Treatment of endophthalmitis due to molds - UpToDate It is difficult to estimate the incidence or frequency of occurrence of Aspergillus endophthalmitis.
Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Although blood cultures can be used as a diagnostic tool, there is a large variation in positivity rates, from 33% to 50%, in all endophthalmitis cases [116,117]. A retrospective study by Majji et al. Treatment of endogenous fungal endophthalmitis: Focus on new antifungal agents. A retrospective study of infectious endophthalmitis that resulted in evisceration showed Aspergillus accounting for 58 cases, with Streptococcus pneumoniae being the one more common causative agent, accounting for 68 cases out of 388 [152]. Long-term systemic use of corticosteroids creates a risk factor for the development of invasive fungal infections. Ocular diseases caused by Aspergillus, such as endophthalmitis, are usually caused by the exogenous route of infection, which can occur via the contamination of surgical instruments with a higher incidence among immunocompromised patients [33]. Due to the interactions of azole drugs with the liver, the overall organ function should also be monitored due to possible increases in liver enzymes [125]. Reeves E.P., Messina C.G., Doyle S., Kavanagh K. Correlation between gliotoxin production and virulence of Aspergillus fumigatus in Galleria mellonella. Haddock L.J., Flynn H.W., Jr., Dubovy S.R., Khurana R.N., Egbert P.R. However, many specific host molecular defense mechanisms are still poorly understood and require further research. official website and that any information you provide is encrypted reported that 90% of the post-operative endophthalmitis cases occur after cataract surgery [9], in addition to an increased risk for Aspergillosis in post-cardiac surgery and organ transplantation patients [16]. Liu C., Ji J., Wang Z., Chen H., Cao W., Sun X. Microbiological Isolates and Antibiotic Susceptibilities in Cases of Posttraumatic Endophthalmitis: A 15-Year Review. Isavuconazole for Treatment of Experimental Fungal Endophthalmitis Caused by Aspergillus fumigatus. The absence of lung disease described in affected individuals suggests that the compensation pathway through IL-1R/MyD88 signaling in mice can adequately compensate for the loss of CARD9-dependent pulmonary neutrophil recruitment [74]. Hence, it is critical to understand its pathobiology to develop and deploy proper therapeutic interventions for combating Aspergillus infections. To determine the overall safety and pharmacokinetics, Shen et al. Citation 27 Prakash et al described a case of endophthalmitis due to Aspergillus fumigatus in a 40-year-old man with angioimmunoblastic T-cell lymphoma, who finally . In an evaluation of 29 eyes of 28 patients with culture-proven endogenous endophthalmitis seen between 1996 and 2006 at the ophthalmology department of a university in Germany, it was reported that Candida species were . Callanan D., Scott I.U., Murray T.G., Oxford K.W., Bowman C.B., Flynn H.W., Jr. Zarrinfar H., Mirhendi H., Fata A., Khodadadi H., Kordbacheh P. Detection of Aspergillus flavus and A. fumigatus in Bronchoalveolar Lavage Specimens of Hematopoietic Stem Cell Transplants and Hematological Malignancies Patients by Real-Time Polymerase Chain Reaction, Nested PCR and Mycological Assays. A decrease in visual acuity is also commonly seen in patients suffering from mycotic eye infections [17,48]. doi: 10.1099/jmm.0.000255. Methods: The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. About 34% of trauma cases were associated with A. flavus endophthalmitis [13]. For Aspergillus, voriconazole is the drug of choice; it has adequate intraocular penetration when used systemically and can be administered intravitreally as well. Joseph J., Sontam B., Guda S.J.M., Gandhi J., Sharma S., Tyagi M., Dave V.P., Das T. Trends in microbiological spectrum of endophthalmitis at a single tertiary care ophthalmic hospital in India: A review of 25 years. (B) A cross-section image of the eye after enucleation. ), 2Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, MI 48201, USA; ude.enyaw.dem@alusaps (S.P. Chazalet V., Debeaupuis J.P., Sarfati J., Lortholary J., Ribaud P., Shah P., Cornet M., Thien H.V., Gluckman E., Brcker G., et al. Lionakis M.S., Kontoyiannis D.P. is the main causative agent of fungal endophthalmitis [10]. Bacteria also can enter the eye through an injury that pierces the eye. Molecular typing of environmental and patient isolates of Aspergillus fumigatus from various hospital settings. Endogenous fungal endophthalmitis has been seen with increasing frequency over the past two decades, concurrent with an increased recognition of systemic fungal infections. There was no loss in light perception and no enucleation was necessary [141]. However, across all microbes, fungal infection is responsible for only 510% of endophthalmitis cases [10]. Hence, the anatomical features of Aspergillus endophthalmitis include a thickened choroid, lack of retinal tissue organization, hypopyon, and high prevalence of subretinal exudates (Figure 3) [65]. Gliotoxin production in Aspergillus fumigatus contributes to host-specific differences in virulence. According to Dave et al., evisceration or enucleation can climb as high as 25% once fungi become filamentous [11,152]. 1. This surpassed patients with classical risk factors, with 36.4% of cases related to neutropenia, malignancy, and transplant recipients on immunosuppression therapy. The site is secure. Disseminated Aspergillosis in the Immunocompetent Host: A Case Report and Literature Review. Design: Retrospective, interventional, multicentric case series. Sugita et al.
Endogenous Aspergillus endophthalmitis. Clinical features and treatment Although smears taken from vitreous specimens may be examined immediately via direct microscopy, they have a success rate of 50% for fungal detection. According to Panackal et al., when calcineurin inhibitors are used in conjunction with voriconazole or other azole drugs, a reduction in the dosage of anywhere from 25 to 75% should be considered. Ramirez Soto M.C. Aspergillus endophthalmitis represents a severe challenge for ophthalmologists. In a clinical setting, these drugs belong to the families of triazoles, echinocandins, or polyenes, and they act by disrupting the integrity of the Aspergillus cell wall [125]. The .gov means its official. Nabili M., Shokohi T., Moazeni M., Khodavaisy S., Aliyali M., Badiee P., Zarrinfar H., Hagen F., Badali H. High prevalence of clinical and environmental triazole-resistant Aspergillus fumigatus in Iran: Is it a challenging issue? Aspergillus endophthalmitis is rare, representing less than 1% of ocular complications in heart and/or lung recipients ( Akerele and Lightman, 2007). Practitioners must diagnose fungal endophthalmitis as soon as possible to prevent possible vision loss. Bilateral simultaneous endogenous Aspergillus endophthalmitis in an immunocompetent patient. Keller N.P. Case reports have shown that a combination of intravenous caspofungin and intravitreal voriconazole has resulted in the improvement of endophthalmitis in patients [87,136]. Mylonakis E. Galleria mellonella and the study of fungal pathogenesis: Making the case for another genetically tractable model host.
Diagnostic and Management Strategies of Aspergillus Endophthalmitis Exogenous fungal endophthalmitis (fungi enter the eye from outside the body): Endophthalmitis is a very rare complication of eye injury or eye surgery; in . Diagnostic and therapeutic challenge of Aspergillus flavus scleritis. Clinically, Aspergillus endophthalmitis presents with symptoms of ocular pain and blurry vision, which can be seen in both endogenous and exogenous forms [30]. Dave T.V., Dave V.P., Sharma S., Karolia R., Joseph J., Pathengay A., Pappuru R.R., Das T. Infectious endophthalmitis leading to evisceration: Spectrum of bacterial and fungal pathogens and antibacterial susceptibility profile. Moalli F., Doni A., Deban L., Zelante T., Zagarella S., Bottazzi B., Romani L., Mantovani A., Garlanda C. Role of complement and Fc{gamma} receptors in the protective activity of the long pentraxin PTX3 against Aspergillus fumigatus. -, Zanganeh E., Zarrinfar H., Rezaeetalab F., Fata A., Tohidi M., Najafzadeh M.J., Alizadeh M., Seyedmousavi S. Predominance of non-fumigatus Aspergillus species among patients suspected to pulmonary aspergillosis in a tropical and subtropical region of the Middle East. Viswanathaiah S., Babu M., Manjunatha M. Endogenous endophthalmitis caused by. The results of the study looked promising, with a corrected visual acuity of 20/400 or better in 7 of the 12 eyes and 20/60 in 2 eyes. Endogenous endophthalmitis: Diagnosis, management, and prognosis. In a separate study, most patients with endogenous endophthalmitis had partially or fully recovered from ocular lesions with the systemic administration of AmB alone or in combination with an oral antifungal, whereas those with exogenous endophthalmitis suffered permanent blindness, enucleation, and evisceration [74]. Another classification of drugs that should be modified includes calcineurin inhibitors. Aspergillosis can cause choroidal and retinal vessel invasion, which is a distinct feature not found in Candida endophthalmitis [16]. Danielescu C., Cantemir A., Chiselita D. Successful treatment of fungal endophthalmitis using intravitreal caspofungin. On the other hand, culturing is a common diagnostic method for fungi but has a relatively low sensitivity of 40%. Dissemination of Aspergillus, typically from the lungs to other organs, is associated with neutropenia. Isavuconazole was administered by oral gavage, intravenous, intravitreal, and oral/intravitreal and intravenous/intravitreal routes in combination. Although postoperative endophthalmitis typically has an acute onset within seven days following surgery, chronic postoperative endophthalmitis is less common, can occur weeks after surgery, and is caused by lesser virulent fungi [9]. Finally, we comprehensively summarize various antifungal regimens and surgical options for the treatment of Aspergillus endophthalmitis. The .gov means its official. Pharmacokinetics and safety of intravitreal caspofungin. 2014 Nov;50(11):808-13. A chest x-ray demonstrated partial collapse of the right upper lobe with hilar . Typically, evisceration is reserved as a last-resort treatment choice against endophthalmitis when the infection cannot be controlled. -. Pt 5. Polyenes are a versatile group of anti-mycotic drugs, one of the most widely used drugs in Aspergillus endophthalmitis treatment, and include amphotericin B (AmB) [11,17,21,61,65]. The results of this study showed oral administration was as effective as an intravitreal injection alone and has laid the groundwork for a possible alternative in treating Aspergillus endophthalmitis. In cases where an early vitrectomy plus intravitreal antifungals was performed, a more favorable outcome was observed in comparison to only having a diagnostic vitrectomy with intravitreal antifungals [64]. Another study showed pentraxin-3 induces interferon- signaling through TLR4/MD-2 and an adaptor containing a TIR domain [78]. investigated the in vitro toxicity of caspofungin in different ocular cell lines. The https:// ensures that you are connecting to the Mithal et al. However, in non-neutropenic immunosuppressed models such as in genetic Chronic Granulomatous Disease (CGD) or corticosteroid-induced immunosuppressive conditions, the Aspergilli conidia persists inside the host due to an compromised fungicidal ability [47]. The overall rarity of Aspergillus endophthalmitis has resulted in a lack of clinical trials. In this review, we comprehensively discuss the possible causes of Aspergillus endophthalmitis and its pathobiology and host immune responses, laboratory diagnostic, and current antifungal treatment options. The image on the right reveals individual Aspergillus hyphae formation, shown in the red box with corresponding arrows that occurs during infection spread. A study in a fly model of aspergillosis. In addition, a study reported the presence of sub-macular abscesses as well (Figure 2) [61]. In their mouse model, isavuconazole reduced the fungal burden, helped retain the retinal structure and function, and inhibited inflammatory cytokine production [90]. Toll-like receptors (TLRs) knockout mice and cytokine-deficient mice both display the importance of TLRs for fungal recognition and cytokine production, such as TNF-alpha, in host defense [32,87,88,89]. 1Disease Entity 1.1Etiology and Risk Factors 1.1.1 1.1.1.1 1.1.2 1.2Prevalence and Incidence 1.3Pathophysiology 2Diagnosis 2.1Blood Cultures 2.2Microbiology 2.3Symptoms 2.4Physical Exam Findings 2.5Imaging 2.5.1OCT 2.5.2B-Scan Endophthalmitis, in general, is an inflammatory condition affecting the tissues and fluid of the eyeball. Chee Y.E., Eliott D. The Role of Vitrectomy in the Management of Fungal Endophthalmitis. Fungal endophthalmitis is a diagnostic challenge, which requires a rigorous history and comprehensive ophthalmic examination. However, due to overlapping clinical symptoms with other endophthalmitis etiology, fungal endophthalmitis pose a challenge in its diagnosis and treatment. described approximately 50% of positive culture specimens as being isolated from corneal scrapings or corneal buttons, which corroborated with the initial location of Aspergillus seeding [107]. Aspergillus endophthalmitis. The guidelines of the Infectious Disease Society of America (IDSA) recommend estimating the levels of serum BDG for diagnosing invasive aspergillosis in high-risk patients such as those with hematologic malignancy and allogeneic HSC. analyzed outcomes of 66 patients where Aspergillus was the most common pathogen isolated. These vesicles could potentially represent a clinical marker for Aspergillus infection, thus directing further research to confirm the presence of these antifungal extracellular vesicles in the eye [104]. Heterogeneity Confounds Establishment of a Model Microbial Strain. Latg J.P., Chamilos G. Aspergillus fumigatus and Aspergillosis in 2019. These nuances in Aspergillus presentation provide challenges in diagnostic and therapeutic regimens [24]. Cunha C., Aversa F., Lacerda J.F., Busca A., Kurzai O., Grube M., Loffler J., Maertens J.A., Bell A.S., Inforzato A., et al. This condition is usually very difficult to diagnose, since the signs and symptoms resemble a lot of other pathological conditions. Mousavi B., Hedayati M.T., Hedayati N., Ilkit M., Syedmousavi S. Aspergillus species in indoor environments and their possible occupational and public health hazards. After evaluation at the University of Southern California Roski Eye Institute, she was diagnosed with a likely fungal endogenous endophthalmitis based on ultrasound findings and underwent emergent vitrectomy. Among the fungal pathogens, the Aspergillus species, Aspergillus fumigatus, continues to be more prevalent in fungal endophthalmitis patients. suggested a vitrectomy as a preventative measure against endophthalmitis, especially in situations where intravitreal injections fail to work or in more advanced cases of fungal keratitis [107]. Relhan N., Forster R.K., Flynn H.W., Jr. Endophthalmitis: Then and Now. In humans, Mendelian defects in CARD9 can cause spontaneous extrapulmonary aspergillosis, and the resulting fungal abscess in affected patients does not contain neutrophils [74]. AlQahtani G.M.S., AlSayed A.A.D., Gangadharan S., Adhi M.I. Gliotoxin is a virulence factor of Aspergillus fumigatus: GliP deletion attenuates virulence in mice immunosuppressed with hydrocortisone. The prevalence of Aspergillus endophthalmitis is reported as being around 7.1% among orthotopic liver transplant recipients [31], suggesting an increased susceptibility to Aspergillus in patients with organ transplants [31].
Aspergillus Endophthalmitis: Clinical Presentations and Fact : The Fungal Endophthalmitis - EyeWiki Functional Characterization of Clinical Isolates of the Opportunistic Fungal Pathogen Aspergillus nidulans. This review highlights the different modes of Aspergillus transmission and the host immune response during endophthalmitis. The infection can be caused by: Bacteria Fungi Viruses Parasites In the United States, most cases result from bacterial infections that follow eye surgery. Endogenous Aspergillus endophthalmitis has been reported by Al Qahtani et al secondary to fungal endocarditis in an immunocompromised patient affected by Wegener' granulomatosis. Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal Resistance, and Management. A study has reported retinal abscesses in an infected patients eyes, who was diagnosed with bilateral endogenous endophthalmitis. Given the emerging drug-resistant strains and fewer available anti-fungal treatment options, studies on effective combination therapy should be considered [29,153]. Sadiq M.A., Hassan M., Agarwal A., Sarwar S., Toufeeq S., Soliman M.K., Hanout M., Sepah Y.J., Do D.V., Nguyen Q.D. In: Long S.S., Prober C.G., Fischer M., editors. Dave V.P., Pappuru R.R., Pathengay A., Gupta R., Joseph J., Sharma S., Das T. Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes. The differential diagnosis for endophthalmitis is extensive. Treatment involves systemic and intravitreal antifungal medications as well as possible pars plana vitrectomy. Specimens collected from corneal scrapings, the conjunctival sac, and the vitreous or aqueous humor can be used for culturing in suitable media [18,63]. Liu K., Fang F., Li H. Reliability of vitreous histological detection of pathogenic fungi in the diagnosis of fungal endophthalmitis.
Endophthalmitis - Clinical Microbiology and Infection Bozza S., Campo S., Arseni B., Inforzato A., Ragnar L., Bottazzi B., Mantovani A., Moretti S., Oikonomous V., De Santis R., et al. Gruener A.M., Allen F., Stanford M.R., Graham E.M. Aspergillus fumigatus Endophthalmitis with Necrotizing Scleritis following Pars Plana Vitrectomy. Beta-D-Glucan Beta-d-glucan testing in patients with fungal endophthalmitis. Jhingran A., Mar K.B., Kumasaka D.K., Knoblaugh S.E., Ngo L.Y., Segal B.H., Iwakura Y., Lowell C.A., Hamerman J.A., Lin X., et al. Infectious endophthalmitis can have either an exogenous (following ocular surgery / penetrating trauma ) or endogenous (hematogenous spread) etiology. Additionally, A. fumigatus has been reported for its cellular heterogeneity, in terms of its virulence and ability to avoid host antifungal pathways, and hence requires further investigation for its possible role in drug resistance [43,46,48]. In other words, dectin-1 signaling leads to increased Aspergillus susceptibility under the pretext of immune system damage. Antifungal Agents. As a library, NLM provides access to scientific literature.
JoF | Free Full-Text | Aspergillus Endophthalmitis: Epidemiology - MDPI Presently, its pathogenesis is associated with various virulent proteins promoting conidial growth or morphology and conferring resistance to the hosts antifungal mechanisms. Due to voriconazoles shorter half-life, there may be a need for repeated injections depending on the response to therapy after examination [82,134]. Licensee MDPI, Basel, Switzerland. Toxicity of intravitreal injection of amphotericin B. Cannon J.P., Fiscella R., Pattharachayakul S., Garey K.W., De Alba F., Piscitelli S., Edward D.P., Danziger L.H. performed a comparative study between intravitreal voriconazole and liposomal AmB in Guinea pigs with Aspergillus endophthalmitis. (A) Eye 4 days after PKP. Endogenous Aspergillus endophthalmitis is a rare complication of invasive aspergillosis and most often is seen in transplant patients receiving intense immunosuppressive agents. 2018;78:265270. Jhingran A., Kasahara S., Shepardson K.M., Junecko B.A., Heung L.J., Kumasaka D.K., Knoblaugh S.E., Lin X., Kazmierczak B.I., Reinhart T.A., et al. Zanganeh E., Zarrinfar H., Rezaeetalab F., Fata A., Tohidi M., Najafzadeh M.J., Alizadeh M., Seyedmousavi S. Predominance of non-fumigatus Aspergillus species among patients suspected to pulmonary aspergillosis in a tropical and subtropical region of the Middle East. Mojumder D.K., Concepcion F.A., Patel S.K., Barkmeier A.J., Carvounis P.E., Wilson J.H., Holz E.R., Wensel T.G. These two domains are critical for their ability to interact with ergosterol and thus their capacity to assert antifungal effects [126]. Mamandhar A., Bajracharya L. Endogenous Aspergillus endophthalmitis in a healthy individual. Gandhi J., Joseph J. after oral administration. 2018;190:574. doi: 10.1007/s10661-018-6952-4. A recent study by Joseph, J. et al., from India, reported that the Aspergillus spp. Recognition of fungal pathogens by Toll-like receptors. Filler S.G., Sheppard D.C. Fungal invasion of normally non-phagocytic host cells. In cases of macular infection or vitritis from Aspergillus endophthalmitis, a combination of systemic and intravitreal antifungal agents should be used to ensure appropriate therapeutic levels within the posterior segment of the eye. Endogenous endophthalmitis is an intraocular infection secondary to hematogenous dissemination of a distant infection. Cytokine networking in lungs of immunocompetent mice in response to inhaled Aspergillus fumigatus.
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