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Published on: February 6, 2021
Fungal endophthalmitis: fourteen years' experience from a center in India
Arunaloke Chakrabarti1, M R Shivaprakash, Ramandeep Singh
1Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. arunaloke@hotmail.com
Background:
As fungal endophthalmitis is an emerging challenge, the study was carried out to determine the prevalence and the spectrum of fungal agents causing endophthalmitis from a single center, to identify the risk factors, and to correlate clinical course of illness with the agents involved.
Methods:
The microbiological and clinical records of all fungal endophthalmitis diagnosed during January 1992 through December 2005 at a tertiary center in India were reviewed retrospectively. During this period, treatment protocol of the patients with fungal endophthalmitis was pars plana vitrectomy, instillation of intravitreal amphotericin B (5 microg) and dexamethasone (400 microg). Additionally, oral fluconazole (27 patients) or itraconazole (78 patients) was given in 105 patients.
Results:
Fungal endophthalmitis was diagnosed in 113 patients and they were categorized into: postcataract surgery (53 patients), posttrauma (48), and endogenous (12) groups. Aspergillus species was the most common (54.4%) agent isolated, followed by yeasts (24.6%), and melanized fungi (10.5%). Among Aspergilli, Aspergillus flavus was the most common (24.6%) species whereas Candida tropicalis (8.8%) was in the yeast. Other rare agents isolated include Fonsecaea pedrosoi, Fusarium solani, Paecilomyces lilacinus, Pseudallescheria boydii, Colletotrichum dematium, Cryptococcus neoformans, and Trichosporon cutaneum. Visual acuity after therapy remained <20/400 in 77.4%, 64.3%, 50.0%, and 16.7% patients infected with Aspergillus species, yeasts, melanized fungi and other mycelial fungi, respectively. The outcome was unfavorable in 52.8%, 66.7%, and 33.3% patients with postoperative, posttrauma, and endogenous groups, respectively.
Conclusions:
This study is the largest series of fungal endophthalmitis from a single center and highlights the fact that a vast array of fungi can cause endophthalmitis though Aspergilli are the common agents. The combination of pars plana vitrectomy and intravitreal amphotericin B with or without fluconazole/itraconazole was the common mode of therapy in such patients. However, the main challenge is suspecting fungal etiology at the time of presentation and accurately diagnosing those patients.
Insights
Fungal endophthalmitis is a growing concern, with Aspergillus species being the most common cause. Early suspicion and accurate diagnosis are crucial for effective treatment, often involving surgery and antifungal medications.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal endophthalmitis presents an increasing challenge in clinical practice.
- Understanding its prevalence, causative agents, and risk factors is essential.
Purpose of the Study:
- To determine the prevalence and spectrum of fungal agents causing endophthalmitis.
- To identify associated risk factors.
- To correlate clinical outcomes with specific fungal agents.
Main Methods:
- Retrospective review of microbiological and clinical records (1992-2005) at a tertiary Indian center.
- Analysis of 113 diagnosed cases of fungal endophthalmitis.
- Standard treatment included pars plana vitrectomy, intravitreal amphotericin B and dexamethasone, with oral fluconazole or itraconazole.
Main Results:
- Aspergillus species (54.4%) were the most frequent agents, followed by yeasts (24.6%).
- Aspergillus flavus and Candida tropicalis were the most common species within their groups.
- Poor visual acuity (<20/400) was noted in 77.4% of Aspergillus cases; unfavorable outcomes occurred in 52.8% of postoperative and 66.7% of post-trauma cases.
Conclusions:
- This study represents the largest single-center series on fungal endophthalmitis, confirming a wide range of fungal pathogens.
- Pars plana vitrectomy combined with intravitreal amphotericin B and oral antifungals is a common therapeutic approach.
- Prompt clinical suspicion and accurate diagnosis remain critical challenges in managing fungal endophthalmitis.
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