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Shagun Dhaliwal, Luke B Potts, Johnathan Kim, Jason Smart, Robert H Rosa, Angela Hochhalter, Juhee Song, Kevin Lai; Screening for Endogenous Fungal Eye Disease: Prospective Implications From A Retrospective Series. Invest. Ophthalmol. Vis. Sci. 2014;55(13):690.
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Early treatment with systemic antifungal medication has led to an overall decrease in the incidence of endogenous fungal endophthalmitis. Current practice guidelines mandate a dilated ocular fundus exam within 2 weeks of a positive fungal blood culture. In light of increasing healthcare costs, decreasing reimbursement, and the diminishing incidence of positive ocular findings, we evaluated cases of fungemia and fungal eye disease over a 5-year period at a tertiary care center to identify risk factors associated with a higher likelihood of progression from fungemia to fungal endophthalmitis.
We evaluated cases of positive fungal cultures from Jan 2007 through July 2012 at Scott & White Memorial in Temple, Texas. Data collected during a retrospective chart review included demographic information, dates of positive cultures, organisms isolated, drug sensitivities, systemic antifungal medications, risk factors for fungemia, ophthalmology consultation, visual symptoms, and clinical course.
231 adult and pediatric patients with positive fungal cultures were identified. Men and women had similar rates of fungemia; majority of cases involved adult patients (79%). Most common organisms were Candida albicans, Candida glabrata, and Candida tropicalis. 81% received antifungal treatment. 50% (126) of all cases received a dilated fundus exam. 4 patients (3%) were found to have fungal endophthalmitis - 3 denied visual symptoms and 1 was not able to communicate presence of symptoms. Of these 4 cases, 1 was lost to follow-up, 1 was placed on hospice care, 1 died approximately 1 mo after ophthalmologic exam, and 1 was followed as an outpatient, maintained on systemic antifungals, and experienced resolution of disease. A comparison of risk factors revealed malignancy to be significantly associated with fungal eye disease.
Herein, we created a shortlist of criteria that increase suspicion for progression to fungal endophthalmitis. Adults were more often afflicted with fungal endophthalmitis. Visual symptoms were not necessarily associated with presence of endophthalmitis. A history of malignancy should arouse suspicion for fungal endophthalmitis. Interestingly, patients with fungal eye disease did not require additional intervention beyond systemic antifungal medications. Thus, patients with positive fungal cultures may be followed on an outpatient basis.
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