Endophthalmitis patients in Makassar City: molecular identification of pathogenic fungal profile

Endophthalmitis is a severe inflammation of the internal ocular structures, usually caused by bacterial or fungal infections, and can lead to rapid, irreversible blindness. Fungal endophthalmitis (FE), primarily due to Candida albicans and Aspergillus, is less common than bacterial endophthalmitis but has shown an increase in prevalence over the past two decades. Diagnosing FE is challenging and often delayed due to the time-consuming nature of traditional culture methods. The timely initiation of targeted antifungal therapy based on the specific fungal pathogen identified by molecular method can improve patient outcomes and reduce the risk of vision loss. This study aims to determine the presence of pathogenic fungal infections in patients with endophthalmitis using molecular methods at Hasanuddin University Hospital Makassar.

This cross-sectional observational study analyzed 83 intraocular fluid samples from patients with endophthalmitis at Hasanuddin University Hospital, Makassar, Indonesia. Samples were examined using microscopy, culture, and molecular methods, including polymerase chain reaction (PCR) and deoxyribonucleic acid (DNA) sequencing.

The study population comprised 49 males (59%) and 34 females (41%), with an average age of 45.85 years. The distribution of affected eyes was nearly equal, with 50.6% involving the right eye and 49.4% involving the left eye. Exogenous transmission, primarily related to external risk factors such as ocular trauma or surgical procedures, was identified as the most common mode of fungal transmission in this population (97.6%). No fungal elements were detected through microscopy or culture; however, PCR could identify 5 positive samples (6%); 3 were males and 2 were females; all have exogenous transmission, predominantly showing Candida species. Sequencing revealed Candida parapsilosis, Lodderomyces beijingensis, and Trichophyton rubrum among the findings.

Cases of fungal endophthalmitis are rare but increasing, posing diagnostic challenges. Our study concludes that PCR is more effective than traditional culture methods in identifying fungal pathogens, with a predominance of Candida species identified in endophthalmitis. Molecular techniques like PCR offer rapid and accurate diagnosis, improving patient treatment outcomes by enabling earlier initiation of targeted antifungal therapy.