Mycology
Clinical characteristics and risk factors of ocular candidiasis

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Abstract

Ocular candidiasis is a major complication of Candida bloodstream infection (BSI). This study was performed to reveal the clinical characteristics of ocular candidiasis. Of the 220 patients with Candida BSI, 204 cases received ophthalmology consultations between January 2005 and December 2011 at 2 teaching hospitals. Fifty-four (26.5%) cases had findings consistent with the diagnosis of ocular candidiasis. Of these 54 cases, 43 (79.6%) were diagnosed within 7 days after a positive blood culture. Among ocular candidiasis cases, more cases were due to Candida albicans (P =0.034 odds ratio [OR]; 3.68 95% confidence interval [CI] 1.11–12.2) and had higher β-d-glucan values (P = 0.001 OR; 9.99 95% CI 2.60–21.3). We need to consider fundoscopic examination to be performed within the first 7 days of therapy, especially for those patients who have C. albicans BSIs and higher β-d-glucan values. Additionally, follow-up fundoscopic examination should be considered before stopping therapy for high-risk patients.

Introduction

Bloodstream infections (BSIs) caused by Candida species have been reported to be increasingly frequent in recent decades, possibly due to rapid changes in medical practice. Candida BSI can lead to hematogenous dissemination and metastatic ocular infection with potentially devastating consequences. Consequently, a rise in related mortality and prolonged hospitalisation have been reported (Edmond et al., 1999, Jarvis, 1995, Kao et al., 1999, Pfaller and Diekema, 2007, Rentz et al., 1998, Sheng et al., 2005, Wisplinghoff et al., 2004).

Normally, patients who have chorioretinitis alone are often asymptomatic and respond better to systemic antifungal therapy than those with vitreal involvement. However, in advanced stages, the intravitreal injection of an antifungal agent with or without vitrectomy is needed. Thus, it is very important for doctors to properly diagnose ocular candidiasis in the early stages of the infection.

In this study, patients with blood cultures positive for Candida BSIs were reviewed for the incidence and clinical characteristics of ocular candidiasis to reveal the risk factors of ocular candidiasis.

Section snippets

Study design

This study was performed at 2 teaching hospitals in Kyoto, Japan: Kyoto University Hospital (KUH) is a tertiary-care university hospital with 1240 beds, and Katsura Hospital is an emergency hospital with 585 beds. Infectious disease physicians perform proactive interventions for all patients with BSI in these hospitals. In cases of Candida BSIs, catheter removal is recommended, blood cultures are collected to confirm all negative results, and, finally, fundoscopy is performed by

Incidence

Of the 220 patients with Candida BSI, 204 that were presented to ophthalmologists for the diagnosis of ocular candidiasis were included in this study. Six of the 16 Candida BSI patients who did not consult ophthalmologists included critically ill patients whose prognosis had been presumed to be very poor or who died before the identification of positive fungal cultures.

Fifty-four (26.5%) of the 204 Candida BSI patients who were evaluated by ophthalmologists had fundoscopic abnormalities that

Discussion

This study investigated the incidence and clinical characteristics of ocular candidiasis. According to previous studies, the prevalence of ocular candidiasis is estimated to be between 1% and 45% (Brooks, 1989, Oude Lashof et al., 2011, Parke et al., 1982, Rodríguez-Adrián et al., 2003, Shah et al., 2008). In this study, ocular abnormalities occurred in 26% of 204 patients. It is likely that patient selection led to the comparatively high prevalence of ocular candidiasis. Among our patients,

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Transparency declaration: This work was partly supported by grant H21-Shinko-Ippan-009 and H23-Shinkou-Ippan-018 from the Ministry of Health, Labor, and Welfare of Japan. Some of the results were generated during routine diagnostic activities. No commercial relationships or potential conflicts of interest exist.

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