Endogenous filamentous fungal endophthalmitis--single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

Mycoses. 2011 Nov;54(6):e704-11. doi: 10.1111/j.1439-0507.2010.02004.x. Epub 2011 May 23.

Abstract

Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / administration & dosage
  • Child
  • Child, Preschool
  • Endophthalmitis / epidemiology*
  • Endophthalmitis / microbiology*
  • Endophthalmitis / pathology
  • Endophthalmitis / therapy
  • Eye Infections, Fungal / epidemiology*
  • Eye Infections, Fungal / microbiology*
  • Eye Infections, Fungal / pathology
  • Eye Infections, Fungal / therapy
  • Female
  • Fungi / isolation & purification*
  • Humans
  • Immunocompromised Host
  • Injections, Intraocular
  • Leukemia / complications*
  • Leukemia / drug therapy
  • Male
  • Middle Aged
  • Stem Cell Transplantation / adverse effects*
  • Survival Analysis
  • Time Factors
  • Treatment Outcome
  • Vitrectomy
  • Young Adult

Substances

  • Antifungal Agents