Etiology and pathogens of fungal endophthalmitis

Abstract

To evaluate epidemiologic features and laboratory findings of fungal endophthalmitis in north China. Eighty-one patients (81 eyes) were diagnosed with fungal endophthalmitis at our institution from January 2000 to December 2012. Patient history, etiological agents, direct smear examination, fungal culture and pathogen sensitivity to antifungal drug were evaluated. The fungal endophthalmitis was exogenous in 73 cases (90.1%), among which 43 had fungal keratitis in which Fusarium was the first pathogen occupied 88.4% (38 of 43 cases). Twenty seven of 73 cases (33.3%) occurred after penetrating ocular trauma and Aspergillus was the most common pathogens isolated in these cases (11 of 27; 40.7%). The left 3 cases were associated with ocular surgery. Four of the other eight eyes (9.9%) with endogenous infection had association with drug abuse. Aspergillus was the main isolated pathogens from the endogenous fungal endophthalmitis (4 of 8 cases). Hyphae were found in 52 (77.6%) of 67 smear samples by direct microscopic examination. Fungal pathogens cultured from 81 samples were identified as 10 genera and 18 species; Fusarium accounted for 60.5% (49 eyes), Aspergillus for 21.0% (17 eyes) and Candida for 6.2% (5/81). The total sensitive rate of Fusarium and Aspergillus in vitro to voriconazole, amphotericin B, ketconazole, itraconazole and fluconazole was 84.7% (33/39), 71.8% (28/39), 43.6% (17/39), 17.9% (7/39) and 7.7% (3/39) respectively. Fungal endophthalmitis in north China is predominantly exogenous. Fungal keratitis and penetrating trauma are the main common etiological factors. Fusarium ranks first in pathogens, followed by Aspergillus and Candida. Fusarium was the first pathogen of exogenous fungal endophthalmitis caused by fungal keratitis. Aspergillus was the most common isolated pathogens from exogenous fungal endophthalmitis caused by penetrating ocular trauma and it also was the first pathogen of endogenous fungal endophthalmitis. Microscopic detection of hyphae from samples is helpful in the diagnosis. Fusarium ranks first in pathogens, followed by Aspergillus. They both are more sensitive to voriconazole and amphotericin B than ketconazole, fluconazole and itraconazole.