: 1.24-2.47, P = 0.001). Candida sp. were less likely in summer (OR 0.25, 95% CI: 0.07-0.82, P = 0.027) and autumn (OR 0.18, 95% CI: 0.05-0.62, P = 0.009), and Acanthamoeba sp. were less likely in summer (OR 0.39, 95% CI: 0.15-0.92, P = 0.037) and spring (OR 0.26, 95% CI: 0.08-0.69, P = 0.011). CONCLUSIONS: Herein we report variation in the incidence of MK-causing organisms by season and temperature; this finding may aid clinicians in predicting possible causative organisms for MK at differing times of the year.


Assuntos
Córnea/microbiologia , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Fúngicas/epidemiologia , Previsões , Ceratite/epidemiologia , Estações do Ano , Temperatura , Bactérias/isolamento & purificação , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Seguimentos , Fungos/isolamento & purificação , Humanos , Incidência , Ceratite/etiologia , Ceratite/microbiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia
11.
Cornea ; 37(11): 1366-1369, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30157050

RESUMO

PURPOSE: To evaluate the incidence, clinical course, and management of fungal interface keratitis (IK) after Descemet membrane endothelial keratoplasty (DMEK). METHODS: This is a single-center retrospective observational case series of 3950 eyes undergoing DMEK. Six eyes with fungal IK were detected and analyzed. Analysis included graft storage condition, incidence of fungal IK, identification of the pathogenic agent, topical/systemic and surgical treatment regimen, and best-corrected visual acuity. RESULTS: Fungal IK after DMEK occurred in 6 of 3950 cases (0.15%). Corneal grafts were either stored in Optisol-GS (n = 4) or in organ culture (n = 2). In all cases, Candida species were isolated (Candida tropicalis, Candida albicans, Candida orthopsilosis, and Candida guilliermondii). Four eyes developed fungal IK during the early postoperative period (3-5 d) and 2 eyes later at 16 to 42 days after surgery. All patients received topical and systemic antifungal treatment and intracameral application of antifungal agents. In the case of an early infection, graft removal was performed in 3 of 4 patients. Late infections were eradicated without graft exchange. Recurrence of fungal infection was observed in 1 case after early IK and in both cases after late IK. Final visual acuity ranged from 20/200 to 20/20. CONCLUSIONS: Fungal IK is a rare complication after DMEK. Based on our experience, we believe that treatment of early fungal IK with aggressive presentation should include both immediate graft exchange and intracameral application of voriconazole and amphotericin, in addition to topical and systemic antifungal treatment. Graft exchange seems not to be mandatory in late infections.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Infecções Oculares Fúngicas/epidemiologia , Ceratite/epidemiologia , Ceratite/microbiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Lâmina Limitante Posterior/cirurgia , Epitélio Posterior/transplante , Infecções Oculares Fúngicas/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
12.
Infection ; 46(5): 635-640, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29959658

RESUMO

PURPOSE: Endogenous fungal endophthalmitis (EFE) is a severe consequence of candidemia. The prevalence of, and risk factors for, EFE is not well studied. METHODS: We retrospectively collected cases of patients with candidemia who had undergone ophthalmological examination between April 2011 and March 2016 in five regional hospitals. We conducted bivariate and multivariate analyses using patients' age, gender, causative Candida species, diabetes status, corticosteroid use, cancer status, neutropenia, intensive care unit admission, presence of central venous catheter (CVC), presence of shock, prior antibiotic use, 30-day mortality, and highest Sequential Organ Failure Assessment (SOFA) score. Data on sustained positive blood culture, ß-D glucan, CVC removal, empirical antifungal drug used, and time to appropriate antifungal therapy were also collected if available. RESULTS: Of 174 patients with candidemia, 35 (20.1%) were diagnosed with EFE, including 31 (17.8%) with chorioretinitis and 4 (2.3%) with vitritis. Bivariate analysis (EFE group vs. non-EFE group) found that Candida albicans candidemia (77.1 vs. 34.5%, P < 0.001), neutropenia (14.3 vs. 5.8%, P = 0.141), CVC placement (94.3 vs. 71.2%, P = 0.004), and the presence of shock (28.6 vs. 16.5%, P = 0.145) were each higher in the EFE group. Multivariate logistic regression analysis found C. albicans candidemia (adjusted odds ratio 6.48; [95% CI 2.63-15.95]) and CVC placement (7.55 [1.56-36.53]) to be significant risk factors for EFE. CONCLUSIONS: Candida albicans is the most common causative agent for Candida EFE. Patients with candidemia and CVC placement should be closely monitored by ophthalmologists.


Assuntos
Candidemia/complicações , Candidemia/epidemiologia , Endoftalmite/epidemiologia , Endoftalmite/etiologia , Idoso , Candida , Comorbidade , Endoftalmite/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
13.
Zhonghua Yan Ke Za Zhi ; 54(6): 432-436, 2018 Jun 11.
Artigo em Chinês | MEDLINE | ID: mdl-29895117

RESUMO

Objective: To analyze the etiology, drug susceptibility and etiological changes of fungal keratitis so as to to provide reference for clinical diagnosis and treatment. Methods: Retrospective case series study. A total of 5 654 copies of specimens for fungal culture were collected from Outpatients suspected of fungal keratitis in Beijing Tongren Ophthalmic Center during January 2007 and December 2016. Specimens were inoculated on Potato dextrose agar (PDA) slant medium, incubated at 30℃ and 40% humidity constantly for 3 to 10 days. Filamentous fungi isolated from positive cultures were identified according to morphological traits. Yeast-like fungi were identified by API 20 C Aux. Drug susceptibility tests were performed by using ROSCO disk diffusion method, which included natamycin, terbinafine, itraconazole, fluconazole, amphotericin B, voriconazole. The Chi-square test and Spearman correlation analysis were performed using SPSS 20.0 software. Results: The positive rate of culture was 26.1%. In positive patients, the ratio of male to female was 1.77∶1, and the age range was 11 days to 95 years. The mean age was 49.0±16.9 years. Among isolated fungi, Fusarium sp. was the most common genus, accounting for 53.5% (789 strains) , followed by 17.5% of Aspergillus sp. (259 stains) and 13.8% of Alternaria sp. (203 stains). The sensitive rate of natamycin was 92.3% (410 strains) , followed by that of terbinafine as 78.5% (1 093 strains), voriconazole as 41.0% (338 strains), amphotericin B as 40.7% (553 strains). Conclusion: The predominant patients of fungal keratitis are adult and male. Fusarium sp., Aspergillus sp., and Alternaria sp. are three common species in northern china with seasonal changes in their proportion. Natamycin should be the preferred drug for empirical treatment. The preferred empirical treatment for Aspergillus sp. is terbinafine. Fluconazole should not be used alone due to the high resistant rate. (Chin J Ophthalmol, 2018, 54: 432-436).


Assuntos
Antifúngicos , Infecções Oculares Fúngicas , Adulto , Idoso , Antifúngicos/uso terapêutico , Criança , China , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/etiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Rev Iberoam Micol ; 35(2): 92-96, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29724456

RESUMO

BACKGROUND: Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. AIMS: The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. METHODS: Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. RESULTS: Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. CONCLUSIONS: It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection.


Assuntos
Lesões da Córnea/complicações , Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Fusariose/etiologia , Infecção dos Ferimentos/microbiologia , Idoso , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Coinfecção/microbiologia , Terapia Combinada , Lentes de Contato Hidrofílicas , Lesões da Córnea/microbiologia , Farmacorresistência Fúngica Múltipla , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Endoftalmite/cirurgia , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/cirurgia , Feminino , Fusariose/tratamento farmacológico , Fusariose/microbiologia , Fusarium/isolamento & purificação , Humanos , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Técnicas de Tipagem Micológica , Especificidade da Espécie , Infecções Estafilocócicas/microbiologia , Falha de Tratamento , Infecção dos Ferimentos/tratamento farmacológico
16.
Zhonghua Yan Ke Za Zhi ; 54(4): 270-276, 2018 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-29747356

RESUMO

Objective: To evaluate the efficacy of vitrectomy and etiological diagnosis in the treatment of fungal endophthalmitis. Methods: A retrospective survey was done on the clinical manifestation, etiological diagnosis and treatment efficacy of 15 patients (15 eyes) who had been diagnosed with fungal endophthalmitis at the inpatient department of Peking Union Medical College Hospital during 2002-2015. A total of 15 eyes of 15 patients, 3 male and 12 female patients, were included in this study. The mean age of the patients was (45.8±15.3) years. Among the 15 eyes, 12 (12 patients) were diagnosed with endogenous fungal endophthalmitis and 3 (3 patients) were diagnosed with exogenous fungal endophthalmitis. Fourteen eyes have been misdiagnosed with uveitis, systematic or local application of glucocorticoid and/or immunosuppressor have been conducted on the patients which resulted in exacerbation. Baseline visual acuity: light perception in 2 eyes, hand movement for 12 eyes, and 1 eye of 0.1. Six eyes showed slight inflammatory reaction in anterior chamber, four eyes showed moderate inflammatory reaction in anterior chamber, while five eyes showed severe inflammatory reaction with hypopyon in anterior chamber. B-Scan ultrasound examination showed inflammatory vitreous opacity in all 15 eyes, combined proliferative vitreoretinopathy (PVR) were found in 11 eyes, retinal detachment were found in 10 eyes, which include 6 cases of tractional retinal detachment, 1 case of exudative retinal detachment, and 3 cases of retinal and choroid detachment. Forty eyes underwent vitrectomy, 1 eye underwent intravitreal injection. Nine eyes were processed with silicone oil tamponade, one eye was processed with C(3)F(8) tamponade. At the beginning of the operation, vitreous fluids were collected for preparing smears which were later used for fungus culture and drug susceptibility testing. Results: According to the smear results of vitreous fluid, fungal hyphae and spores were found in 10 eyes. The fungus culture indicated positive results in 12 eyes, including candida albicans in 6 eyes, fusarium, candida parapsilosis, paecilomyces lilacinus, asoergullus terreus, mulan candida and aspergillus in 1 eye respectively. Based on etiological diagnosis, 14 eyes received amphotericin B intraocular injection during operation, and 9 patients received fluconazole (venous transfusion or oral administration), 2 patients received voriconazole through venous transfusion or oral administration, one patient received itraconazole through oral administration. All 15 eyes received local application of amphotericin B eyedrop or fluconazole eyedrop. The intraocular inflammations in all 15 eyes were mitigated. The visual acuity improved in 6 eyes, remained unchanged in 4 eyes, and reduced in 5 eyes. Postoperative visual acuity achieved 0.1 to 0.15 in 2 eyes, 0.01 to 0.04 in 2 eyes, CF in 2 eyes, HM in 4 eyes, LP in 2 eyes, and NLP in 3 eyes. The retina of 5 eyes remained in position, the retina of 2 eyes reattached, the retina of 2 eyes failed to reattach. Recurrent retinal detachment happened in the other 6 eyes, 5 of which received reoperation. Eventually, the retina of 10 eyes reattached, and the retina of the 5 eyes failed to reattach. Conclusions: Vitrectomy is an effective method for treatment of fungal endophthalmitis. The positive rates of vitreous smear and fungus culture were really high. Application of sensitive anti-fungal drugs based on etiological diagnose can improve therapeutic level. (Chin J Ophthalmol, 2018, 54: 270-276).


Assuntos
Endoftalmite , Infecções Oculares Fúngicas , Fungos , Adulto , Endoftalmite/etiologia , Endoftalmite/cirurgia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/cirurgia , Feminino , Fungos/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitrectomia
17.
Cornea ; 37(9): 1204-1211, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29781928

RESUMO

PURPOSE: To examine the management and associated outcomes of reported cases of interface fungal infection after Descemet stripping automated endothelial keratoplasty (EK). METHODS: A literature review identified reports of interface fungal infection after Descemet stripping automated EK. Data retrieved from the same included patient demographics, surgical procedure undertaken, donor rim culture result, clinical course, and outcome. A review of the relevant literature was also conducted. RESULTS: Twenty-four cases of interface fungal infection after Descemet stripping automated EK were analyzed. Mean age of those affected was 66 years with range 52 to 85 years. Interface fungal infection after Descemet stripping automated EK was noted at a mean of 49.2 days postoperatively. Candida species were the causative infection in 79% cases. Penetrating keratoplasty was eventually performed in 79% of cases. The mean posttreatment best-corrected visual acuity was 0.44 logMAR. CONCLUSIONS: Penetrating keratoplasty is frequently required to eliminate interface fungal infection after Descemet stripping automated EK. A satisfactory visual outcome is usually achieved.


Assuntos
Substância Própria/patologia , Úlcera da Córnea/etiologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Infecções Oculares Fúngicas/etiologia , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/terapia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos
18.
Cornea ; 37(4): 515-518, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29303885

RESUMO

PURPOSE: To report 2 cases with late postoperative Candida albicans interface keratitis and endophthalmitis after Descemet stripping automated endothelial keratoplasty (DSAEK) with corneal grafts originating from a single donor with a history of presumed pulmonary candidiasis. METHODS: Two patients underwent uncomplicated DSAEK by 2 corneal surgeons at different surgery centers but with tissue from the same donor and were referred to the Bascom Palmer Eye Institute with multifocal infiltrates at the graft-host cornea interface 6 to 8 weeks later, and anterior chamber cultures that were positive for the same genetic strain of C. albicans. Immediate explantation of DSAEK lenticules and daily intracameral and instrastromal voriconazole and amphotericin injections failed to control the infection. Thus, both patients underwent therapeutic penetrating keratoplasty with intraocular lens explantation, pars plana vitrectomy, and serial postoperative intraocular antifungal injection. RESULTS: Both patients are doing well at 2 years postoperatively with best-corrected vision of 20/20 and 20/30+ with rigid gas permeable lenses. One patient required repeat optical penetrating keratoplasty and glaucoma tube implantation 1 year after the original surgery. Literature review reveals that donor lenticule explantation and intraocular antifungals are often inadequate to control fungal interface keratitis, and a therapeutic graft is commonly needed. CONCLUSIONS: Interface fungal keratitis and endophthalmitis due to infected donor corneal tissue is difficult to treat, and both recipients of grafts originating from the same donor are at risk of developing this challenging condition.


Assuntos
Candidíase/etiologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/etiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Doadores de Tecidos
19.
Am J Ophthalmol ; 187: xx-xxvii, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29217351

RESUMO

PURPOSE: To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. DESIGN: A perspective on relevant topics in the prophylaxis and management of endophthalmitis. METHODS: This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. RESULTS: The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post-cataract surgery, and other anterior segment-related (eg, post-penetrating keratoplasty), bleb-associated, glaucoma drainage device-associated, and open globe injury-associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. CONCLUSIONS: Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.


Assuntos
Endoftalmite/etiologia , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Fúngicas/etiologia , Anti-Infecciosos/uso terapêutico , Extração de Catarata/efeitos adversos , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Fúngicas/tratamento farmacológico , Traumatismos Oculares/complicações , Implantes para Drenagem de Glaucoma/efeitos adversos , Humanos , Injeções Intravítreas/efeitos adversos , Fatores de Risco , Vitrectomia/efeitos adversos
20.
Int Ophthalmol ; 38(5): 2211-2217, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28900769

RESUMO

PURPOSE: To report for the first time a case of interface Scopulariopsis gracilis fungal keratitis following Descemet's stripping automated endothelial keratoplasty (DSAEK) with a contaminated graft. METHODS: A 57-year-old man with bilateral keratoconus and previous bilateral penetrating keratoplasties (PK) developed graft failure in association with marked corneal ectasia. He underwent a successful DSAEK. Unfortunately, a contaminated graft was transplanted and the following morning we were contacted by the eye bank to inform us a slow-growing fungus had been detected in the culture plates inoculated with dextran solution used to store the issued corneoscleral button. Immediate patient review revealed four infiltrates in the interface between the donor and the recipient tissue. The patient returned to theatre for the removal of the infected graft and was successfully treated with topical amphotericin 0.15%, voriconazole 1% and oral voriconazole and later oral itraconazole. Two intracameral injections of 5 µg in 0.1 ml of amphotericin B were also performed. RESULTS: A reference laboratory cultured and identified the fungus as Scopulariopsis gracilis species. The patient responded to treatment and eventually achieved a spectacle-corrected logMAR visual acuity of 0.3 following a delayed PK. CONCLUSION: Scopulariopsis gracilis fungal keratitis is a rare infection, and the species can be difficult to eradicate. This is the first case report of an infection secondary to a contaminated graft with the species, and we report its successful treatment with an excellent visual outcome.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Epitélio Posterior/transplante , Infecções Oculares Fúngicas/etiologia , Ceratite/etiologia , Micoses/etiologia , Scopulariopsis/isolamento & purificação , Infecção da Ferida Cirúrgica/etiologia , Epitélio Posterior/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Sobrevivência de Enxerto , Humanos , Ceratite/diagnóstico , Ceratite/microbiologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Doadores de Tecidos
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