1/25. Candida endophthalmitis: an unusual complication of prolonged intravenous access.A 16 year old boy awaiting a defunctioning colostomy for Crohn's disease complained of reduced vision in his left eye. Four weeks previously candida had been isolated from his central line used for parenteral feeds. Fundal examination of the left eye revealed a macular abscess with a classic "string of pearls" appearance of multiple vitreous abscesses. This was treated with pars plana vitrectomy and intravitreal antifungal therapy. Microbiological studies confirmed a diagnosis of candida endophthalmitis.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
2/25. Recurrent endogenous candidal endophthalmitis in a premature infant.Endogenous Candida endophthalmitis resulting from candidemia in low-birth-weight infants usually occurs as a retinochoroiditis, which is effectively treated with systemic antifungal agents. We report a case of Candida endophthalmitis that recurred 4 months after completion of systemic antifungal therapy. The recurrent Candida infection affected primarily the iris and lens, rather than the retina and choroid. vitrectomy was required for diagnosis and treatment.- - - - - - - - - - ranking = 2keywords = candida (Clic here for more details about this article) |
3/25. Candidal endophthalmitis after keratoplasty.PURPOSE: To report a case of explosive fungal endophthalmitis after penetrating keratoplasty and to review additional published and unpublished cases to consider possible strategies for prevention. methods: Records of this patient with postkeratoplasty candidal endophthalmitis and previously reported cases of postkeratoplasty candidal endophthalmitis were reviewed. Additional information of 26 unpublished cases was obtained from the eye Bank association of America. RESULTS: After standard keratoplasty, the patient developed precipitous endophthalmitis on the second postoperative day. Abundant contamination with Candida was found in the residual donor corneoscleral rim, and candida albicans was isolated from the aqueous humor of the recipient. Despite therapy with local antimicrobial agents, intraocular amphotericin b, and systemic fluconazole, the patient had a poor outcome with hand-motion visual acuity. Of the 44 collected cases of postkeratoplasty candidal endophthalmitis, 40 (91%) had the same organism cultured from the donor rim or medium. Forty-three donor corneas had been preserved in cold storage medium at 4 degrees C. Of 15 cases in which the outcome was available, 9 (60%) resulted in visual acuity of 20/200 or worse. CONCLUSION: case reports confirm the occurrence of donor-to-host transmission of postkeratoplasty candidal endophthalmitis. Despite the low reported incidence, the poor prognosis of the affected eye in the ajority of these cases suggests the need for antifungal supplementation of cold preservation media and other preventative strategies.- - - - - - - - - - ranking = 2keywords = candida (Clic here for more details about this article) |
4/25. Clinicopathological report of Candida granuloma from an endogenous candidal endophthalmitis.fluconazole was reported to be an effective alternative to amphotericin b for candidal endophthalmitis. However, the dose for systemic use had not been determined and few pathological reports on its use have been published. An epiretinal membrane harvested from a regressed candidal endophthalmitis in a patient treated with fluconazole (200 mg/day) was sent for pathologic study. On the inner side of the retina, a granuloma was found. Fungal debris was found within the center of the granuloma, but an intact fungus was seen next to the granuloma. Pathologic study showed incomplete treatment in this case, although systemic status had improved. The use of systemic fluconazole should be maintained for a longer period of time to treat candidal endophthalmitis.- - - - - - - - - - ranking = 3.5keywords = candida (Clic here for more details about this article) |
5/25. Unusual etiology of visual loss in an hiv-infected patient due to endogenous endophthalmitis.Disseminated candidiasis, especially ocular infections such as endophthalmitis, is uncommon in hiv-infected patients. We report a case of candidal endophthalmitis in an hiv-positive non-drug-user patient, following candidemia from a cutaneous abscess at the site of a peripheral catheter. Ocular disease was revealed by a visual decrease in the left eye. dna analysis using RAPD showed identical patterns of candida albicans isolated from the skin and eye. Combination therapy with high-dose fluconazole and intravenous amphotericin b was performed. Two intravitreal amphotericin b injections and a vitrectomy were administered because of an amblyopic right eye and severe vitritis. The outcome was favorable without relapse at 18 months.- - - - - - - - - - ranking = 0.5keywords = candida (Clic here for more details about this article) |
6/25. Visual and anatomical outcome following submacular surgery for choroidal neovascularization secondary to Candida endophthalmitis.PURPOSE: To report the long-term visual and anatomical outcomes for patients treated with submacular surgery for choroidal neovascularization associated with endogenous candidal endophthalmitis. methods: review of the medical records, fluorescein angiograms, fundus photographs, and histopathologic specimens of patients treated with submacular surgery for choroidal neovascularization following candidal endophthalmitis. RESULTS: This series included 3 patients (1 woman and 2 men) who were 26, 30, and 60 years of age. Each patient had received systemic antifungal treatment for culture-proven candidal septicemia before the development of choroidal neovascularization. Each patient had bilateral choroidal neovascularization diagnosed by biomicroscopic examination and angiographic appearance: 2 eyes had an active subfoveal membrane; 2, an active juxtafoveal subretinal membrane; and 2, a mixture of active subfoveal neovascularization with subfoveal fibrosis. Submacular surgery was performed on five eyes with choroidal neovascularization; one eye with subfoveal fibrosis was observed. visual acuity improved substantially in 4 eyes of 3 patients treated with submacular surgery. Visual improvement was limited in the two eyes with preexisting submacular fibrosis. During 13-month to 82-month follow-ups, vision remained stable, with no recurrence of neovascularization. CONCLUSION: choroidal neovascularization can cause severe visual loss in patients with endogenous candidal infection. Submacular surgery with removal of choroidal neovascularization may restore vision in selected patients. Subfoveal fibrosis may limit visual improvement.- - - - - - - - - - ranking = 2keywords = candida (Clic here for more details about this article) |
7/25. The first echinocandin: caspofungin.The antifungal agent caspofungin is the first echinocandin that has been approved in the US and in europe for treatment of invasive aspergillosis in adult patients who are refractory to or intolerant of conventional amphotericin b, its lipid-based formulations, and/or itraconazole. It is given as a 70 mg loading dose and a 50 mg daily maintainance dose as a one hour infusion. Due to low intestinal absorption an oral formulation has not been developed. Caspofungin is active against Candida spp. and aspergillus spp. by inhibition the synthesis of beta-(1,3)-D-glucan, a cell wall component. The drug is inactive against cryptococcus spp., fusarium spp., trichosporon spp., rhizopus spp., and Pseudoallescheria spp. In invasive aspergillosis caspofungin resulted in higher response rates compared to a historic control under standard therapy. Efficacy data on persistently febrile neutropenic patients are pending. In several multicenter randomised double blind trials on candida infections caspofungin proved to be at least non-inferior to standard therapies. Reports of combination therapy or highly effective antifungal treatment (HEAT) in limited patient numbers are promising. New trials of combination therapy are warranted.- - - - - - - - - - ranking = 0.5keywords = candida (Clic here for more details about this article) |
8/25. fluconazole in the treatment of candida albicans endophthalmitis.A 29-year-old former drug addict with candida albicans endophthalmitis determined by cultivation was treated with vitrectomy and systemic fluconazole. The infection resolved completely and the patient recovered a visual acuity of 6/6. fluconazole was well tolerated and a high concentration was found in the vitreous cavity.- - - - - - - - - - ranking = 2.5keywords = candida (Clic here for more details about this article) |
9/25. fluconazole treatment of catheter-related right-sided endocarditis caused by candida albicans and associated with endophthalmitis and folliculitis.An unusual case of catheter-related right-sided endocarditis, endophthalmitis, and extensive folliculitis, apparently caused by a single dna biotype of Candida albicans, was successfully treated with a 6-month course of fluconazole plus two intravitreous doses of amphotericin b. The patient was a 21-year-old man who underwent colectomy for diffuse polyposis and developed the clinical syndrome just described following total parenteral nutrition for the treatment of purulent anal fistulas. fluconazole was initially administered at a daily dose of 200 mg, with 600 mg daily given after 4 weeks. Clinical improvement resulted, with no relapse during 14 months of follow-up. Sequential measurements by an enzyme-linked immunosorbent inhibition assay demonstrated that levels of circulating mannoprotein antigen of C. albicans fell from 75 ng/mL to less than 1 ng/mL after the institution of fluconazole therapy. These observations seem to confirm previous reports on the efficacy of fluconazole as sole therapy for candidal endocarditis and suggest a role for serological studies in clinical monitoring of severe candidal infections.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
10/25. Donor-to-host transmitted Candida endophthalmitis after penetrating keratoplasty.OBJECTIVE: To report the first case of candida albicans endophthalmitis following penetrating keratoplasty after warm preservation. DESIGN: Observational case report. methods: We reviewed the patient's chart and the available literature on fungal endophthalmitis after keratoplasty. RESULTS: After keratoplasty, a 45-year-old man developed an endophthalmitis on the first postoperative day. The same day, results of the culture of the transportation medium were available and revealed candida albicans. Despite therapy with topical and subtenon amphotericin b, there was no clinical improvement, and a regraft was performed 4 days after the initial corneal transplant. A best corrected visual acuity of 20/32 was achieved. CONCLUSION: The majority of reported cases of postkeratoplasty candidal endophthalmitis are associated with cold storage preservation and a poor prognosis of the affected eye. We describe a case of postkeratoplasty candidal endophthalmitis after organ-cultured preservation, with a final visual acuity above expectations. In our opinion, early diagnosis based on routine culturing of the transportation medium and early removal of the infected corneal graft when local antifungal therapy failed are important factors contributing to the good clinical outcome.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
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