Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea.
PLoS One. 2019 Sep 6;14(9):e0222356. doi: 10.1371/journal.pone.0222356. eCollection 2019.
Ocular involvement of candidemia can result in serious complications, including vision loss. This study investigated the risk factors for ocular involvement in patients with candidemia and the outcomes of treatment.
Episodes of candidemia in hospitalized adults who underwent ophthalmic examinations within 2 weeks of candidemia onset between January 2014 and May 2017 were retrospectively reviewed. Their demographic characteristics, antifungal treatments, and visual outcomes were evaluated.
During the study period, 438 adults were diagnosed with candidemia, with 275 (62.8%) undergoing ophthalmic examinations within 2 weeks. Of these 275 patients, 59 (21.5%) had fundoscopic abnormalities suggestive of ocular involvement, including 51 with chorioretinitis and eight with Candida endophthalmitis. Eleven patients were symptomatic. Persistent candidemia (adjusted odd ratio [aOR], 2.55; 95% confidence interval [CI], 1.29-5.08; P = 0.01), neutropenia during the preceding 2 weeks (aOR, 2.92; 95% CI, 1.14-7.53; P = 0.03), and C. albicans infection (aOR, 2.15; 95% CI, 1.09-4.24; P = 0.03) were independently associated with ocular involvement. Among the 24 patients with neutropenia, 41.7% had ocular involvements at the initial examination. Ophthalmologic examination even before the neutrophil recovery was positive in one-third of neutropenic patients. Out of the 37 patients in whom ocular outcomes after 6 weeks were available, 35 patients showed favorable or stable fundoscopic findings. Two patients had decreased visual acuity despite the stable fundoscopic finding.
Neutropenia within two weeks of candidemia was a risk factor for ocular involvement. More than 80 percent of patients with ocular involvements were asymptomatic, emphasizing the importance of routine ophthalmic examinations. The median 6 weeks of systemic antifungal treatment resulted in favorable outcomes in 89.2% of patients.
念珠菌血症可导致眼部受累，从而引发严重并发症，包括视力丧失。本研究旨在探讨念珠菌血症患者眼部受累的危险因素和治疗结局。
回顾性分析了 2014 年 1 月至 2017 年 5 月期间确诊为念珠菌血症的住院成人患者，这些患者在念珠菌血症发病后 2 周内行眼部检查。评估其人口统计学特征、抗真菌治疗和视力结局。
在研究期间，共诊断出 438 例成人念珠菌血症患者，其中 275 例（62.8%）在 2 周内行眼部检查。这 275 例患者中，59 例（21.5%）眼底镜检查结果异常，提示眼部受累，其中 51 例为视网膜炎，8 例为念珠菌性眼内炎。11 例患者有症状。持续性念珠菌血症（调整后的比值比[aOR]，2.55；95%置信区间[CI]，1.29-5.08；P=0.01）、前 2 周中性粒细胞减少症（aOR，2.92；95%CI，1.14-7.53；P=0.03）和 C. albicans 感染（aOR，2.15；95%CI，1.09-4.24；P=0.03）与眼部受累独立相关。在 24 例中性粒细胞减少症患者中，41.7%在初次检查时即存在眼部受累。在三分之一的中性粒细胞减少症患者中，即使中性粒细胞恢复正常，眼科检查也呈阳性。在 37 例可获得 6 周后眼部结局的患者中，35 例眼底镜检查结果稳定或改善。尽管眼底镜检查结果稳定，但仍有 2 例患者视力下降。
念珠菌血症发病后两周内的中性粒细胞减少症是眼部受累的危险因素。超过 80%的眼部受累患者无症状，强调了常规眼科检查的重要性。89.2%的患者接受中位数为 6 周的全身抗真菌治疗后结局良好。
