A Retrospective Case Study of the Incidence of Endogenous Fungal Endophthalmitis in Patients with Positive Blood Cultures for Systemic Fungemia: Review of the Literature

Abstract

Aims: To determine the incidence of fungal ocular involvement, manifesting as chorioretinitis or endophthalmitis, in patients with positive fungal blood cultures in a tertiary care center. Study Design: Retrospective case series and literature review. Place and Duration of Study: Department of Surgery–Section of Ophthalmology and Visual Science, University of Chicago Pritzker School of Medicine, Chicago, Illinois. August 2006 to October 2009. Methodology: Ophthalmology was consulted for evaluation of 100 adult and pediatric patients (47 men, 53 women; age range 10 days–84 years) with fungemia. Results: Of 100 patients, blood cultures most frequently grew Candida albicans (42%), followed by Candida parapsilosis (22%), and Candida glabrata (16%). One patient had clinical signs of fungal ocular involvement (1/100, 1%) but no ocular symptoms.  Blood cultures in this case were positive for Candida glabrata, and the patient clinically improved after switching antifungal therapy to PO voriconazole.  Two other patients (2%) had nonspecific fundus lesions that were not consistent with chorioretinitis or endophthalmitis. Conclusions: The incidence of ocular involvement in patients with fungemia is 1%, which is consistent with recent trends in literature.  We believe that guidelines for screening criteria in at-risk inpatients for fungal chorioretinitis and endophthalmitis should be updated.