ABSTRACT
PURPOSE: To report clinical findings, diagnostic and treatment possibilities of patients with endogenous fungal endophthalmitis (EFE). METHODS: Retrospective study of 13 patients (19 eyes) with EFE diagnosed and treated in the Dept. of Ophthalmology, 1st Medical Faculty, Charles University in Prague. A detailed personal medical history was taken in all patients. Standard ophthalmic examinations were performed in all cases. RESULTS: All of our patients had one or more of known risk factors for ocular fungal infections. There were intravenous drug users, immunosuppressed patients, postoperative patients receiving broad-spectrum antibiotics in our investigated group. The mean age of the patients was 39 years (from 19 to 68 years), the interval between the first ocular symptoms and correct diagnosis was up to 7 months (mean 2.1 months). Pars plana vitrectomy (PPV) was performed in 15 eyes and Amphotericin B was instilled into vitreous cavity at the end of the procedure. Amphotericin B was injected into vitreous without PPV in two eyes. All patients were treated with systemic antifungal agents. Only Candida albicans was the cause of EFE in 10 patients. Microscopic examination and culture were positive in 9 patients, 1 patient had positive serum antibodies against Candida albicans in significant titres. Final visual acuity improved in 47% of the eyes, stabilized in 36% of the eyes, and decreased in 17% of the eyes. CONCLUSION: Endogenous fungal endophthalmitis was seen as an opportunistic disease in all patients. Candida albicans was the only evidenced cause of fungal endophthalmitis. If prompt antifungal treatment after clinical suspicion of EFE begins, successful visual outcome is possible.
Subject(s)
Endophthalmitis/surgery , Eye Infections, Fungal/surgery , Vitrectomy , Adult , Aged , Antifungal Agents/therapeutic use , Endophthalmitis/drug therapy , Eye Infections, Fungal/drug therapy , Female , Humans , Male , Middle Aged , Opportunistic Infections/drug therapy , Opportunistic Infections/surgery , Retrospective StudiesABSTRACT
The diagnosis of mycotic infections still remains a serious problem. The clinical picture lacks specific manifestations, usually it does not differ substantially from bacterial infections. Routine laboratory examinations are only of subsidiary importance and even more specific methods (assessment of antibodies, and in particular detection of mycotic antigens) do not meet expectations so far. To establish the diagnosis of systemic mycosis it is thus most important to consider the possibility and to support clinical suspicion by an aimed examination.
Subject(s)
Mycoses/diagnosis , HumansABSTRACT
Thirteen patients with oropharyngeal and oesophageal mycosis were treated with a new triazole antimycotic, fluconazole. In the whole group in addition to the basic neoplastic disease as multifactorial predisposition to mycotic infection was revealed. After treatment a 100% clinical as well a laboratory effect was achieved. However, within one month a relapse developed in three of eight patients and reinfection in four of eight (renewal of laboratory evidence). The preparation was well tolerated by the patients, no laboratory signs of organ toxicity were revealed. In patients with cumulation of predisposing factors for mycotic infection the authors recommend long-term prophylactic protection with a small dose of fluconazole.
