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Delphine Lam, Rafik Belazzougui, Christine Fardeau, Valerie Touitou, Phuc Lehoang, Yves Edel, Bahram Bodaghi; Ocular candidiasis in intravenous drug misusers. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6381. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To study the characteristics, the management and evolution of Candida endophthalmitis among intravenous drug misusers in the era of new systemic antifungal agents.
Retrospective, descriptive study of patients with ocular candidiasis performed at Pitié-Salpêtrière hospital, Paris, France, from December 2002 to October 2015.
Twelve patients (14 eyes) were hospitalized for fungal endophtalmitis associated with drug misuse. Mean age at diagnosis was 41.1 years old (range 29-58) and 83% of patients were male. Misuse of buprenorphine and morphin sulfate were noted in 83% and 17% respectively. Furthermore, 50% had polymedications (3 buprenorphine and heroine, 2 morphin sulfate and crack, 1 buprenorphine and crack). The way of infection was 50% hand transmission and 50% salivary transmission. The extra-ocular symptoms were hand erysipelas, folliculitis, sycosis, cheilitis and cutaneous abscess. Many of them had systemic co-infections: hepatitis B in 6 cases, hepatitis C in 8 cases, hepatitis D in 2 cases and Human Immunodeficiency Virus in 4 cases. Patients presented with chorioretinitis (50%), endophthalmitis (57%) or both (36%). The microbiological diagnosis was obtained from anterior chamber tap (43%), vitrectomy (50%), skin, hair or mouth sample (7% each). Twenty nine percent of the samples were positive and gave a fungal identification (75% positive for Candida albicans; 25% positive for Candida tropicalis and dubliniensis). At diagnosis of endophtalmitis, mean visual acuity was 0.9 log MAR [0.2-2] and 0.3 logMAR [0-0.7] after resolution of endophthalmitis. Patients received fluconazole (50%), voriconazole (42%) or amphotericin B (8%), associated with intravitreal injections of amphotericin B (50%) or vitrectomy (50%). Mean time of treatment was 2 months [1-3]. Ten patients had drug substitution with methadone. Due to the lack of observance of these patients, 50% of them were not seen after hospitalization.
Fungal endophthalmitis is a sight-threatening disease most commonly caused by Candida species. It is important to maintain a high index of suspicion of Candida ocular infection, particularly among intravenous drug users, even if they have drug substitution. Most of the time, infection is due to the preparation process (cup, lemon, saliva, needle licking). An early treatment based on antifungal agents and the support of their underlying medical problems highly improve the visual and systemic prognosis.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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