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Fungal feeding-line infections: beware the eyes and teeth
J M Nightingale1, A J Simpson, H M Towler
1St Mark's Hospital, London, UK.
Abstract:
Twenty-four fungal feeding-line infections occurred in 17 patients during 1984-1992. Thirteen were receiving long-term home parenteral feeding and, in them, the first infection occurred after a median of 30 months (range 1-120) continuous feeding with a line that had been in situ for a median of 20 months (range 1-37). Four were receiving short-term feeding through a line that had been inserted 1-2 months previously. At the time of the first infection all patients were febrile and most were anaemic (15/16), however a leucocytosis was rare (three of 16). The fungi isolated were Candida albicans(6), Candida parapsilosis(5), Candida glabrata(2), Candida guillermondii(2) and other species (2). In 16 patients, the feeding-line was removed at the time of the first infection and no other treatment was given, and no other complications occurred in eight (50%) of these. In 11, the line was reinserted a median of 7 days after removal (range 1-11). Four patients (24%) developed a Candida infection of the eye 1-8 weeks after the diagnosis, uveitis (2) and endophthalmitis (2) which, in one patient, led to complete blindness in one eye. Two patients had recurrent infections which began within a month of dental therapy. In one, the infections stopped after dental extractions and, in the other, after a dental clearance. An ophthalmoscopic examination should be performed in all patients with a fungal feeding-line infection. Recurrent candidal infections may have a dental origin.
Insights
Fungal feeding-line infections, often caused by Candida species, can lead to serious complications like eye infections. Dental issues may trigger recurrent fungal infections in some patients.
Area of Science:
- Infectious Diseases
- Medical Mycology
- Clinical Microbiology
Background:
- Fungal infections associated with indwelling medical devices, particularly parenteral feeding lines, pose a significant clinical challenge.
- Understanding the incidence and causative agents of fungal feeding-line infections is crucial for patient management.
Observation:
- A study identified 24 fungal feeding-line infections in 17 patients between 1984 and 1992.
- Infections occurred in patients on both long-term and short-term parenteral feeding, with varying durations of catheter use.
- Commonly isolated fungi included Candida albicans, Candida parapsilosis, and Candida glabrata.
Findings:
- Most infected patients presented with fever and anemia, but leukocytosis was infrequent.
- Line removal was the primary intervention in 16 patients, with 50% experiencing no further complications.
- Ocular candidiasis (uveitis, endophthalmitis) developed in 24% of patients, with one case resulting in blindness.
- Recurrent infections in two patients were linked to dental therapy, resolving after dental interventions.
Implications:
- Ophthalmoscopic examination is recommended for all patients with fungal feeding-line infections to detect potential ocular involvement.
- Recurrent candidal infections may indicate an underlying dental source, necessitating dental evaluation and treatment.
- These findings highlight the importance of vigilance for fungal infections related to parenteral feeding lines and prompt investigation of recurrent cases.