Nijmegen Institute for Infection, Inflammation and Immunity, and Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Clin Infect Dis. 2011 Aug 1;53(3):262-8. doi: 10.1093/cid/cir355.
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.
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.
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%.
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.
眼念珠菌病是念珠菌血症的主要并发症。眼念珠菌病的发病率、危险因素和预后在很大程度上尚不清楚。我们前瞻性地研究了一项大型、全球性、随机多中心试验中念珠菌血症患者的眼部表现，该试验比较了伏立康唑与两性霉素 B 随后氟康唑治疗念珠菌血症。
非中性粒细胞减少症患者血培养阳性的念珠菌物种被分配接受伏立康唑或两性霉素 B 随后氟康唑治疗，比例为 2:1。在基线、第 7 天、治疗结束后 2 周和 6 周（如果临床需要，在 EOT 后 12 周），对每位患者进行散瞳眼底检查。
在 370 名患者中，49 名患者在基线时有与眼部念珠菌病一致的诊断发现，另有 11 名患者在治疗过程中出现异常，共有 60 名患者（16%）出现眼部受累。这些患者中，40 名患者诊断为可能的眼内念珠菌感染（6 例为眼内炎，34 例为脉络膜视网膜炎），20 名患者诊断为可能的眼内念珠菌感染（均为脉络膜视网膜炎）。眼念珠菌病患者的念珠菌血症持续时间明显长于无眼部受累患者（中位数，4 天；范围，1-18 天）与患者（中位数，3 天；范围，1-26 天；对数秩检验，P =.026）。伏立康唑（44 例）或两性霉素 B 随后氟康唑（16 例）治疗的成功率为 65%；32%的病例无法评估，3%的病例结果不佳。
念珠菌血症患者中有 16%发生眼部受累；然而，眼内炎并不常见（1.6%）。在大多数情况下，随访中，伏立康唑或两性霉素 B 随后氟康唑治疗眼念珠菌病是成功的。
