Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan.
Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan.
PLoS One. 2019 May 23;14(5):e0216956. doi: 10.1371/journal.pone.0216956. eCollection 2019.
The incidence of ocular candidiasis (OC) in patients with candidemia varies across different reports, and the issue of whether routine ophthalmoscopy improves outcomes has been raised. This study investigated the incidence of OC and evaluate whether the extent of OC impacts the clinical outcomes.
This retrospective study included non-neutropenic patients with candidemia who underwent treatment at one of 15 medical centers between 2010 and 2016. Chorioretinitis without other possible causes for the ocular lesions and endophthalmitis was classified as a probable OC. If signs of chorioretinitis were observed in patients with a systemic disease that causes similar ocular lesions, they were classified as a possible OC.
In total, 781 of 1089 patients with candidemia underwent an ophthalmic examination. The prevalence of OC was 19.5%. The time from the collection of a positive blood culture to the initial ophthalmic examination was 5.0 ± 3.9 days in patients with OC. The leading isolate was Candida albicans (77.9%). Possible OC was associated with unsuccessful treatments (resolution of ocular findings) (odds ratio: 0.354, 95% confidence interval: 0.141-0.887), indicating an overdiagnosis in patients with a possible OC. If these patients were excluded, the incidence fell to 12.8%. Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients.
Even when early routine ophthalmic examinations were performed, a high incidence of advanced ocular lesions was observed. These results suggest that routine ophthalmic examinations are still warranted in patients with candidemia.
不同报道中血液真菌病患者眼念珠菌病（OC）的发病率有所不同，是否进行常规眼科检查以改善预后的问题也已提出。本研究调查了 OC 的发生率，并评估 OC 的严重程度是否会影响临床结局。
本回顾性研究纳入了 2010 年至 2016 年期间在 15 家医疗中心接受治疗的非中性粒细胞减少症血液真菌病患者。将无其他眼部病变可能原因且无眼内炎的脉络膜视网膜炎归类为可能的 OC；如果系统性疾病患者存在引起类似眼部病变的迹象，则将其归类为可能的 OC。
共有 1089 例血液真菌病患者中的 781 例接受了眼科检查，OC 的患病率为 19.5%。OC 患者从阳性血培养到首次眼科检查的时间为 5.0±3.9 天。主要分离株为白色念珠菌（77.9%）。可能的 OC 与治疗失败（眼部病变消退）相关（比值比：0.354，95%置信区间：0.141-0.887），表明可能的 OC 患者存在过度诊断。如果排除这些患者，发病率将降至 12.8%。43.1%的患者检测到需要积极治疗的眼内炎和/或黄斑受累，这些患者的视力症状发生率显著更高。
即使进行了早期常规眼科检查，仍观察到大量晚期眼部病变。这些结果表明，血液真菌病患者仍需要进行常规眼科检查。
