Gittins-Núñez Luis Othon, Hernández-Núñez Fabiola
Médico residente, Hospital de Oftalmología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
Rev Med Inst Mex Seguro Soc. 2015 Jan-Feb;53(1):92-6.
Candida endophthalmitis is related to immunosuppression state, intravenous catheters, invasive procedures and parenteral feeding. It is estimated that between 2% and 10% of endophthalmitis are endogenous, within fungal etiology the most frequently isolated microorganism is Candida albicans. The infection by C. dubliniensis is reported in less than 2 % of the cases of infection by Candida at systemic level and few reported cases of endophthalmitis. The clinical presentation is poor vision , vitritis, cottony deposits, chorioretinitis, and necrosis. The confirmatory diagnosis must be made with vitreous culture and the treatment is based on combination of vitrectomy and intravitreal antifungal.
It is reported a case of a patient with enterocutaneous fistula, long hospital stay with parental nutrition that cause endophthalmitis without immunosuppression.
Endogenous endophthalmitis by C. dubliniensis is barely documented in the literature. Candida endophthalmitis should always be considered in patients with risk factors, in order to provide timely diagnosis and appropriate management, yet the prognosis in these patients is poor for function and organ preservation and for life from complications involving these patients from associated pathologies.
念珠菌性眼内炎与免疫抑制状态、静脉导管、侵入性操作及肠外营养有关。据估计,2%至10%的眼内炎为内源性,在真菌病因中,最常分离出的微生物是白色念珠菌。都柏林念珠菌感染在念珠菌全身感染病例中报告不足2%,眼内炎报告病例很少。临床表现为视力下降、玻璃体炎、棉絮状渗出、脉络膜视网膜炎及坏死。确诊需进行玻璃体培养,治疗基于玻璃体切除术联合玻璃体内抗真菌药物。
报告1例肠皮肤瘘患者,长期住院接受肠外营养,发生眼内炎,无免疫抑制。
文献中几乎没有都柏林念珠菌引起内源性眼内炎的记载。对于有危险因素的患者,应始终考虑念珠菌性眼内炎,以便及时诊断并进行适当处理,然而这些患者的功能和器官保留预后以及因相关病理并发症导致的生命预后较差。