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Megan Nichols, Sina Vahedi, Murtaza Khuzema Adam, Robert E Fintelmann, Jeremy D Keenan, Sunir Garg, Jason Hsu, Marc Spirn; Inpatient Ophthalmology Consultation for Fungemia: Prevalence of Ocular Involvement and Necessity of Funduscopic Screening. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3860.
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Recently published data suggest routine ophthalmic consultation for asymptomatic, verbal patients with positive fungal blood cultures may be an inefficient use of resources as the risk of ocular involvement was less than 1%. To determine the generalizability of these findings, we examined the prevalence of and current microbial profile of fungal chorioretinitis and endophthalmitis among patients with positive fungal blood cultures who received ophthalmologic consultation at a tertiary care medical center.
Inpatient ophthalmology consults from Thomas Jefferson University Hospital (TJUH) between January 1, 2006 and December 31, 2012 were retrospectively reviewed and cross referenced to a microbiologic database of positive fungal blood cultures for study inclusion. Clinical data was obtained from records held by the microbiology laboratory and TJUH inpatient records. Patients were deemed to have ocular fungal involvement if they had evidence of chorioretinitis or endophthalmitis on dilated fundus examination.
Of 215 consults requested to rule out ocular involvement following positive fungal blood cultures over a 6 year period, 11 patients (5.2%, 95% CI 2.6-9.0%) were diagnosed with fungal chorioretinitis or endophthalmitis. Of these 11 patients, 4 were unable to communicate, 5 were symptomatic, and 2 were asymptomatic. An additional 11 patients (5.2%) had non-specific fundus lesions considered to be inconsistent with ocular fungal involvement. Of the remaining 193 patients, 4 (2.1%) had visual symptoms without visible retinal pathology. The most common fungal species identified in decreasing order of frequency were Candida albicans (N=78), Candida glabrata (N=56), and Candida parapsilosis (N=40).
Our study found a low rate of disseminated ocular involvement in patients with positive fungal cultures referred for ophthalmologic consultation. However, over half of the affected patients were asymptomatic or unable to communicate, which supports the current practice of routine ophthalmic examinations for patients with fungemia.
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