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. 2000;98:183–194.

A comparative clinicopathologic study of endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared to aspergillosis.

N A Rao 1, A Hidayat 1
PMCID: PMC1298225  PMID: 11190022

Abstract

PURPOSE: Endophthalmitis caused by endogenous Candida and Aspergillus species has emerged as a visually threatening complication in patients with immune deficiency of various causes. Twenty-five patients who underwent enucleation, 13 with endogenous Aspergillus endophthalmitis and 12 with endogenous Candida intraocular infections, were evaluated. Both clinical features and intraocular spread of the fungi were studied to determine which clinical and/or histopathologic features could help distinguish aspergillosis from Candida infections. METHODS: Clinical information was sought from each case to determine whether there was any underlying systemic condition and to delineate the characteristic clinical features seen at initial presentation. The results of vitreous and other tissue cultures for bacteria and fungi were evaluated. Patients with AIDS were excluded. The enucleated globes were processed for histopathologic analysis to detect location of the fungal elements, inflammatory response, and vascular invasion by the fungi. RESULTS: With respect to the various predisposing systemic conditions, Candida species endophthalmitis was noted in patients with a history of gastrointestinal surgery, hyperalimentation, or diabetes mellitus, whereas aspergillosis was present in patients who had undergone organ transplantation or cardiac surgery. The vitreous was the primary focus of infection for Candida, whereas subretinal or sub-retinal pigment epithelium infection was noted in eyes with aspergillosis. Retinal and choroidal vessel wall invasion by fungal elements was noted in cases of aspergillosis but not in cases with candidiasis. The high rate of cerebral and cardiac infection in patients with Aspergillus endophthalmitis was not seen in those with Candida infection. CONCLUSIONS: The present study indicates that unlike Candida endophthalmitis, aspergillosis is seen in organ transplant or cardiac surgery patients, and its initial clinical presentation includes extensive areas of deep retinitis/choroiditis. Contrary to the findings in Candida endophthalmitis, vitreous biopsy may not yield positive results in aspergillosis. Aspergillus endophthalmitis is usually associated with a high rate of mortality caused by cerebral and cardiac complications.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berenguer J., Allende M. C., Lee J. W., Garrett K., Lyman C., Ali N. M., Bacher J., Pizzo P. A., Walsh T. J. Pathogenesis of pulmonary aspergillosis. Granulocytopenia versus cyclosporine and methylprednisolone-induced immunosuppression. Am J Respir Crit Care Med. 1995 Sep;152(3):1079–1086. doi: 10.1164/ajrccm.152.3.7663787. [DOI] [PubMed] [Google Scholar]
  2. Bodoia R. D., Kinyoun J. L., Lou Q. L., Bunt-Milam A. H. Aspergillus necrotizing retinitis. A clinico-pathologic study and review. Retina. 1989;9(3):226–231. [PubMed] [Google Scholar]
  3. Boldrey E. E. Bilateral endogenous Aspergillus endophthalmitis. Retina. 1981;1(3):171–174. doi: 10.1097/00006982-198101030-00006. [DOI] [PubMed] [Google Scholar]
  4. Cogan D. G. Immunosuppression and eye disease. First Vail lecture. Am J Ophthalmol. 1977 Jun;83(6):777–788. doi: 10.1016/0002-9394(77)90903-5. [DOI] [PubMed] [Google Scholar]
  5. Demicco D. D., Reichman R. C., Violette E. J., Winn W. C., Jr Disseminated aspergillosis presenting with endophthalmitis. A case report and a review of the literature. Cancer. 1984 May 1;53(9):1995–2001. doi: 10.1002/1097-0142(19840501)53:9<1995::aid-cncr2820530932>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  6. DiMattio J., Zadunaisky J. A., Altszuler N. Onset of changes in glucose transport across ocular barriers in streptozotocin-induced diabetes. Invest Ophthalmol Vis Sci. 1984 Jul;25(7):820–826. [PubMed] [Google Scholar]
  7. Doft B. H., Clarkson J. G., Rebell G., Forster R. K. Endogenous Aspergillus endophthalmitis in drug abusers. Arch Ophthalmol. 1980 May;98(5):859–862. doi: 10.1001/archopht.1980.01020030853010. [DOI] [PubMed] [Google Scholar]
  8. Edwards J. E., Jr, Foos R. Y., Montgomerie J. Z., Guze L. B. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis. Medicine (Baltimore) 1974 Jan;53(1):47–75. doi: 10.1097/00005792-197401000-00002. [DOI] [PubMed] [Google Scholar]
  9. Essman T. F., Flynn H. W., Jr, Smiddy W. E., Brod R. D., Murray T. G., Davis J. L., Rubsamen P. E. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers. 1997 Mar;28(3):185–194. [PubMed] [Google Scholar]
  10. Friedman A. H., Chishti M. I., Henkind P. Endogenous ocular aspergillosis. Ophthalmologica. 1974;168(3):197–205. doi: 10.1159/000307040. [DOI] [PubMed] [Google Scholar]
  11. Gabriele P., Hutchins R. K. Fusarium endophthalmitis in an intravenous drug abuser. Am J Ophthalmol. 1996 Jul;122(1):119–121. doi: 10.1016/s0002-9394(14)71976-2. [DOI] [PubMed] [Google Scholar]
  12. Gerson S. L., Talbot G. H., Hurwitz S., Strom B. L., Lusk E. J., Cassileth P. A. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med. 1984 Mar;100(3):345–351. doi: 10.7326/0003-4819-100-3-345. [DOI] [PubMed] [Google Scholar]
  13. Graham D. A., Kinyoun J. L., George D. P. Endogenous Aspergillus endophthalmitis after lung transplantation. Am J Ophthalmol. 1995 Jan;119(1):107–109. doi: 10.1016/s0002-9394(14)73829-2. [DOI] [PubMed] [Google Scholar]
  14. Henderly D. E., Liggett P. E., Rao N. A. Cryptococcal chorioretinitis and endophthalmitis. Retina. 1987 Summer;7(2):75–79. doi: 10.1097/00006982-198700720-00003. [DOI] [PubMed] [Google Scholar]
  15. Hunt K. E., Glasgow B. J. Aspergillus endophthalmitis. An unrecognized endemic disease in orthotopic liver transplantation. Ophthalmology. 1996 May;103(5):757–767. doi: 10.1016/s0161-6420(96)30619-2. [DOI] [PubMed] [Google Scholar]
  16. Jampol L. M., Dyckman S., Maniates V., Tso M., Daily M., O'Grady R. Retinal and choroidal infarction from Aspergillus: clinical diagnosis and clinicopathologic correlations. Trans Am Ophthalmol Soc. 1988;86:422–440. [PMC free article] [PubMed] [Google Scholar]
  17. Lam D. S., Koehler A. P., Fan D. S., Cheuk W., Leung A. T., Ng J. S. Endogenous fungal endophthalmitis caused by Paecilomyces variotii. Eye (Lond) 1999;13(Pt 1):113–116. doi: 10.1038/eye.1999.23. [DOI] [PubMed] [Google Scholar]
  18. Leen C. L., Brettle R. P. Fungal infections in drug users. J Antimicrob Chemother. 1991 Jul;28 (Suppl A):83–96. doi: 10.1093/jac/28.suppl_a.83. [DOI] [PubMed] [Google Scholar]
  19. Lundquist O., Osterlin S. Glucose concentration in the vitreous of nondiabetic and diabetic human eyes. Graefes Arch Clin Exp Ophthalmol. 1994 Feb;232(2):71–74. doi: 10.1007/BF00171666. [DOI] [PubMed] [Google Scholar]
  20. MacCormick W. F., Schochet S. S., Jr, Weaver P. R., MacCrary J. A., 3rd Disseminated aspergillosis. Aspergillus endophthalmitis, optic nerve infarction, and carotid artery thrombosis. Arch Pathol. 1975 Jul;99(7):353–359. [PubMed] [Google Scholar]
  21. McDonnell P. J., McDonnell J. M., Brown R. H., Green W. R. Ocular involvement in patients with fungal infections. Ophthalmology. 1985 May;92(5):706–709. doi: 10.1016/s0161-6420(85)33989-1. [DOI] [PubMed] [Google Scholar]
  22. Michelson J. B., Freedman S. D., Boyden D. G. Aspergillus endophthalmitis in a drug abuser. Ann Ophthalmol. 1982 Nov;14(11):1051–1054. [PubMed] [Google Scholar]
  23. Naidoff M. A., Green W. R. Endogenous Aspergillus endophthalmitis occurring after kidney transplant. Am J Ophthalmol. 1975 Mar;79(3):502–509. doi: 10.1016/0002-9394(75)90628-5. [DOI] [PubMed] [Google Scholar]
  24. Patel A. S., Hemady R. K., Rodrigues M., Rajagopalan S., Elman M. J. Endogenous Fusarium endophthalmitis in a patient with acute lymphocytic leukemia. Am J Ophthalmol. 1994 Mar 15;117(3):363–368. doi: 10.1016/s0002-9394(14)73147-2. [DOI] [PubMed] [Google Scholar]
  25. Rao N. A., Wu G. S. Free radical mediated photoreceptor damage in uveitis. Prog Retin Eye Res. 2000 Jan;19(1):41–68. doi: 10.1016/s1350-9462(99)00003-8. [DOI] [PubMed] [Google Scholar]
  26. Roilides E., Uhlig K., Venzon D., Pizzo P. A., Walsh T. J. Enhancement of oxidative response and damage caused by human neutrophils to Aspergillus fumigatus hyphae by granulocyte colony-stimulating factor and gamma interferon. Infect Immun. 1993 Apr;61(4):1185–1193. doi: 10.1128/iai.61.4.1185-1193.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Samiy N., D'Amico D. J. Endogenous fungal endophthalmitis. Int Ophthalmol Clin. 1996 Summer;36(3):147–162. doi: 10.1097/00004397-199603630-00014. [DOI] [PubMed] [Google Scholar]
  28. Scherer W. J., Lee K. Implications of early systemic therapy on the incidence of endogenous fungal endophthalmitis. Ophthalmology. 1997 Oct;104(10):1593–1598. doi: 10.1016/s0161-6420(97)30091-8. [DOI] [PubMed] [Google Scholar]
  29. Sheu S. J., Chen Y. C., Kuo N. W., Wang J. H., Chen C. J. Endogenous cryptococcal endophthalmitis. Ophthalmology. 1998 Feb;105(2):377–381. doi: 10.1016/s0161-6420(98)93679-x. [DOI] [PubMed] [Google Scholar]
  30. Todeschini G., Murari C., Bonesi R., Pizzolo G., Verlato G., Tecchio C., Meneghini V., Franchini M., Giuffrida C., Perona G. Invasive aspergillosis in neutropenic patients: rapid neutrophil recovery is a risk factor for severe pulmonary complications. Eur J Clin Invest. 1999 May;29(5):453–457. doi: 10.1046/j.1365-2362.1999.00474.x. [DOI] [PubMed] [Google Scholar]
  31. Vishniavsky N., Sagar K. B., Markowitz S. M. Aspergillus fumigatus endocarditis on a normal heart valve. South Med J. 1983 Apr;76(4):506–508. doi: 10.1097/00007611-198304000-00027. [DOI] [PubMed] [Google Scholar]
  32. Washburn R. G., Gallin J. I., Bennett J. E. Oxidative killing of Aspergillus fumigatus proceeds by parallel myeloperoxidase-dependent and -independent pathways. Infect Immun. 1987 Sep;55(9):2088–2092. doi: 10.1128/iai.55.9.2088-2092.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Weishaar P. D., Flynn H. W., Jr, Murray T. G., Davis J. L., Barr C. C., Gross J. G., Mein C. E., McLean W. C., Jr, Killian J. H. Endogenous Aspergillus endophthalmitis. Clinical features and treatment outcomes. Ophthalmology. 1998 Jan;105(1):57–65. doi: 10.1016/s0161-6420(98)71225-3. [DOI] [PubMed] [Google Scholar]
  34. Wilmarth S. S., May D. R., Roth A. M., Cole R. J., Nolan S., Goldstein E. Aspergillus endophthalmitis in an intravenous drug user. Ann Ophthalmol. 1983 May;15(5):470-2, 74-6. [PubMed] [Google Scholar]
  35. Wu G. S., Rao N. A. A novel retinal pigment epithelial protein suppresses neutrophil superoxide generation. I. Characterization of the suppressive factor. Exp Eye Res. 1996 Dec;63(6):713–725. doi: 10.1006/exer.1996.0165. [DOI] [PubMed] [Google Scholar]

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