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C. Dozier, R. Tarantola, K. Jiramongkolchai, S. P. Donahue; Fungal Chorioretinitis Among Inpatients at a Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2903.
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Hematogenous dissemination of fungus to the eyes can manifest as chorioretinitis or endophthalmitis. Previous studies describe the prevalence to range from 10-40 percent; however, more recent studies have suggested a declining prevalence, possibly due to widespread use of prophylactic antifungal therapy. The purpose of this study is to identify the current prevalence and microbial profile of fungal chorioretinitis and endophthalmitis among patients with positive fungal cultures at a tertiary care hospital.
All ophthalmology consultations to evaluate for ocular involvement by fungal organisms from 6/3/06 to 9/3/09 were examined. We recorded: ability to verbalize complaints, visual symptoms, site of culture and species of fungus identified, time since last positive culture, type/duration of antifungal therapy, and presence or absence of ocular lesions consistent with disseminated fungus.
211 patients (83 pediatric, 128 adult) had consult requests containing the word "fungemia" or a similar term indicating concern for ocular fungal infection. More than 97% of patients had a positive fungal culture. In decreasing order of frequency, the organisms identified were: C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, and others. Greater than 98% of all patients were on systemic antifungal therapy (average duration 6.5 days) at the time of exam. No pediatric patients and only 2 adult patients had positive findings (i.e., chorioretinitis or endophthalmitis); 1 of these 2 was able to verbalize complaints and reported floaters and blurring, while the other patient was unable to verbalize. Three other adults had indeterminate white retinal lesions. Visual complaints were rare (3.5%) among patients with negative findings who could verbalize visual symptoms.
Disseminated ocular fungal infection is rare in the current era of widespread prophylactic antifungal therapy. Fewer than 1% of patients in our study had ocular involvement. Fungemic patients who report visual changes and those who are unable to verbalize visual complaints should continue to be evaluated by ophthalmology; patients who are able to verbalize and have no visual complaints do not need inpatient ophthalmologic exams.
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