The incidence of endophthalmitis or macular involvement and the necessity of a routine ophthalmic examination in patients with candidemia

• DOI: 10.1371/journal.pone.0216956
• Publication Date: 2019-05-23T18:39:18Z
• Authors: Takashi Ueda; Yoshio Takesue; Issei Tokimatsu; Taiga Miyazaki; Nana Nakada-Motokawa; Miki Nagao; Kazuhiko Nakajima; Hiroshige Mikamo; Yuka Yamagishi; Kei Kasahara; Shingo Yoshihara; Akira Ukimura; Koichiro Yoshida; Naomi Yoshinaga; Masaaki Izumi; Hiroshi Kakeya; Koichi Yamada; Hideki Kawamura; Kazuo Endou; Kazuaki Yamanaka; Mutsunobu Yoshioka; Kayoko Amino; Hiroki Ikeuchi; Motoi Uchino; Yoshitsugu Miyazaki
• Keywords: Male; Risk; Candida parapsilosis; Science; Candida glabrata; 03 medical and health sciences; 0302 clinical medicine; Japan; Candida albicans; Prevalence; Humans; Macula Lutea; Candida tropicalis; Aged; Retrospective Studies; Endophthalmitis; Incidence; Q; R; Candidemia; Middle Aged; 3. Good health; Ophthalmoscopy; Chorioretinitis; Medicine; Female; Eye Infections, Fungal; Research Article

The incidence of ocular candidiasis (OC) in patients with candidemia varies across different reports, and the issue of whether routine ophthalmoscopy improves outcomes has been raised. This study investigated the incidence of OC and evaluate whether the extent of OC impacts the clinical outcomes.This retrospective study included non-neutropenic patients with candidemia who underwent treatment at one of 15 medical centers between 2010 and 2016. Chorioretinitis without other possible causes for the ocular lesions and endophthalmitis was classified as a probable OC. If signs of chorioretinitis were observed in patients with a systemic disease that causes similar ocular lesions, they were classified as a possible OC.In total, 781 of 1089 patients with candidemia underwent an ophthalmic examination. The prevalence of OC was 19.5%. The time from the collection of a positive blood culture to the initial ophthalmic examination was 5.0 ± 3.9 days in patients with OC. The leading isolate was Candida albicans (77.9%). Possible OC was associated with unsuccessful treatments (resolution of ocular findings) (odds ratio: 0.354, 95% confidence interval: 0.141-0.887), indicating an overdiagnosis in patients with a possible OC. If these patients were excluded, the incidence fell to 12.8%. Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients.Even when early routine ophthalmic examinations were performed, a high incidence of advanced ocular lesions was observed. These results suggest that routine ophthalmic examinations are still warranted in patients with candidemia.