Journal Article

Ocular Manifestations of Candidemia

Astrid M. L. Oude Lashof, Aniki Rothova, Jack D. Sobel, Markus Ruhnke, Peter G. Pappas, Claudio Viscoli, Haran T. Schlamm, Iwona T. Oborska, John H. Rex and Bart Jan Kullberg

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 53, issue 3, pages 262-268
Published in print August 2011 | ISSN: 1058-4838
Published online August 2011 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cir355
Ocular Manifestations of Candidemia

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Background. Ocular candidiasis is a major complication of candidemia. The incidence, risk factors, and outcome of eye involvement during candidemia are largely unknown. We prospectively studied the ocular manifestations of candidemia in a large, worldwide, randomized multicenter trial that compared voriconazole with amphotericin B followed by fluconazole for the treatment of candidemia.

Methods. Nonneutropenic patients with blood cultures positive for Candida species were assigned treatment with voriconazole or with amphotericin B followed by fluconazole in a randomized 2:1 ratio. Dilated fundoscopy was performed in each patient at baseline, on day 7, at 2 and 6 weeks after the end of treatment (EOT), and, if clinically indicated, at 12 weeks after EOT.

Results. Of 370 patients, 49 had findings consistent with the diagnosis of ocular candidiasis at baseline, and an additional 11 patients developed abnormalities during treatment, totaling 60 patients with eye involvement (16%). Of these patients, probable Candida eye infection was diagnosed in 40 patients (6 with endophthalmitis, 34 with chorioretinitis), and possible Candida eye infection in 20 (all with chorioretinitis). The duration of candidemia was significantly longer in patients with ocular candidiasis (median, 4 days; range, 1–18 days) compared with patients without ocular involvement (median, 3 days; range 1–26 days; log rank, P = .026). Therapy with either voriconazole (44 cases) or amphotericin B followed by fluconazole (16 cases) was successful in 65% of patients; outcome was not evaluable in 32% and was unfavorable in 3%.

Conclusions. Ocular involvement occurred in 16% of patients with candidemia; however, endophthalmitis was uncommon (1.6%). Treatment with either voriconazole or amphotericin B followed by fluconazole was successful for ocular candidiasis in most cases with follow-up.

Journal Article.  4056 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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