Cases reported "Eye Infections, Fungal"

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1/103. Endogenous endophthalmitis caused by histoplasma capsulatum var. capsulatum: a case report and literature review.

    OBJECTIVE: We report the first case of clinically diagnosed endogenous endophthalmitis caused by histoplasma capsulatum var. capsulatum in a patient with the acquired immune deficiency syndrome. DESIGN: Interventional case report and literature review. INTERVENTION: Pars plana vitrectomy and scleral buckling procedure in the left eye with intravenous and intravitreal amphotericin in both eyes. MAIN OUTCOME MEASURES: The clinical features, culture results, visual outcome, and complications were studied. RESULTS: This case demonstrates a bilateral endophthalmitis with severe subretinal exudation, choroidal granulomas, and intraretinal hemorrhage leading to exudative bilateral retinal detachments. Vitreous cultures grew H. capsulatum var. capsulatum. Treatment consisted of intravenous amphotericin, intravitreal amphotericin (both eyes), pars plana vitrectomy (left eye), and scleral buckling procedure (left eye) with resulting counting fingers vision (right eye) and 20/300 (left eye). Four cases of histoplasma endophthalmitis have been reported previously, all of which had a documented history of disseminated histoplasmosis and resulted in enucleation. CONCLUSIONS: H. capsulatum should be considered a possible etiologic agent of endophthalmitis, especially in patients with a history of disseminated histoplasmosis and/or immune deficiency.
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2/103. Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid.

    PURPOSE: To report fungal endophthalmitis in nonimmunocompromised patients, each of whom received a single intravenous administration of presumably contaminated dextrose infusion fluid for minor ailments in rural settings. methods: This noncomparative case series included 12 nonimmunocompromised patients (12 eyes) with culture-positive fungal endophthalmitis. All eyes underwent initial vitreous tap with injection of intravitreal antibiotics. Eleven eyes required pars plana vitrectomy and oral fluconazole or itraconazole for 4 to 6 weeks. One patient with panophthalmitis was treated with intravenous amphotericin b. To support the hypothesis that contaminated intravenous fluid was the possible risk factor, samples from 72 sealed bottles of 5% dextrose were subjected to fungal culture. RESULTS: patients presented 1 to 11 weeks (mean, 4.6 weeks) after the intravenous infusion. All eyes had a positive smear and cultures for fungi. Aspergillus specimen was isolated in nine eyes, Candida in two eyes, and mucor in one eye. Final visual acuity was 20/80 or better in 8 (66.6%) eyes. Eleven of the 72 samples from dextrose bottles were culture-positive for fungi: six for aspergillus fumigatus, three for aspergillus niger, and two for candida albicans. CONCLUSION: A presumed contaminated intravenous infusion administered in a rural setting was found as a new risk factor for development of endogenous fungal endophthalmitis. These patients were successfully treated with pars plana vitrectomy and oral fluconazole and itraconazole therapy.
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3/103. Recurrent fungal keratitis and endophthalmitis.

    PURPOSE: To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection. methods: A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin b were necessary to eradicate the fungal infection. RESULTS: visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK. CONCLUSION: The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.
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4/103. exophiala werneckii endophthalmitis following cartaract surgery in an immunocompetent individual.

    A case of infectious endophthalmitis caused by the saprophyte exophiala werneckii is reported. This has not been recognized as a pathogen for ocular infections previously. The infection followed uncomplicated cataract surgery involving phacoemulsification and IOL implant. Clinical presentation was that of an indolent endophthalmitis with relatively acute onset. Pars plana vitrectomy, fungal stains, and culture established the diagnosis. Initial management consisted of empirical intravitreal injection of vancomycin, ceftazidime, and amphotericin b. Treatment was supplemented with a 3-week course of systemic fluconazole and topical therapy with natamycin, atropine, ciprofloxacin, and diclofenac. The visual acuity returned to 20/20-2 with no recurrence of infection. The source of the infection could not be determined. Fungal endophthalmitis has to be considered as a rare, though important, complication following ophthalmic surgery. Specific fungal stains and cultures are helpful for establishing the diagnosis early in the course of disease. E werneckii should be considered in the differential diagnosis of fungal endophthalmitis.
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5/103. Pseudophakic penicillium endophthalmitis.

    A healthy 76-year-old woman complained of redness and a painful sensation in her right eye after cataract surgery 5 months previously. The eye was treated with topical corticosteroid and ciprofloxacin, and a soft exudative mass on the nasal lower iris was noted later. Fungal endophthalmitis was suspected and a repeat aqueous culture grew penicillium spp. After treatment with topical natamycin and an intracameral injection of amphotericin b, the endophthalmitis was cured. We describe the disease course and management and discuss topical corticosteroids as a possible risk factor for increasing the dissemination of penicillium infection. This was a unique case of successful therapy resulting in the cure of penicillium endophthalmitis in an immunocompetent patient.
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6/103. Treatment of postkeratitis fusarium endophthalmitis with amphotericin b lipid complex.

    PURPOSE: The authors report the first case of fusarium solani keratitis that progressed to fungal endophthalmitis and was successfully treated with amphotericin b lipid complex (ABLC). METHOD: The case of a 34-year-old immunocompetent woman who developed a contact lens-related F. solani keratitis requiring emergency penetrating keratoplasty (PKP) was analyzed. The immunocompetent patient developed fungal endophthalmitis (anterior chamber tap positive for F. solani three months after PKP) and was eventually treated with ABLC. RESULTS: Systemic amphotericin b (total, 0.42 g) and ketoconazole in addition to topical natamycin and amphotericin did not prove to be effective in eradicating the mycosis in the anterior chamber. Under ABLC treatment (total, 8.79 g), the anterior chamber inflammation resolved completely. No recurrence was observed during an 11-month follow-up after treatment was discontinued. CONCLUSION: ABLC proved to be effective in treating F. solani endophthalmitis. It is an important addition to the ophthalmic armamentarium, and appeared to be a better therapeutic agent than standard amphotericin b in this patient.
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7/103. Systemic candidiasis with cataract formation in a premature infant.

    Endogenous Candida endophthalmitis is a well-recognized complication in low-birth-weight premature infants. The incidence of systemic candidiasis in premature and low-birth-weight infants is approximately 3%. As many as half of these infants will develop Candida endophthalmitis. eye involvement typically presents as one or more tiny white "fungal ball" chorioretinal lesions with overlying vitritis. Lens involvement is extremely rare. We report a case of cataract due to candida albicans in a premature, low-birth-weight infant unresponsive to systemic and intracameral antifungal therapy and requiring lensectomy with vitrectomy.
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8/103. Candida endophthalmitis: an unusual complication of prolonged intravenous access.

    A 16 year old boy awaiting a defunctioning colostomy for Crohn's disease complained of reduced vision in his left eye. Four weeks previously candida had been isolated from his central line used for parenteral feeds. Fundal examination of the left eye revealed a macular abscess with a classic "string of pearls" appearance of multiple vitreous abscesses. This was treated with pars plana vitrectomy and intravitreal antifungal therapy. Microbiological studies confirmed a diagnosis of candida endophthalmitis.
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9/103. Curvularia lunata endophthalmitis with secondary keratitis.

    PURPOSE: To report a case of pseudophakic endophthalmitis with secondary keratitis caused by Curvularia lunata. methods: A 40-year-old man presented with a fluffy mass in the anterior chamber with low-grade delayed postoperative inflammation in the right eye. RESULTS: The anterior chamber and vitreous aspirate demonstrated C. lunata. A large corneal infiltrate developed after aspiration of the mass. Treatment with systemic, topical, and intraocular antifungal agents cleared the vitreous, but the cornea perforated. CONCLUSION: Delayed low-grade infection with a fluffy mass in the anterior chamber after cataract surgery can rarely be a clinical presentation of dematiaceous fungal infection. Secondary keratitis may result after a diagnostic aspiration.
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ranking = 0.625
keywords = endophthalmitis
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10/103. Microsphaeropsis olivacea keratitis and consecutive endophthalmitis.

    PURPOSE: To report a case of fungal keratitis with consecutive endophthalmitis caused by Microsphaeropsis olivacea. methods: Case report. RESULTS: A 51-year-old man developed fungal keratitis and consecutive endophthalmitis after sustaining a penetrating injury to the right eye. Cultures of the aqueous humor yielded M. olivacea. infection resolved after intraocular fungal debridement, intravitreous amphotericin b, and aggressive topical natamycin and oral fluconazole. Persistent, low-grade smoldering corneal and intraocular inflammation required topical corticosteroid therapy. CONCLUSION: M. olivacea is an exceedingly rare ocular pathogen. The intraocular portion of the infection responded quickly to intravitreal antifungal treatment; however, the course was prolonged by smoldering corneal inflammation. Prompt recognition of intraocular spread and aggressive treatment may be beneficial in fungal infections caused by unusual organisms with uncertain virulence.
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