Endophthalmitis in patients with disseminated fungal disease

Fungal endophthalmitis caused by dissemination from extraocular fungal infections has been reported to vary between 9% and 45%. However, recent clinical experience disagrees with that. This study is an investigation of patients in an inner city teaching hospital, the risks associated with endogenous fungal endophthalmitis, and this incidence. All ophthalmology consultations between February 1995 and August 2000 that might be associated with disseminated fungal infection were examined in a prospective manner. Patients were excluded if there was no evidence of a positive fungal culture from any site at any time. Visual symptoms were recorded along with ophthalmologic and systemic examination features. Information was gathered, including the identity of cultured organisms, the sites from which the organisms were obtained, and the patients' disposition. During this interval, 170 consultation requests contained the words "endophthalmitis" or "retinitis" and/or indicated concern about disseminated fungal infections. Extraocular fungal infections were found in 114 patients, but only 82 of them had evidence of systemic dissemination. Some patients had more than one organism. The following are listed in decreasing frequency of occurrence: Candida albicans, Torulopsis glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Aspergillus niger, and others. Only two patients had evidence of chorioretinitis and progressed to fungal endophthalmitis. Endophthalmitis was rare among these patients with known fungal infections. Less than 2% had any related ophthalmic manifestations. Nevertheless, since treatment can save vision, evidence of intraocular infection should be sought as eagerly as before.