Case Of Fungal Endophthalmitis Research Articles

Deciphering infectious uveitis etiology: Immune cell profiling in keratic precipitates using in vivo confocal microscopy

PurposeTo elucidate the etiology of infectious uveitis through the comprehensive analysis of keratic precipitates (KPs) using in vivo confocal microscopy (IVCM). DesignCross-sectional, observational case series. MethodsThis single-center, cross-sectional study was conducted at a tertiary care eye hospital from January 2021 to October 2023. It involved a detailed ophthalmologic evaluation of all subjects and included a total of 46 eyes from 36 subjects who were diagnosed with infectious uveitis. IVCM, specifically utilizing the HRT II Rostock corneal module, was employed to study the biomicroscopic morphology of KPs. The categorization of KPs was based on cell size, morphology, and reflection. ResultsCells of KPs were assessed for size, morphology, and reflection through in vivo confocal microscopy. Patients, ranging in age from 13 to 80 years (median 51 years), exhibited diverse morphologic forms of KPs. Neutrophil-dominated KPs with uniform size were predominantly observed in bacterial and fungal endophthalmitis cases (19/19, 100 %), accompanied by small numbers of mononuclear-macrophages in three eyes (3/19, 15.8 %). Viral uveitis cases displayed a broader array of immune cell types, including characteristic striated or dendritic cells in all eyes (27/27, 100 %). Lymphocytes were commonly present (24/27, 88.9 %), forming clusters in sixteen eyes and dispersed in the corneal endothelium below the midline in eight eyes. Neutrophil infiltration was notable in three cytomegalovirus-infected eyes (3/27, 11.1 %). A marked increase in sub-basal corneal epithelial Langhans cells was associated with viral uveitis. ConclusionsNeutrophil-dominated KPs strongly indicate endogenous bacterial or fungal endophthalmitis, while the presence of dendritic cells and lymphocytes in KPs is suggestive of viral uveitis. In vivo confocal microscopy emerges as a crucial tool for differentiating the etiologic diagnosis of infectious uveitis.

Cases of endophthalmitis caused by Candida albicans and Candida dubliniensis identified via internal transcribed spacer deep sequencing

BackgroundWe report two cases of fungal endophthalmitis induced by Candida species identified based on internal transcribed spacer 1 (ITS1) sequencing.Case presentationIn two cases, endophthalmitis was suspected, and the patients underwent pars plana vitrectomy. Case 1 was a 64-year-old woman with a history of cataract surgery 10 days prior. She had a history of anal primary melanoma, which metastasized throughout the body and subsequently relapsed. Vitreous culture and ITS-1 deep sequencing revealed the presence of the rare fungus, Candida dubliniensis. Case 2 was a 54-year-old man with a history of liver cancer and kidney failure. Culture methods and ITS1 deep sequencing both revealed the presence of Candida albicans. Both patients exhibited good visual prognoses after treatment with topical and systemic antibiotics.ConclusionsWe present two cases of fungal endophthalmitis caused by two Candida species identified by both the culture method and ITS1 deep sequencing. The fungal pathogen was identified by ITS deep sequencing three days after sample submission; the culture method yielded results after 1 week. These findings support the applicability of ITS1 sequencing for timely pathogen identification for cases of fungal endophthalmitis and provide detailed taxonomic information at the species level.

Fungal endophthalmitis following transscleral cyclophotocoagulation

Most cases of refractory glaucoma not amenable to filtration surgery or glaucoma drainage device are managed by cyclodestructive procedures. An 84-year-old female had undergone oculus sinister (OS) transscleral cyclophotocoagulation (TSCPC) after a diagnosis of OS closed angle stage of neovascular glaucoma was made. On the 1st week post-TSCPC, discharge on the conjunctival surface was noted along with a 6 mm hypopyon in the anterior chamber and associated vitritis. Treatment on the lines of fungal endophthalmitis was initiated. At 1 month review, the reaction had reduced significantly. Cases with significant reaction and vitritis post-TSCPC must be treated aggressively on the lines of endophthalmitis to salvage the globe. A rather safe approach to the management of such cases, TSCPC does have rare complications such as inadvertent sclerostomy or panophthalmitis, being reported as isolated case reports. To the best of our knowledge, this is the first case of fungal endophthalmitis being reported post-TSCPC.

Fungal Endophthalmitis Outbreak after Cataract Surgery, South Korea, 2020.

In November 2020, an unusual increase in fungal endophthalmitis cases after cataract surgery was reported to the Korea Disease Control and Prevention Agency, South Korea. We initiated an outbreak investigation to identify the cause. We identified 156 cases nationwide, 62 confirmed and 94 probable. Most case-patients were exposed during surgery to ocular viscoelastic devices (OVDs) from the same manufacturer (company A). We isolated Fusarium spp. from 50 confirmed cases. Molecular identification of 39 fungal isolates from clinical samples and 13 isolates from OVDs confirmed F. oxysporum caused the infections. The risk ratio for fungal endophthalmitis from company A's OVDs was 86.0 (95% CI 27.4-256.9), much higher than risk from other manufacturers' products. We determined this fungal endophthalmitis outbreak was caused by a contaminated lot of OVDs and recommended discontinued use of this product. Early recognition of outbreaks and joint responses from related government agencies can reduce risk for fungal endophthalmitis.

Wickerhamomyces Anomalus Postoperative Endophthalmitis

ABSTRACT Introduction We describe the case of a postoperative fungal endophthalmitis caused by Wickerhamomyces anomalus, an opportunistic yeast common in nature but rare as a causative agent in ocular infections. This would be the second reported case of W. anomalus endophthalmitis. Case report A patient came to our hospital with a dense hemovitreous caused by an inadvertent ocular perforation and retinal detachment during a cataract surgery. In the days following the first vitreoretinal surgery a chronic postoperative endophthalmitis was evidenced. Only after several surgeries as well as intravitreal antibiotics and sample takings, Wickerhamomyces was detected. The treatment with oral voriconazole and an intraocular lens extraction controlled the infection. Discussion Wickerhamomyces anomalus, despite not being particularly aggressive in our case, was resistant to various consequent vitreoretinal surgeries. The unresponsiveness to treatment led us to contemplate the fungal etiology, and fortunately the cultures were positive for this yeast. In conjunction to antifungal therapy, it is possible that the IOL explantation played an important role in the treatment. Conclusion A high index of suspicion must be held in cases of fungal endophthalmitis. Both IOL explantation and oral antifungal therapy are useful treatment options in cases of W. anomalus endophthalmitis.

The Role of Corneal Donor Rim Fungal Cultures: Pro Side.

Fungal infection after corneal transplantation is a rare but potentially devastating complication. It is of paramount concern for transplant surgeons and the eye banking community. The value of universal corneal rim cultures for keratoplasty remains controversial. In 2016, The Eye Bank Association for America reported an increasing trend in the incidence of post keratoplasty fungal infections and a higher incidence of post keratoplasty [penetrating keratoplasty and endothelial keratoplasty (EK)] fungal endophthalmitis cases. This increasing trend in rate over time from previous Eye Bank Association for America reports was disproportionately associated with EK and Candida species. Additionally, several studies confirmed a high correlation between positive corneoscleral donor rim fungal cultures and postoperative infections, and a higher risk to the mate eye of a cornea that had the positive fungal corneal rim culture and developed an infection. Positive fungal donor rim cultures-especially in the setting of interface keratitis after EK surgery-can raise the index of suspicion for a fungal cause and may help direct therapy, especially in the early stages, where the symptoms and signs of spread may not be obvious and obtaining direct cultures is inherently difficult without surgical intervention.

Microbial diagnosis of endophthalmitis using nanopore amplicon sequencing

ObjectivesWe investigated whether nanopore amplicon sequencing of aqueous humor was capable of rapid pathogen identification in infectious endophthalmitis. Methods5 cases of culture-positive bacterial endophthalmitis and 3 cases of fungal endophthalmitis (1 culture-positive and 2 presumed) were included. DNA was extracted from the aqueous humor and vitreous specimen, and PCR of bacterial rDNA (16S) and fungal rDNA (ITS1 and D1/2/3) was performed. Then, nanopore amplicon sequencing was performed for 2 h. The results of amplicon sequencing were compared to those of conventional culture studies. ResultsIn all cases, pathogens were identified by amplicon sequencing of aqueous humor specimens. In 3 cases of bacterial endophthalmitis, the identified microbes were confirmed by culture studies of both aqueous humor and vitreous specimens. In 2 cases of bacterial and 1 case of fungal endophthalmitis, the identified pathogens were confirmed only by culture studies of vitreous specimens. In all cases, amplicon sequencing identified pathogen in a shorter turnaround time than culture studies. In 2 cases with negative culture results, amplicon sequencing of aqueous humor identified fungal pathogens. ConclusionsOur data demonstrates the potential of amplicon nanopore sequencing using aqueous humor to enable rapid, sensitive and less invasive microbial diagnosis of endophthalmitis.

One case of fungal endophthalmitis after cataract surgery

One case of fungal endophthalmitis after cataract surgery

A Case of Fungal Endophthalmitis after Having Received Extraction of Wisdom Tooth in Healthy Woman

A Case of Fungal Endophthalmitis after Having Received Extraction of Wisdom Tooth in Healthy Woman

RESULTS OF PARS PLANA VITRECTOMY FOR THE MANAGEMENT OF ENDOGENOUS FUNGAL ENDOPHTHALMITIS AFTER URINARY TRACT PROCEDURES.

To report the results of pars plana vitrectomy with adjuvant intravitreal amphotericin B and systemic fluconazole in the management of endogenous endophthalmitis after the urinary tract procedures. Retrospective study of 10 eyes of 7 patients diagnosed as endogenous fungal endophthalmitis. Pars planavitrectomy with adjuvant intravitreal amphotericin B and oral fluconazole was conducted once the general condition is suitable. The final anatomical and functional results were evaluated. Ten eyes of seven patients, five men and two women had pars plana vitrectomy. Control of infection was achieved in all cases. Visual acuity improved in 7 eyes (70%), remained the same in 2 eyes (20%), and worsened in 1 eye (10%). The retina was flat in all cases. No eye developed phthisis bulbi. In cases of fungal endophthalmitis, after urinary tract procedures, the prevention of phthisis bulbi can be achieved in all cases. Improvement of vision can be achieved in most of the cases. The final visual status depends on visual acuity at presentation, macular affection, and the presence of retinal detachment at presentation.

Incidence and Outcomes of Positive Donor Corneoscleral Rim Fungal Cultures after Keratoplasty

To determine the incidence of positive corneoscleral donor rim fungal cultures after keratoplasty and to report clinical outcomes of grafts with culture-positive donor rims. Retrospective cohort study. Consecutive donor corneas and keratoplasty recipients at a single tertiary referral center over 20 years. Patient charts were reviewed to determine the incidence of positive donor rim fungal cultures and clinical outcomes of all grafts using contaminated tissue. The primary outcome measures were positive donor rim fungal culture results and the development of postkeratoplasty fungal infection using corresponding corneal tissue. The secondary outcome measure was the impact of postoperative prophylaxis on donor tissue-associated infections. A total of 3414 keratoplasty cases were included in the statistical analysis. Seventy-one cases (2.1%) were associated with a fungal culture-positive donor rim. Candida species were cultured in 40 cases (56.3%). There was a higher incidence of positive rim cultures over the last 5 years of the analytic period compared with the first 15 years (P= 0.018). Fungal keratitis developed in 4 cases (5.6%), and all patients required further surgical intervention to achieve cure. There were no cases of fungal endophthalmitis. Empiric antimycotic prophylaxis initiated at the time of positive culture result reduced the incidence of keratitis from 15.8% in untreated cases to 1.9% in treated cases (P= 0.056). Positive donor rim fungal cultures are uncommon, but carry an unacceptably high risk of postoperative fungal infection. This risk may be reduced with prophylactic antimycotic therapy when culture-positive donor rims are identified.

The first case of fungal endophthalmitis caused by Emericella nidulans after cataract surgery

Emericellanidulans is a species that has only rarely been implicated in human disease after cataract surgery. Here, we report the first postoperative case in the literature, as far as we know. The patient was a 50-year-old patient presented with mild anterior uveitis one week after cataract surgery, and hypopion developed over the next two days. First microbiological evaluation and the results of direct microscopy and cultures of the anterior chamber and vitreous samples were found to be negative. Despite vigorous topical and intravitreal (vancomycin and amikacin) therapy, the endophthalmitis did not improve. Anterior chamber paracentesis, vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens (IOL) were performed. The anterior chamber, vitreous fluid samples and IOL were submitted to the microbiology laboratory: the culture yielded E.nidulans growth. Ocular inflammation resolved and vision improved on intravenous, subconjunctival and long-term oral voriconazole treatment. E.nidulans can be an important cause of ocular fungal infections including endophthalmitis, and voriconazole seems to be effective for the treatment of E.nidulans endophthalmitis.

Anterior and Pan-endophthalmitis Caused by Candida albicans and Aspergillus fumigatus: Report of Two Cases

We report two posttraumatic fungal endophthalmitis cases with anterior and entire segment involvement caused, respectively, by Candida albicans and Aspergillus fumigatus. The anterior endophthalmitis induced by C. albicans presented multifocal lesions with hyphael structures in anterior chamber, but without involvement of posterior vitreous. The pan-endophthalmitis caused by A. fumigatus displayed significant hypopyon and vitritis. Treatment strategies are anterior chamber cleaning for anterior endophthalmitis and vitrectomy for pan-endophthalmitis, excepting systemic and topical antifungal drug applications including intravitreal injection for both types of endophthalmitis. There is a much better outcome in the case with anterior segment involvement than that with entire segment involvement. This case report provides evidence that the different types of posttraumatic fungal endophthalmitis related to different fungal infections indeed existed and should be managed with different strategies.

Surgical treatment of infectious endophthalmitis

Objective To study the etiology,pathogen,treatment and prognosis of infectious endophthalmitis.Methods 12 cases (12 eyes) with infectious endophthalmitis were retrospectively studied.Data collected including gender,age,physical injury,etiology,treatment and results were analyzed.Restlts In 12 patients,1 case underwent enucleation,1 case progressed to eyeball atrophy after conservative treatment,10 cases underwent vitrectomy surgery.Among patients underwent vitrectomy surgery,1 case of huge introcular foreign body was not removed and gradually progressed to eyeball atrophy during follow-up,1 case of fungal endophthalmitis relapsed during follow-up and gradually progressed to eyeball atrophy.The remaining 8 cases were retained the eye,and the corrected visual acuity ranged from light perception to 0.3.One case was detected subspecies of staphylococcus schleiferi from purulent vitreous culture,2 cases were detected aspergillus,7 ocular fluid samples showed negative growth on culture,2 cases did not send vitreous culture pus.Conclusion For patients confirmed or with highly suspected endophthalmaitis without relief under introvitreal injection of drugs and systematic antibiotics application,timely vitrectomy may be suitable to retain the eyeball and save part of vision. Key words: Endophthalmitis, infectious; Foreign body, intraocular; Vitrectomy; Prognosis.

Successful Treatment of Postoperative Fungal Endophthalmitis Using Intravitreal and Intracameral Voriconazole

The aim of this study was to describe 3 cases of postoperative fungal endophthalmitis successfully treated with anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injection. Three (3) patients from a single retina center in India developed culture-proven fungal endophthalmitis after cataract surgery in 1 eye. All patients underwent anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injections intraoperatively. All cases demonstrated substantial improvement in vision and intraocular inflammation after surgery. The combination of anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injection is a viable therapeutic option in cases of fungal endophthalmitis.

Post-traumatic fungal endophthalmitis—a prospective study

To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury. This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin. Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 microg/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better. Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.

The infectious complications of anabolic-androgenic steroid injection.

One million individuals in the United States alone are estimated to be current or past users of anabolic-androgenic steroids. In the United States fifty-percent of anabolic-androgenic steroid users administer their compounds intramuscularly, and twenty-five percent of adolescent anabolic-androgenic steroid users share needles, placing these young adults at risk for infections related to injection. To examine the medical literature for reports of infections attributable to anabolic-androgenic steroids, we conducted a MEDLINE (1966-1998) and AIDSLINE (1980-1998) world literature review to examine all references that attributed infections to anabolic-androgenic steroid injection. Infections associated with anabolic-androgenic steroid injection include three cases of HIV, one case of hepatitis B, one case of hepatitis C, eight abscesses, and a case of fungal endophthalmitis. No cross-sectional or prospective studies exist that document the risk of infections related to anabolic-androgenic steroid injection. These serious infectious complications of anabolic-androgenic steroid injection may be avoided with education and prevention techniques. Infections occurring in anabolic-androgenic steroid users are not as common as in intravenous drug users.

Endophthalmitis From Contaminated Donor Corneas Following Penetrating Keratoplasty

We encountered six (0.2%) cases of endophthalmitis resulting from contaminated donor corneas between January 1983 and July 1990 following a total of 3000 consecutive penetrating keratoplasties. Causative organisms in the three cases of fungal endophthalmitis were Torulopsis glabrata, Candida albicans, and Aspergillus flavus; the three cases of bacterial endophthalmitis were due to Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. All organisms were resistant to gentamicin in the preservation media. A significantly higher incidence of endophthalmitis was noted in patients receiving corneas from a Sri Lankan eye bank (1.25%) than in those receiving US eye bank tissue (0.14%). Donor rim cultures are important to identify those patients at increased risk of developing endophthalmitis, enabling earlier diagnosis and more specific treatment should endophthalmitis occur.

Incidence of endophthalmitis in Sweden.

A retrospective review of all suspected and proven cases of endophthalmitis (EO) during a period of 18 months in Sweden is presented. This period covered the time of transition in the surgical technique at a large number of clinics. Sixty-two cases of EO were reported out of which 52 were post-operative. A total incidence of post-operative endopthalmitis (POE) was found to be 0.33%. The incidence of culture proven POE was however only 0.06%. No cultures or only conjunctival cultures had been taken in 32 (61.5%). S. epidermidis and S. aureus comprised the majority of isolates. No case of fungal EO was reported. The number of posttraumatic EO was low.

Experimental Aspects and Their Clinical Application

After laboratory evaluation of nontoxic doses of intravitreal antibiotics, 26 cases of bacterial and fungal endophthalmitis were treated by intravitreal antibiotic or vitrectomy. In 46% of all cases, visual acuity was better than 20/100, whereas 27% had light perception to 20/300 visual acuity, 4% had no light perception, and 23% of the cases were enucleated or eviscerated. Best results have been achieved when the treatment began within 36 hours after symptomatic onset of infection and when the organism involved was not to virulent. We advocate intravitreal antibiotics immediately after intracameral and vitreous tap for culture, to be followed by vitrectomy 24 hours later if the culture is positive. In bacterial endophthalamitis when the vitreous is severely involved and in cases of fungal endophthalmitis, we advocate vitrectomy plus intravitreal antibiotics as the primary procedure.