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Kristine K. Yin, Benjamin M. Levine; Ocular involvement among inpatients with fungemia: Analysis from a New York City tertiary care center. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1682.
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Fungal dissemination can lead to ocular infections in the form of chorioreitinitis and endophthalmitis, and is a common reason for ophthalmic consultation in hospitalized patients. Early studies have estimated the prevalence of ocular involvement at up to 45%.1 We sought to evaluate the current prevalence, microbial profile, and risk factors of fungal ocular disease among patients with positive fungal cultures at a tertiary care medical center in New York City.
All consultation requests to evaluate for ocular involvement by fungal organisms at New York Presbyterian Hospital-Weill Cornell Medical Center from July 8, 2008 to November 7, 2011 were retrospectively reviewed. Ophthalmic examination, including indirect ophthalmoscopy, was performed by residents and confirmed by attending ophthalmologists.
132 patients (14 pediatric, 118 adult) had consult requests indicating concern for ocular fungal disease in the setting of positive fungal cultures. 57% of patients were male, and 43% were female. Age ranged from 27 days to 95 years, with mean age of 53 years. All patients had at least one positive fungal culture; 120 (90.9%) had at least one positive blood culture. The most commonly identified organisms were Candida albicans (40%), Candida glabrata (26%), Candida parapsilosis (14%), Candida tropicalis (6%), Candida krusei (2%), Candida lusitaniae (1%), and Candida dubliniensis (1%). In addition, Aspergillus fumigatus, Histoplasma capsulatum, Trichosporon mucoides, and Rhodutula species were found. All patients were receiving systemic antifungal therapy at time of examination. Risk factors for fungal infection included: malignancy, immunosuppression, indwelling catheters, treatment in an intensive care unit, recent surgery, and parental nutrition. All patients had at least one risk factor, with the most common being malignancy. 5 adult and no pediatric patients (3.8%) had retinal findings consistent with fungal chorioretintis (4 cases) or endophthalmitis (1 case). Among these, one patient verbalized visual symptoms of new floaters. All patients improved with systemic antifungal therapy, and did not require intravitreal treatment. 39 patients had nonspecific findings inconsistent with fungal chorioretinitis and endophthalmitis. Visual symptoms were rare (4.0%) among patients with negative findings.
Ocular involvement seems to occur infrequently in hospitalized patients with systemic fungal disease in the current era of widespread prophylactic antifungal therapy. Prospective and controlled studies may help to determine a specific subset of patients with fungemia that require routine ophthalmic screening. Chen JY. Acta Paediatr Jpn 1994;36:261-5.
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