McCabe Grace A, McHugh Jack W, Goodwin Todd, Johnson Douglas F, Fok Anthony, Campbell Thomas G
Department of Ophthalmology, the Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia.
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55902, USA.
Int J Ophthalmol. 2022 Jan 18;15(1):119-127. doi: 10.18240/ijo.2022.01.18. eCollection 2022.
To report 4 cases of () species complex infection with diverse ophthalmic manifestations, and to review the literature to examine pathobiology of disease, classical ophthalmic presentations and outcomes, and treatment modalities for this emerging pathogen.
Cases of meningoencephalitis with ophthalmic manifestations were identified chart review at two institutions in Australia and one institution in the mid-west region of the United States and are reported as a case series. Additionally, a MEDLINE literature review was conducted to identify all reported cases of with ophthalmic manifestations from 1990-2020. Cases were reviewed and tabulated, together with our series of patients, in this report.
Four cases of with ophthalmic manifestations are presented; three from Australia and one from the USA. A literature review identified a total of 331 cases of with visual sequelae. The majority of cases occurred in immunocompetent individuals. Blurred vision and diplopia were the most common presenting symptoms, with papilloedema the most common sign, reported in 10%-50% of cases. Visual loss was reported in 10%-53% of cases, as compared to rates of visual loss of 1%-9% in infection. Elevated intracranial pressure, cerebrospinal fluid (CSF) fungal burden, and abnormal neurological exam at presentation correlated with poor visual outcomes. The mainstays of treatment are anti-fungal agents and aggressive management of intracranial hypertension with serial lumbar punctures. CSF diversion procedures should be considered for refractory cases. Acetazolamide and mannitol are associated with high complication rates, and adjuvant corticosteroids have demonstrated higher mortality rates; these treatments should be avoided.
Permanent visual loss represents a devastating yet potentially preventable sequelae of infection. Intracranial hypertension needs to be recognised early and aggressively managed. Referral to an ophthalmologist/neuro-ophthalmologist in all cases of cryptococcal infection independent of visual symptoms at time of diagnosis is recommended.
报告4例具有多种眼部表现的（）菌种复合体感染病例，并回顾文献以研究该新兴病原体的疾病病理生物学、典型眼部表现及转归，以及治疗方式。
通过对澳大利亚两家机构和美国中西部地区一家机构的病历回顾，确定了伴有眼部表现的脑膜脑炎病例，并作为病例系列进行报告。此外，进行了MEDLINE文献回顾，以确定1990年至2020年所有报告的伴有眼部表现的（）病例。在本报告中，将这些病例与我们的患者系列一起进行了回顾和列表。
呈现了4例伴有眼部表现的（）病例；3例来自澳大利亚，1例来自美国。文献回顾共确定了331例伴有视力后遗症的（）病例。大多数病例发生在免疫功能正常的个体中。视力模糊和复视是最常见的首发症状，视乳头水肿是最常见的体征，在10% - 50%的病例中报告。10% - 53%的病例报告有视力丧失，而（）感染的视力丧失率为1% - 9%。颅内压升高、脑脊液（CSF）真菌负荷以及就诊时异常的神经系统检查与不良视力转归相关。治疗的主要方法是抗真菌药物以及通过连续腰椎穿刺积极处理颅内高压。对于难治性病例应考虑脑脊液分流术。乙酰唑胺和甘露醇并发症发生率高，辅助性皮质类固醇显示死亡率较高；应避免这些治疗。
永久性视力丧失是（）感染的一种毁灭性但可能可预防的后遗症。颅内高压需要早期识别并积极处理。建议在所有隐球菌感染病例中，无论诊断时是否有视觉症状，均转诊至眼科医生/神经眼科医生处。
