ENDOGENOUS FUNGAL ENDOPHTHALMITIS FOLLOWING COVID-19 INFECTION: CASE REPORT AND REVIEW OF LITERATURE.

PURPOSE: To describe a case of endogenous endophthalmitis (EE) following severe COVID-19 disease, review patient outcomes with EE following COVID-19 infection, review evidence regarding risk factors for developing EE. METHODS: Review of health records, imaging, intravitreal injection, and pars plana vitrectomy for bilateral fungal EE following severe COVID-19 disease. Literature review on outcomes in EE following COVID-19 disease. RESULTS: 63 year-old male with diabetes and hypertension was admitted to hospital for severe COVID-19 disease for 3 months. His stay required ICU admission, intubation, high-dose corticosteroids, tocilizumab, and was complicated by bacteremia, empyema, and fungal esophagitis. He developed floaters and bilateral vision loss (visual acuity 20/40 OD, CF OS) with vitritis 2.5 months into his stay that did not respond to intravitreal voriconazole. Pars plana vitrectomy was performed for both eyes, resulting in visual acuity of 20/40 OD, 20/30 OS. Vitreous cultures were positive for candida albicans. EE following COVID-19 disease has been reported in 22 patients to date, and outcomes are poor, with 40%+ of eyes legally blind (20/200 or worse). Although influenced by availability of imaging modalities and degree of training of the evaluating physician, misdiagnosis can affect » of cases, delaying treatment. Age, male gender, and diabetes increase risk of severe COVID-19, which requires prolonged hospitalization, invasive catheretization, and immunosuppression, which in turn increases risk of nosocomial infection. CONCLUSION: Low threshold for suspecting endogenous endophthalmitis in patients presenting with floaters and decreased vision following severe COVID-19 disease is necessary to ensure prompt recognition and treatment.

Factors Associated with Willingness to be Vaccinated Against COVID-19 in a Large Convenience Sample.

Willingness and reasons to be vaccinated against COVID-19 were examined among 26,324 respondents who completed a survey on willingness and questions related to Confidence in vaccine safety, Complacency about the disease, Convenience of vaccination, tendency to Calculate risks versus benefits, and Concern for protecting others. Willingness to be vaccinated differed by age (p < 0.001), by race and ethnicity (p < 0.001) and by level of education (p < 0.001). Willingness generally increased with age and education. Asians were most willing to be vaccinated, followed by non-Hispanic Whites, Hispanics, and non-Hispanic Blacks (p < 0.001). Occupational groups differed in willingness (p < 0.001). Retired and students were more willing than all others (p < 0.001) followed by disabled or unemployed, healthcare workers, and educators. First Responders were least willing to be vaccinated (p < 0.001) followed by construction, maintenance and landscaping, homemakers, housekeeping, cleaning and janitorial workers, and retail and food service. The strongest predictor of willingness was confidence with the safety of the vaccine (r = 0.723, p < 0.001), followed by concern with protecting others by being vaccinated (r = 0.574, p < 0.001), and believing COVID-19 was serious enough to merit vaccination (r = 0.478, p < 0.00). Using multiple regression, confidence in safety was the strongest predictor for all groups. Protecting others was strongest for 13 of 15 demographic groups and 8 of 11 occupational groups. College educated, non-Hispanic Whites, first responders, construction, maintenance and landscape workers, housekeeping, cleaning and janitorial workers all gave greater weight to complacency about the disease. These results can help in designing programs to combat vaccine hesitancy.