Karmisholt Marianne Kirkegaard, Hjort Ulla, Knudsen Lars Loumann, Schønheyder Henrik Carl
Department of Ophthalmology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
Scand J Infect Dis. 2008;40(3):241-6. doi: 10.1080/00365540701642120. Epub 2007 Sep 7.
Intraocular infection is a feared complication in patients with candidaemia. We therefore assessed the current risk and prognosis in Danish candidaemia patients. Candidaemia patients at a Danish university hospital were identified prospectively during a 10-y period, 1995-2004, and ophthalmologic records were retrieved retrospectively. Among 203 incident cases of candidaemia, 86 (42%) were examined at least once by an ophthalmologist. Nine patients had retinitis and 1 patient had endophthalmitis; eye involvement was bilateral in 8 and monocular in 2 patients. Lesions were generally mild and progression was observed in only 1 patient. Surgical treatment was not indicated and the median duration of systemic antifungal therapy was 19 d. The median survival time was 77 d for candidaemia patients with eye involvement, 480 d in candidaemia patients without such an involvement, and only 9 d in candidaemia patients without an ophthalmologic examination. In conclusion, the cumulative rate of intraocular infection was 11.6%, but we suspect an underestimation due to the circumstances of the eye examinations and the rapid death of many patients. We continue to recommend eye examinations for candidaemia patients, but timing seems not to be critical if overt signs of infection are absent, thereby facilitating the use of improved diagnostic methods.
念珠菌血症患者发生眼内感染是一种令人担忧的并发症。因此，我们评估了丹麦念珠菌血症患者当前的风险和预后情况。在1995年至2004年的10年期间，前瞻性地确定了丹麦一家大学医院的念珠菌血症患者，并回顾性检索了眼科记录。在203例念珠菌血症确诊病例中，86例（42%）至少接受过一次眼科医生检查。9例患者发生视网膜炎，1例患者发生眼内炎；8例患者眼部病变为双侧，2例为单眼。病变通常较轻，仅1例患者病情出现进展。无需手术治疗，全身抗真菌治疗的中位持续时间为19天。有眼部受累的念珠菌血症患者的中位生存时间为77天，无眼部受累的念珠菌血症患者为480天，未接受眼科检查的念珠菌血症患者仅为9天。总之，眼内感染的累积发生率为11.6%，但由于眼部检查情况以及许多患者迅速死亡，我们怀疑这一数字被低估了。我们继续建议对念珠菌血症患者进行眼部检查，但如果没有明显感染迹象，检查时机似乎并不关键，这有助于采用改进的诊断方法。
