1/9. 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 = 1keywords = candidemia (Clic here for more details about this article) |
2/9. 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 = 1keywords = candidemia (Clic here for more details about this article) |
3/9. Management of endogenous fungal endophthalmitis with voriconazole and caspofungin.PURPOSE: Voriconazole, a new generation triazole, has been shown to achieve therapeutic intraocular levels after oral administration. Caspofungin is the first approved agent from a new class of antifungals, the echinocandins. This series describes experience at two centers using these novel antifungals to treat endogenous fungal endophthalmitis. DESIGN: Retrospective review. methods: Treatment of five patients with Candida endophthalmitis are reviewed. Postmortem intraocular voriconazole concentrations on a sixth patient are presented as well. RESULTS: All patients had systemic cultures positive for Candida species. Three patients had prompt resolution of intraocular mycosis with intravenous and oral voriconazole, caspofungin, or both. The fourth patient with bilateral disease responded well to i.v. voriconazole and caspofungin but had a recurrence when discharged on oral voriconazole and i.v. caspofungin. This patient had a bowel resection with an ileostomy; therefore, absorption of oral voriconazole may have been inadequate. Bilateral amphotericin b intravitreal injection ultimately treated this patient. The fifth patient received 100 microg/0.1 ml of intravitreal voriconazole (final vitreous concentration approximately 25 microg/ml) followed by oral voriconazole and responded favorably. Our sixth patient had multisystem failure and passed away 1 week after initiating intravenous voriconazole for non-ocular candidemia. Postmortem HPLC analysis of the aqueous and vitreous revealed voriconazole concentrations of 1.52 microg/ml and 1.12 microg/ml, respectively (MIC90 of candida albicans is 0.06 microg/ml). CONCLUSIONS: Voriconazole and caspofungin appear to be powerful weapons to add to the existing armamentarium against fungal endophthalmitis. Further studies are warranted to define precisely the role of these new agents alone or in combination with other antifungals.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
4/9. Subtherapeutic ocular penetration of caspofungin and associated treatment failure in candida albicans endophthalmitis.Candida endophthalmitis represents the most serious ocular complication of candidemia. The pharmacokinetics and pharmacodynamics of fluconazole, amphotericin b, and flucytosine are fairly well established in endophthalmitis therapy. There remains a paucity of clinical data regarding the utility of new antimycotic agents in the treatment of fungal chorioretinitis and endophthalmitis. We report a case of clinical failure of caspofungin in the management of candida albicans endophthalmitis associated with poor vitreous penetration.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
5/9. Successful treatment of Candida endophthalmitis with a synergistic combination of amphotericin b and rifampin.Candida endophthalmitis, caused by transient candidemia, developed in a 14-year-old white girl receiving intravenous hyperalimentation. Antifungal synergism was established in vitro for the combination of amphotericin b and rifampin against the C. albicans isolate. A combined ten-day course of intravenous amphotericin b and oral rifampin was followed by the elimination of the infection and the preservation of good visual acuity.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
6/9. candidemia, look at the eyes.Two patients with disseminated candidiasis are presented. The diagnosis was established by fundoscopy. Candida endophthalmitis can be the only manifestation of disseminated candidiasis. The role of fundoscopy in the management of candidemia is emphasized because it can provide evidence of disseminated disease. Every positive blood culture requires repeated fundoscopic examination. Early recognition is essential to prevent irreversible loss of vision.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
7/9. Treatment of Candida endophthalmitis.A 51-year-old man who was being treated with corticosteroids for chronic extrinsic asthma developed biliary tract sepsis, candidemia, and Candida endophthalmitis with vitreous fluff-ball lesions in both eyes. Extensive vitreous fibrosis and retinal detachment with loss of useful vision occurred in his left eye, which had a vitreous biopsy. Useful vision was maintained in his right eye with two full courses of systemic amphotericin b, 5-flucytosine, and a cataract extraction. Encapsulated Candida organisms remained in the vitreous of his right eye at the time of death. Useful vision can be preserved without aggressive vitreous surgery and intravitreal anti-fungal agents in eyes with intravitreal candida albicans.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
8/9. Failure of therapy with fluconazole for candidal endophthalmitis.The incidence of candidemia and its complications, such as endophthalmitis, has measurably increased in recent years. However, the optimal method of treatment of hematogenous candidal infection remains a controversial issue. Traditional therapy with amphotericin b is associated with well-known adverse reactions. Many clinicians therefore prefer to use fluconazole, which is administered orally and is relatively less toxic. We recently observed a patient with candidal sepsis in whom blinding endophthalmitis developed despite aggressive and lengthy therapy with fluconazole. This grave clinical outcome and the data derived from experimental models of ocular candidal infection suggest that empirical usage of fluconazole may not be warranted in cases of disseminated candidiasis potentially complicated by endophthalmitis.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
9/9. Hematogenous endophthalmitis in a patient with candidemia.candidiasis has emerged as the most common opportunistic fungal disease over recent decades owing to the progressively increasing use of antibiotics, immunosuppressive and cytotoxic drugs, indwelling foreign bodies and organ transplantation. Hematogenous candida endophthalmitis, which has a characteristic finding of single or multiple fluffy white cotton ball-like chorioretinal lesions often extending into vitreous, is the most fulminant manifestation of systemic candidiasis and may result in blindness. These ocular lesions can be easily recognized on funduscopic examination and should be serially looked for in all patients with known and suspected systemic candidiasis. We report hematogenous candida endophthalmitis in a patient of systemic candidiasis and, to our knowledge, it is the first reported case in our country.- - - - - - - - - - ranking = 4keywords = candidemia (Clic here for more details about this article) |