An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England
An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England
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DOI：
10.1001/jamaophthalmol.2017.0650
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发表时间：
2017-06-01
影响因子：
8.1
通讯作者：
Baumal, Caroline R.
中科院分区：
文献类型：
--
作者：
Tirpack, Aubrey R.;Duker, Jay S.;Baumal, Caroline R.
重要性静脉内药物滥用（IVDA）是内源性真菌性眼内炎（EFE）的已知危险因素，EFE是一种严重的眼内感染，由肌源性微生物的血行接种引起。自2014年以来，海洛因相关死亡报告显著增加，新英格兰地区正处于阿片类药物危机之中，导致这种威胁视力的疾病的患者风险大幅增加。目的：介绍EFE患者的特征、管理和视力结局的最新情况。设计、环境和参与者：2016年7月1日开始进行病历审查。评价2014年5月1日至2016年5月1日期间转诊至塔夫茨医学中心新英格兰眼科中心（分布于马萨诸塞州的三级护理眼科实践）的所有EFE患者。包括有IVDA病史和培养证实或临床证据的真菌性眼内炎患者。暴露静脉内药物使用。主要结果和指标患者人口统计学资料、合并症、症状和视力、玻璃体视网膜发现、治疗方案、培养数据和最终视力。2016年-从2012年5月至2014年4月治疗的3名患者增加。患者平均（SD）年龄为34（11）岁（范围：24-60岁）。视力范围为20/25至手部运动。最常见的症状是飞蚊症（n = 8），视力下降（n = 6）和疼痛（n = 5）。初始治疗包括所有患者的全身抗真菌药和9只眼的玻璃体内抗真菌药。5例患者因玻璃体炎恶化而需要行睫状体平坦部玻璃体切除术。最常见的病原体是白色念珠菌，占20%。最终视力范围从20/40到20/300。结论和相关性本报告提供的数据表明，EFE代表与IVDA相关的严重终末器官损害，并预示着不良的视力结果。医疗保健专业人员必须保持对EFE的高度怀疑，因为患者通常在没有全身感染体征的情况下走动。
IMPORTANCE Intravenous drug abuse (IVDA) is a known risk factor for endogenous fungal endophthalmitis (EFE), a severe intraocular infection caused by hematogenous seeding of mycotic organisms to the eye. Reporting significant increases in heroin-related deaths since 2014, the New England region is in the midst of an opioid crisis that has led to a substantial increase in patients at risk for this vision-threatening disease.OBJECTIVE To present an update on characteristics, management, and visual outcomes in patients with EFE.DESIGN, SETTING, AND PARTICIPANTS Medical records review was initiated on July 1, 2016, evaluating all patients with EFE referred to New England Eye Center at Tufts Medical Center, a tertiary care ophthalmology practice distributed throughout Massachusetts, from May 1, 2014, to May 1, 2016. Patients with a history of IVDA and culture-proven or clinical evidence of fungal endophthalmitis were included.EXPOSURES Intravenous drug use.MAIN OUTCOMES AND MEASURES Patient demographics, comorbidities, presenting symptoms and vision, vitreoretinal findings, treatment regimens, culture data, and final visual acuities.RESULTS Ten patients (5 women) with IVDA-related EFE were identified between May 1, 2014, and May 1, 2016-an increase from 3 patients treated from May 2012 to April 2014. The mean (SD) patient age was 34 (11) years (range, 24-60 years). Presenting visual acuities ranged from 20/25 to hand motion. The most common presenting symptoms were floaters (n = 8), reduced vision (n = 6), and pain (n = 5). Initial treatment included systemic antifungals in all patients and intravitreal antifungals in 9 eyes. Five patients required pars plana vitrectomy for worsening vitritis. The most commonly isolated pathogen was Candida albicans in 20% of the patients. Final visual acuity ranged from 20/40 to 20/300.CONCLUSIONS AND RELEVANCE The data provided in this report suggest that EFE represents severe end organ damage associated with IVDA and portends poor visual outcomes. Health care professionals must maintain a high suspicion for EFE, as patients are typically ambulatory on presentation without systemic signs of infection.