Endophthalmitis in Immunocompromised and Diabetic Patients

Abstract

Endophthalmitis is a serious condition in immunocompromised patients. Exogenous endophthalmitis that develops in the setting of ocular surgery, trauma, and corneal infections also occurs in immunocompromised hosts, sometimes more frequently than in immunocompetent individuals. More importantly, immunocompromised patients are at increased risk of developing endogenous endophthalmitis due to their weakened immune defense and susceptibility to bacteremia and fungemia. Endogenous fungal endophthalmitis is of particular concern because fungemia has a high mortality in this patient population. The diagnosis of endogenous endophthalmitis is suspected clinically, and antibiotics are often started empirically as soon as blood cultures are drawn. Intravitreal antibiotics, systemic antibiotics, and vitrectomy are utilized in combination based on the infection severity and response to initial treatments. Prognosis is variable depending on the virulence of the organism and the severity of the intraocular inflammation. In patients with HIV/AIDS, endophthalmitis is relatively rare compared with other ocular diseases. Patients with HIV who are intravenous drug users are at increased risk of endogenous endophthalmitis, and in these cases, fungal pathogens such as Candida and Aspergillus are the most common etiologies. In transplant patients on immunosuppressive therapies, endophthalmitis is also most commonly fungal, and pathogens include Candida, Aspergillus, Scedosporium, and Fusarium. Patients with rheumatologic conditions receiving immunosuppressive medications and patients with hematologic malignancies or asplenia are also at increased risk for endophthalmitis, either bacterial or fungal.