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Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis.

ABSTRACT: To report the clinical settings, microbiological isolates, and best-corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis.Retrospective consecutive case series.Setting: Tertiary referral center.Sixteen eyes of 16 patients with at least 2 consecutive positive vitreous cultures between 1981 and 2015.Intravitreal antifungal injection, pars plana vitrectomy (PPV).Clinical settings, microbiologic isolates, BCVA.The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ?20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (?20/1400, P = .83). The 9 patients (56%) who had intraocular lens (IOL) and capsular bag removals had better final BCVAs than those who did not (P = .011). The BCVAs were similar in eyes with yeast and mold (P = .37). The visual acuity at the last follow-up was ?20/40 in 13% (2/16), ?20/400 in 50% (8/16), and no light perception in 25% (4/16).Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.

SUBMITTER: Leung EH

PROVIDER: S-EPMC5121022 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis.

Leung Ella H EH Kuriyan Ajay E AE Flynn Harry W HW Relhan Nidhi N Huang Laura C LC Miller Darlene D

American journal of ophthalmology 20160916

<h4>Purpose</h4>To report the clinical settings, microbiological isolates, and best-corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis.<h4>Design</h4>Retrospective consecutive case series.<h4>Methods</h4>Setting: Tertiary referral center.<h4>Patient population</h4>Sixteen eyes of 16 patients with at least 2 consecutive positive vitreous cultures between 1981 and 2015.<h4>Interventions</h4>Intravitreal antifungal injection, pars plana ...[more]

PMID: 27644590

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Project description:To evaluate the clinical utility of high-throughput sequencing (HTS) approach-based analysis of the bacterial and fungal genome in vitreous fluids from patients clinically diagnosed as endophthalmitis, we subjected 75 vitreous fluids from clinically presumed infectious endophthalmitis patients to high-throughput sequencing (Illumina HiSeq 2500) after DNA extraction and amplification of the 16S rRNA for the detection of bacteria, and ITS 2 region for detection of fungal pathogens. As controls, we included vitreous biopsies from 70 patients diagnosed with other non-infectious retinal disorders. Following the construction of the curated microbial genome database and filtering steps to reduce ambiguousness/contaminants from the environment, the paired reads were analyzed. Our HTS reads revealed in almost all cases the same organism that was grown in culture (bacterial-14/15, fungal 3/3) by conventional microbiological workup. HTS additionally diagnosed the presence of microbes in 42/57 (73.7%) patients who were conventionally negative (fungal pathogens in 36/57, bacterial pathogens in 11/57, including five cases that showed the presence of both bacterial and fungal organisms). Aspergillus sp., Fusarium sp., Exserohilum sp., and Candida sp. were the most predominant genera in our cohort of culture-negative endophthalmitis cases. Heat map based microbial clustering analysis revealed that these organisms were taxonomically similar to the species identified by conventional culture methods. Interestingly, 4/70 control samples also showed the presence of bacterial reads, although their clinical significance is uncertain. HTS is useful in detecting pathogens in endophthalmitis cases that elude conventional attempts at diagnosis and can provide actionable information relevant to management, especially where there is a high index of suspicion of fungal endophthalmitis, particularly in tropical countries. Outcome analyses and clinical trials addressing the success and cost savings of HTS for the diagnosis of endophthalmitis are recommended.

Dataset Information

Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis.

Publications

Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis.

Similar Datasets

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