Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections.
Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections.
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内源性真菌性内膜：霉菌和酵母菌感染中的危险因素，临床特征和治疗结果。
DOI：
10.1186/1869-5760-3-60
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发表时间：
2013-09-20
影响因子：
2.9
通讯作者：
Albini T
中科院分区：
文献类型：
--
作者：
Sridhar J;Flynn HW Jr;Kuriyan AE;Miller D;Albini T
本研究的目的是分析内源性真菌性眼内炎伴酵母菌和霉菌感染患者的危险因素、临床特征和治疗结果。对于该回顾性连续病例系列，审查了微生物学和临床记录，以确定1990年1月1日至2011年12月31日期间在单一机构接受治疗的所有眼内培养证实的内源性真菌性眼内炎患者。确定了53例患者的67只眼; 39例患者的51只眼酵母菌培养阳性，14例患者的16只眼霉菌培养阳性。霉菌作为致病微生物的患者在诊断前症状持续时间明显较短（霉菌3.8天，酵母菌21.0天，p = 0.002），更有可能接受医源性免疫抑制（霉菌57.1%，酵母菌7.7%，p = 0.001），有全器官移植史（霉菌35.7%，酵母菌2.6%，p = 0.001），并且在诊断时更可能具有前房积脓（霉菌37.5%，酵母菌6.0%，p = 0.001）。与酵母菌作为致病微生物的患者相比，由霉菌引起的内源性眼内炎患者在诊断时（logMAR视力霉菌1.80，酵母菌1.15，p = 0.008）和最终访视时（logMAR视力霉菌1.97，酵母菌1.05，p = 0.005）的视力显著较差。两组视网膜脱离的发生率无显著差异（霉菌12.5%，酵母菌30.6%，p = 0.201）。霉菌培养阳性的患者更容易接受眼球摘除术（霉菌25.0%，酵母菌0%，p < 0.001）。霉菌引起的内源性真菌性眼内炎患者的全身危险因素是医源性免疫抑制和全器官移植史。霉菌感染病例诊断前症状持续时间短，前房积脓发生率高。虽然内源性真菌性眼内炎通常与视力不良有关，但霉菌感染与酵母菌感染相比，在就诊和最终随访时视力较差。霉菌病例的眼球摘除率更高。
The purpose of the current study was to analyze risk factors, clinical features, and treatment outcomes in patients with endogenous fungal endophthalmitis with yeast and mold infections. For this retrospective consecutive case series, microbiologic and clinical records were reviewed to identify all patients with intraocular culture-proven endogenous fungal endophthalmitis treated at a single institution between January 1, 1990 and December 31, 2011. Sixty-seven eyes of 53 patients were identified; 51 eyes of 39 patients had positive cultures for yeast and 16 eyes of 14 patients had positive cultures for molds. Patients with molds as a causative organism had significantly shorter duration of symptoms prior to diagnosis (molds 3.8 days, yeast 21.0 days, p = 0.002), were more likely to be receiving iatrogenic immunosuppression (molds 57.1%, yeast 7.7%, p = 0.001), have a history of whole-organ transplantation (molds 35.7%, yeast 2.6%, p = 0.001), and were more likely to have hypopyon at the time of diagnosis (molds 37.5%, yeast 6.0%, p = 0.001). Patients with endogenous endophthalmitis caused by molds had significantly worse visual acuity at the time of diagnosis (logMAR visual acuity molds 1.80, yeast 1.15, p = 0.008) and at final visit (logMAR visual acuity molds 1.97, yeast 1.05, p = 0.005) compared to those patients with yeast as a causative organism. There was no significant difference in the rate of retinal detachment between the two groups (mold 12.5%, yeast 30.6%, p = 0.201). Patients with cultures positive for mold were significantly more likely to undergo enucleation (molds 25.0%, yeast 0%, p < 0.001). Systemic risk factors for patients with endogenous fungal endophthalmitis caused by molds were iatrogenic immunosuppression and a history of whole-organ transplantation. Shorter duration of symptoms before diagnosis and higher rates of hypopyon occurred in mold cases. While endogenous fungal endophthalmitis is generally associated with poor visual acuity outcomes, infection with mold species was associated with worse visual acuity on presentation and on final follow-up than infection with yeast species. Enucleation rates were much higher in mold cases.