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A comparative clinicopathologic study of endogenous mycotic endophthalmitis: variations in clinical and
Purpose:
Endophthalmitis caused by endogenous Candida and Aspergillus species has emerged as a visually threatening complication in patients with immune deficiency of various causes. Twenty-five patients who underwent enucleation, 13 with endogenous Aspergillus endophthalmitis and 12 with endogenous Candida intraocular infections, were evaluated. Both clinical features and intraocular spread of the fungi were studied to determine which clinical and/or histopathologic features could help distinguish aspergillosis from Candida infections.
Methods:
Clinical information was sought from each case to determine whether there was any underlying systemic condition and to delineate the characteristic clinical features seen at initial presentation. The results of vitreous and other tissue cultures for bacteria and fungi were evaluated. Patients with AIDS were excluded. The enucleated globes were processed for histopathologic analysis to detect location of the fungal elements, inflammatory response, and vascular invasion by the fungi.
Results:
With respect to the various predisposing systemic conditions, Candida species endophthalmitis was noted in patients with a history of gastrointestinal surgery, hyperalimentation, or diabetes mellitus, whereas aspergillosis was present in patients who had undergone organ transplantation or cardiac surgery. The vitreous was the primary focus of infection for Candida, whereas subretinal or sub-retinal pigment epithelium infection was noted in eyes with aspergillosis. Retinal and choroidal vessel wall invasion by fungal elements was noted in cases of aspergillosis but not in cases with candidiasis. The high rate of cerebral and cardiac infection in patients with Aspergillus endophthalmitis was not seen in those with Candida infection.
Conclusions:
The present study indicates that unlike Candida endophthalmitis, aspergillosis is seen in organ transplant or cardiac surgery patients, and its initial clinical presentation includes extensive areas of deep retinitis/choroiditis. Contrary to the findings in Candida endophthalmitis, vitreous biopsy may not yield positive results in aspergillosis. Aspergillus endophthalmitis is usually associated with a high rate of mortality caused by cerebral and cardiac complications.
Insights
Differentiating endogenous fungal endophthalmitis is crucial for patient outcomes. Aspergillus endophthalmitis, common in transplant patients, presents differently from Candida infections, often with deeper ocular involvement and higher mortality.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Endogenous fungal endophthalmitis from Candida and Aspergillus species poses a significant threat to vision, particularly in immunocompromised individuals.
- Distinguishing between Aspergillus and Candida endophthalmitis is clinically important due to differing prognoses and management strategies.
Purpose of the Study:
- To compare clinical and histopathologic features of endogenous Aspergillus versus Candida endophthalmitis in patients who underwent enucleation.
- To identify distinguishing characteristics that differentiate aspergillosis from candidiasis in intraocular infections.
Main Methods:
- Retrospective analysis of 25 enucleated eyes (13 Aspergillus, 12 Candida) with endogenous endophthalmitis.
- Evaluation of clinical data, underlying conditions, and histopathologic findings, including fungal element location, inflammation, and vascular invasion.
- Exclusion of patients with Acquired Immunodeficiency Syndrome (AIDS).
Main Results:
- Candida endophthalmitis associated with gastrointestinal surgery, hyperalimentation, or diabetes; Aspergillus with organ transplantation or cardiac surgery.
- Candida primarily infected the vitreous, while Aspergillus involved subretinal spaces and retinal pigment epithelium.
- Aspergillus showed vascular invasion and higher rates of cerebral/cardiac infection, unlike Candida.
Conclusions:
- Aspergillus endophthalmitis occurs in organ transplant/cardiac surgery patients, presenting with deep retinitis/choroiditis, unlike Candida endophthalmitis.
- Vitreous biopsy may be less effective for diagnosing Aspergillus endophthalmitis compared to Candida.
- Aspergillus endophthalmitis is linked to a higher mortality rate due to systemic complications.