INTRAOCULAR CANDIDIASIS IN PATIENTS WITH CANDIDEMIA - CLINICAL IMPLICATIONS DERIVED FROM A PROSPECTIVE MULTICENTER STUDY
INTRAOCULAR CANDIDIASIS IN PATIENTS WITH CANDIDEMIA - CLINICAL IMPLICATIONS DERIVED FROM A PROSPECTIVE MULTICENTER STUDY
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DOI：
10.1016/s0161-6420(94)31175-4
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发表时间：
1994-07-01
期刊：
影响因子：
13.7
通讯作者：
LU, VL
中科院分区：
文献类型：
--
作者：
DONAHUE, SP;GREVEN, CM;LU, VL
目的：念珠菌引起的眼内感染可对视力造成破坏性后果。随着念珠菌作为一种主要的医院病原体的出现，作者调查了念珠菌血症患者眼部病变的患病率，并评估了眼部受累的危险因素。方法：本研究是一项前瞻性，多中心，观察性设计。118例念珠菌血症患者接受了传染病服务的评估，并在72小时内接受了间接眼科检查，报告阳性血培养。根据客观的、预先确定的标准对眼部检查结果进行分类。念珠菌性脉络膜视网膜炎定义为局灶性、白色、浸润性脉络膜视网膜病变，无玻璃体受累。念珠菌性眼内炎定义为扩展到玻璃体或玻璃体内“绒毛球”的脉络膜视网膜炎。''结果：与先前的念珠菌血症患者研究（引用眼内炎患病率接近40%）相反，没有患者显示患有眼内炎。念珠菌脉络膜视网膜炎被认为是在9%的患者，所有这些人接受抗真菌药物。脉络膜视网膜炎从未进展为眼内炎的观察结果表明，全身性抗真菌药物提供了足够的眼部治疗。念珠菌性脉络膜视网膜炎的危险因素包括白色念珠菌（与非白色念珠菌属相比）引起的真菌血症、多重阳性血培养、视觉症状和免疫抑制。20%的患者有非特异性眼部病变不直接相关的infection.Conclusion：念珠菌血症的患者有上述危险因素值得正式眼科检查。
Purpose: Intraocular infection caused by Candida species can have devastating visual consequences. With the emergence of Candida as a major nosocomial pathogen, the authors investigated the prevalence of ocular lesions in patients with candidemia and evaluated risk factors for eye involvement.Methods: This study is a prospective, multicentered, observational design. One hundred eighteen patients with candidemia were evaluated by the infectious disease service and received indirect ophthalmologic examination within 72 hours of a reported positive blood culture. Ocular findings were classified on the basis of objective, predetermined criteria. Candida chorioretinitis was defined as the presence of focal, white, infiltrative chorioretinal lesions without vitreal involvement. Candida endophthalmitis was defined as chorioretinitis with extension into the vitreous or intravitreal ''fluff balls.''Results: In contrast to previous studies of patients with candidemia citing prevalence rates of endophthalmitis approaching 40%, no patients were shown to have endophthalmitis. Candida chorioretinitis was seen in 9% of the patients, all of whom received antifungal agents. The observation that chorioretinitis never progressed to endophthalmitis suggests that systemic antifungal agents provided adequate ocular therapy. Risk factors for Candida chorioretinitis include fungemia with Candida albicans (versus nonalbicans species), multiple positive blood cultures, visual symptoms, and immunosuppression. Twenty percent of patients had nonspecific ocular lesions not directly related to infection.Conclusion: Patients with candidemia who have the risk factors noted above warrant formal ophthalmologic examination.