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Ocular involvement in patients with fungal infections
Abstract:
Autopsy findings of 133 patients who died following fungemia or with invasive fungal infection were reviewed. Common clinical factors included antibiotic therapy, chemotherapy, corticosteroid administration, hyperalimentation, malignancy, and bone marrow transplantation. Fungal infection was seldom diagnosed antemortem and fungemia was detected in only 24 patients (18%). Ocular involvement occurred in 14 patients (Candida 11, Aspergillus 2, and Cryptococcus 1). The eye was the fifth most commonly involved organ at autopsy among patients with candida infection. Ocular involvement occurred with a significantly greater frequency in patients with Candida tropicalis than with Candida albicans infections (P less than 0.05). Although only about 10% of patients with fungal infections had ocular involvement, all those with ocular lesions had widely disseminated disease. Realizing the potential toxicity of antifungal therapy, we recommend that screening ophthalmologic examinations be performed on patients with fungemia or patients at high risk for development of fungal infection. The presence of ocular lesions consistent with fungal disease, in the appropriate setting, is a strong indication for investigation of possible systemic fungal infection and therapy once a definitive diagnosis is established.
Insights
Ocular involvement is common in invasive fungal infections, particularly Candida tropicalis. Early ophthalmologic screening is crucial for high-risk patients to detect disseminated fungal disease.
Area of Science:
- Medicine
- Infectious Diseases
- Ophthalmology
Background:
- Invasive fungal infections and fungemia pose significant risks, especially in immunocompromised patients.
- Antemortem diagnosis of fungal infections is often challenging, with fungemia detected in only 18% of cases.
- Risk factors include antibiotic therapy, chemotherapy, corticosteroid use, hyperalimentation, malignancy, and bone marrow transplantation.
Purpose of the Study:
- To review autopsy findings of patients with invasive fungal infections.
- To determine the frequency and patterns of ocular involvement in these patients.
- To evaluate the significance of ocular findings in diagnosing systemic fungal infections.
Main Methods:
- Retrospective review of autopsy findings from 133 patients with fungemia or invasive fungal infection.
- Analysis of clinical factors associated with fungal infections.
- Documentation of organ involvement, with a focus on ocular manifestations.
Main Results:
- Ocular involvement was observed in 14 patients (10.5%), with Candida being the most common pathogen (11 cases).
- The eye was the fifth most commonly involved organ in Candida infections.
- Ocular involvement was significantly more frequent in Candida tropicalis infections compared to Candida albicans (P < 0.05).
- All patients with ocular lesions had widely disseminated fungal disease.
Conclusions:
- Ocular involvement in invasive fungal infections, though occurring in about 10% of cases, indicates disseminated disease.
- Screening ophthalmologic examinations are recommended for patients with fungemia or at high risk.
- Ocular lesions suggestive of fungal disease warrant investigation for systemic infection and prompt therapy.