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Jill Zaveri, Joseph A Santamaria, Jack A Cohen, Kamaljit Singh; Evaluation of Endophthalmitis in Patients with Candidemia. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4170.
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The Infectious Disease Society of America recommends a dilated fundus examination to screen for ocular candidiasis in all patients with candidemia. Our aim was to establish the incidence of candida endophthalmitis or chorioretinitis diagnosed via ophthalmology consultation in our institution. Further review also elucidated which patients had evidence of acute ocular symptoms, the ability to verbalize symptoms, the type of systemic antifungal treatment at the time of consultation, and the species of candida being treated.
All inpatients with candidemia confirmed by positive blood or catheter culture from June 2011 to June 2013 were retrospectively reviewed to reveal those that required an ophthalmology consultation to screen for ocular candidasis via dilated fundus examination.
Candidemia was confirmed by blood or catheter cultures in 110 patients. Cultures were positive for C. albicans in 49 patients (44.5%), C. tropicalis in 9 patients (8.2%), C. parapsilosis in 17 patients (15%), C. glabrata in 24 patients (15.4%), C. krusei in 1 patient (1%), C. kefyr in 1 patient (1%), and C. lusitaniae in 1 patient (1%). The remaining 8 patients had cultures positive for multiple Candida species (7.2%). An opthalmology consult was obtained for 76 patients. One patient received 2 consults for the growth of different Candida species on different dates, resulting in 77 total ophthalmology consults. All 77 patients were receiving systemic fluconazole or caspofungin at the time of examination. During exam, 56 patients (73%) were able to verbalize if they had acute visual symptoms. None had acute visual symptoms in this review. The remaining 21 patients were unable to communicate effectively due to intubation or altered mental status. Of the 77 consultations for the evaluation of ocular candidiasis, zero patients had candida endophthalmitis or chorioretinitis (0%).
The current incidence of ocular involvement of patients with candidemia is rare. A systematic approach for consultation in patients with candidemia is necessary. Due to the decreasing incidence of candida endophthalmitis, a prospective study is unlikely to reveal statistically significant risk factors for ocular involvement in these patients. Instead, a retrospective review of patients with endogenous candida endophthalmitis is needed to elucidate risk factors which would aid in creating guidelines for ophthalmology consultation in patients with candidemia.
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