Endogenous Aspergillus Endophthalmitis Research Articles

Endogenous Aspergillus endophthalmitis in a chronic kidney disease

Fungal endogenous endophthalmitis (FEE) is an intraocular infection secondary to the fungemia, spreading through the hematogenous route. We here report a case of a 60-year-old female diagnosed with FEE and culture-proven Aspergillus fumigatus in a chronic kidney disease (CKD) patient, which is a rare and challenging condition to manage. Early diagnosis and prompt treatment are the only keys to achieve suitable outcomes. It can be achieved by a multidisciplinary approach involving nephrologists and ophthalmologists. Routine ophthalmology review in CKD patients under hemodialysis may prove to be effective in early diagnosis of the fungal endophthalmitis or even help in ruling out systemic infections.

Endogenous endophthalmitis caused by Aspergillus flavus in an immunocompetent individual – A rare case with review of literature

There are very few reports of Aspergillus flavus causing endogenous Aspergillus endophthalmitis (EAE) in immunocompetent individuals although it is well recognized in the immunocompromised. Treatment can be with intravitreal, intravenous and oral antifungal agents. We present a case of EAE in a 23-year-old female with no predisposing risk factors. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received an intravenous dextrose infusion two days before this episode while being treated at a rural hospital for fever. She presented with a sudden loss of vision and was subsequently managed with intravitreal voriconazole therapy. This case adds to the limited literature on the prevalence of endogenous endophthalmitis in immunocompetent patients and supports the use of voriconazole in such cases.

Endogenous aspergillus endophthalmitis after kidney transplantation.

Endogenous aspergillus endophthalmitis(EAE) after kidney transplant is a rare but important clinical problem due to potentially devastating consequences. Early diagnosis of EAE, timely removal of affected vitreous by vitrectomy, proper anti-fungal treatment, all contributed to the successful control of the disease. Therapeutic success of EAE in post-transplant patients depends largely on prompt diagnosis. Definite diagnosis of EAE is based on positive culture results of vitreous specimen, while fundoscopy and B scan ultrasound may aid early diagnosis. In terms of anti-fungal medicine, amphotericin B has long been the first choice, but its systemic applicaiton has severe adverse reactions, especially for patients with impaired renal function. Herein, we report the treatment modality of EAE after kidney transplant with vitrectomy, systemic administration of micafungin plus voriconazole, topical application of fluconazol and amphotercin B.

Bilateral simultaneous endogenous Aspergillus endophthalmitis in an immunocompetent patient.

To report a case of bilateral endogenous Aspergillus endophthalmitis in an immunocompetent patient. We report a young immunocompetent 26-year-old Indian woman who presented with bilateral simultaneous endogenous endophthalmitis and was managed with pars plana vitreous surgery in both the eyes. Smear examination of the vitrectomy specimen from the left eye identified septate hyphae with acute-angle branching, which on culture showed growth of Aspergillus fumigatus. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received an intravenous dextrose infusion 2 weeks before this episode while being treated at a rural hospital for malarial infection. During follow-up, she developed bilateral rhegmatogenous retinal detachment requiring revised pars plana vitreous surgery with silicon oil tamponade. An immunocompetent patient can present with bilateral simultaneous endogenous Aspergillus endophthalmitis after receiving an intravenous infusion of presumably contaminated dextrose solution.

Cerebral Basilar Artery Mycotic Aneurysm Associated With Aspergillus Endogenous Endophthalmitis

Purpose: To report a case of mycotic aneurysm of the cerebral basilar artery associated with bilateral endogenous aspergillus endophthalmitis. Case summary: A 41-year-old man with no underlying disease presented with decreased vision in both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis, and the authors performed a vitrectomy and lensectomy on the right eye. Hyphae were detected in the vitreous sample, and systemic amphotericin was administered. Three days after the operation, the patient became comatose due to a subarachnoid hemorrhage. Aspergillus antigen was detected in the vitreous sample and in the cerebrospinal fluid. Subarachnoid hemorrhage was due to the rupture of a mycotic aneurysm of the cranial basilar artery, complicated by aspergillus infection of the central nervous system.

Endogenous Aspergillus Endophthalmitis Occurring After Liver Transplantation: A Case Report

Endogenous Aspergillus endophthalmitis (AE) is a rare complication of invasive aspergillosis in transplant patients. In this report, we have described a patient who underwent liver transplantation because of drug-induced cholestatic cirrhosis and developed AE at 2 weeks after the surgery. The patient was a 22-year-old man who received a right liver lobe from his father. The operation was uneventful but the patient developed signs and symptoms of small-for-size syndrome after the second day of surgery. The patient received intense immunosuppression with methylprednisolone for 3 days, tacrolimus and mycophenolate mofetil from the first day after the operation, with ceftriaxone and metronidazole as prophylactic antibiotics. Because of signs of respiratory distress with pneumonia, vancomycin and amphotericin B were added empirically to his regimen. Polymerase chain reaction for aspergillus DNA in the blood was positive. The patient received one course of methylprednisolone pulse therapy for signs of acute rejection at day 10, and tacrolimus was changed to sirolimus because of a rising serum creatinine and convulsions. After 2 weeks, the patient's symptoms improved and liver function tests were normal, but the complained of sudden intense pain in the left eye with unilateral blurred vision, redness, and other signs of endophthalmitis upon examination by an ophthalmologists. After 24 hours, visual acuity decreased to light perception. AE was confirmed by microscopy and culture of the vitreous fluid and retinal biopsy. Despite changing amphotericin to intravitreal injection of voriconazole followed by intravenous voriconazole and transient resolution of the symptoms, no improvement was seen in visual acuity. Pain and signs of inflammation in the eye recurred after 2 weeks. At last the patient underwent enucleation for resistant infection and fear of involvement of the other eye by aspergillosis or sympathetic ophthalmia.

Embolic aspergillus endophthalmitis in an immunocompetent patient from aortic root aspergillus endocarditis

We report the first case of endogenous aspergillus endophthalmitis in an immunocompetent person with systemic aortic root aspergillus endocarditis.

Aspergillus iris granuloma in a young male: A case report with review of literature

Endogenous aspergillosis is a rare occurrence. Endogenous Aspergillus endophthalmitis is a rare but devastating infection usually associated with disseminated aspergillosis or with intravenous drug abuse. We report a case of an isolated Aspergillus iris granuloma in a young immunocompetent male patient with review of the literature.

Endogenous Aspergillus endophthalmitis: Report of three cases and review of the literature

Endogenous Aspergillus endophthalmitis: Report of three cases and review of the literature

Endogenous Aspergillus endophthalmitis occurring in a child with normal immune function

Endogenous Aspergillus endophthalmitis occurring in a child with normal immune function

Endogenous aspergillus endophthalmitis: Clinical features and treatment outcomes

This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis. The study design was a multicenter retrospective chart review. Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied. Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed. Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured. All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated. Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

Endogenous Aspergillus endophthalmitis in AIDS

We present the course of an endogenous Aspergillus endophthalmitis in a 38-year-old HIV-positive man. HISTORY AND CLINICAL SIGNS: The first examination because of a sudden visual loss in the right eye showed a central subretinal infiltration, peripheral vascular sheeting and retinal hemorrhages. In spite of high-dose systemic antifungal therapy we could not prevent the penetration of the posterior wall of the eye and infiltration of adjacent orbital structures. Enucleation had to be performed. In case of scleral involvement in Aspergillus endophthalmitis the necessity of enucleation has to be considered.

Endogenous Aspergillus Endophthalmitis After Lung Transplantation

By fundus photography and histopathologic examination, we documented a case of early endogenous Aspergillus endophthalmitis in a 29-year-old man after lung transplantation. The clinical and histopathologic features of this case are consistent with those of previous case reports of endogenous Aspergillus endophthalmitis. Endogenous Aspergillus endophthalmitis represents a manifestation of disseminated aspergillosis, usually a fatal infection. This diagnosis should be considered in immunocompromised patients with visual disturbances, as early recognition of the fundus appearance may aid in systemic treatment.

Endogenous Aspergillus endophthalmitis in an immunocompetent individual

We present an unusual case of Aspergillus fumigatus endogenous endophthalmitis in a 27 year old Hispanic male with no history of ocular trauma, surgery, hematologic malignancy, compromised immune system, or intravenous drug use. The patient presented with a two-day history of pain, redness, and visual acuity of bare count fingers in his right eye. He was originally suspected of having toxoplasmic retinochoroiditis, but clinically worsened on systemic anti-toxoplasma medication and corticosteroids. He subsequently underwent pars plana vitrectomy and treatment with intravenous and intravitreal amphotericin B. Aspergillus fumigatus was isolated and identified in the vitreous aspirate. With aggressive medical and surgical management, he eventually regained visual acuity of 20/30 in his right eye. This case illustrates the occurrence of endogenous Aspergillus endophthalmitis in a patient with no history of intravenous drug use, ocular trauma, or compromised immune system, and successful outcome with combined medical and surgical management.

Endogenous Aspergillus Endophthalmitis in Drug Abusers

One of two cases of endogenous Aspergillus endophthalmitis in abusers of intravenously administered drugs was treated successfully by subtotal pars plana vitrectomy; amphotericin B administered by intravitreal, periocular, and systemic routes; and flucytosine administered systemically. Aspergillus sp should be considered a possible pathogenic organism in drug abusers with endogenous endophthalmitis. An aggressive diagnostic and therapeutic approach may result in preservation of useful vision.

Endogenous Aspergillus Endophthalmitis Occurring After Kidney Transplant

Two months after renal transplantation, a 26-year-old man developed pneumonia that was recalcitrant to antibiotic therapy and proved by biopsy to be due to cytomegalovirus and Aspergillus fumigatus. Ten days later while on amphotericin B therapy, he developed an endophthalmitis proved by smear and culture of a vitreous aspiration to be caused by A. fumigatus. Despite intravitreous and systemic amphotericin B the vision deteriorated and the eye was enucleated. Microscopic examination disclosed an intense endophthalmitis with vitreous and retinal abscesses. The second patient was a 29-year-old woman who developed severe hypertension and graft rejection one month after renal transplant, despite massive immunosuppressive therapy with prednisone, azathioprine, and cobalt 60 irradiation. She developed pneumonia, meningitis, and died. A postmortem examination revealed disseminated aspergillosis. A single choroidal abscess due to Aspergillus with an associated retinal hemorrhage was observed in the left eye.

Endogenous Aspergillus endophthalmitis in a healthy individual

Fungal endogenous endophthalmitis in a healthy individual without any predisposing factors is very uncommon. It can occur in intravenous drug abusers, where Aspergillus is more frequently isolated as the causative organism. We treated an unusual case of culture-proven endogenous Aspergillus endophthalmitis who was immunocompetent and was not an intravenous drug user. The affected eye was successfully treated with repeated intravitreal, intracameral and intrastromal injections of amphotericin B and anterior chamber wash. Endogenous fungal endophthalmitis can occur in healthy individuals.