Histopathological study on experimental endophthalmitis induced by bloodstream infection with Candida albicans

To investigate the details of the pathophysiology of endogenous fungal endophthalmitis (EFE), we performed sequential histological and ophthalmoscopic examination on a rabbit model comparing immunocompromised EFE developed using a steroid with an immunocompetent one intravenously inoculated with Candida albicans. The ophthalmoscopic examination and histological analysis of the retina in both groups demonstrated that lesions appear on the equator of the eyeball and then spread toward the posterior pole. It has been speculated that, because of the unique innate vasculature system of the equator, there is a sudden, decrease of shear stress in rheologically, resulting in adhesion of yeast cells to the endothelial cells. Histological examination revealed that the degree of polymorphonuclear leukocyte (PMN) infiltration was equivalent in the two groups. However, the appearance of PMN was delayed and the number of fungi was higher in the state of hyphae and/or pseudohyphae in the steroid-treated group. Furthermore, the eyeball was found to be the second earliest organ involved in candidemia. Our results indicate that ophthalmic examination is useful to monitor the development and systemic involvement of endophthalmitis in patients with candidemia.