Ocular candidiasis in intravenous drug misusers

Abstract

PurposeTo study the characteristics, the management and evolution of Candida endophthalmitis among intravenous drug misusers in the era of new systemic antifungal agents.MethodsRetrospective, descriptive study of patients with ocular candidiasis performed at Pitié‐Salpêtrière hospital, Paris, France, from 2002 to 2015.Results12 patients (14 eyes) had fungal endophtalmitis associated with drug misuse. Mean age at diagnosis was 41.1 years old and 83% of patients were male. Misuse of buprenorphine and morphin sulfate were noted in 83 and 17% respectively. 50% had polymedications. The way of infection was 50% hand transmission and 50% salivary transmission. Many of them had systemic co‐infections: hepatitis B, C, D or Human Immunodeficiency Virus. Patients presented with chorioretinitis (50%), endophthalmitis (57%) or both (36%). The microbiological diagnosis was obtained from anterior chamber tap (50%), vitrectomy (57%), skin, hair or mouth sample (7% each). 36% 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 and 0.3 logMAR 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.ConclusionsFungal 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. Infection is mostly due to the preparation process. An early treatment based on antifungal agents highly improve the visual prognosis.