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R. R. Rathod, P. K. Rao; Incidence of Intraocular Infection in the Setting of Systemic Fungal Infection. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3554.
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To determine the incidence of intraocular infection in the setting of hospitalized patients with evidence of systemic fungal infection.
All inpatient and emergency room consults at our medical center were reviewed over a one year period. Consults that specifically asked to look for evidence of ocular infection based on systemic fungal infection were identified. The characteristics of these consults were reviewed.
Of 1182 consults reviewed, 77 were identified in which the consulting service specifically asked us to look for ocular involvement based on systemic fungal disease (71 with positive blood cultures, 1 with esophageal disease, 2 with disseminated disease, 1 with positive joint aspirate culture, 1 with lung disease based on chest CT, and 1 with positive sputum culture). All patients received full ophthalmologic examination within 72 hours of disease identification. The most common organisms identified were Candida albicans (27) and Candida glabrata (23). All patients were started on antimicrobial therapy as soon as disease was identified and prior to ophthalmologic exam. Of the 77 patients examined by the ophthalmology service, 3 were identified with choriodal or retinal lesions consistent with or suggestive of ocular involvement (3.9%). One of the patients identified was intubated and unable to express complaints (C. albicans blood culture). The other two did not have any symptoms (one had disseminated balstomycoses, the other had blood culture positive for C. krusei in the setting of leukemia). No cases of fungal endophthalmitis were identified.
Fungal endophthalmitis remains extremely rare with early identification and treatment of systemic fungal disease. Chorioretinitis was still identified in a small percentage of patients. Patients who are unable to communicate symptoms, children, those with disseminated disease, those with prolonged positive blood cultures, and those with delayed antimicrobial therapy should be evaluated with full ophthalmologic examination. Further studies need to be done to determine whether all patients (without the above risk factors) require routine surveillance.
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