Skip to main content

Advertisement

Log in

Fungal Eye Infections: New Hosts, Novel Emerging Pathogens but No New Treatments?

  • Advances in Diagnosis of Invasive Fungal Infections (S Chen, Section Editor)
  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We sought to explore the current incidence and associated risk factors associated with fungal eye infections. We also reviewed new diagnostic strategies and recent clinical studies exploring the use of topical and oral antifungal agents.

Recent Findings

Incidence and associated risks continue to vary with geographic region, and access to timely healthcare. Nosocomial fungal endophthalmitis can result from minor surgical procedures to the eye. Molecular methods offer increasing diagnostic utility. Clinical treatment studies have mainly focussed on the treatment of fungal keratitis and have been conducted in South Asia. Topical natamycin remains superior to topical reconstituted voriconazole and remains the preferred therapy including for Fusarium eye infections. Neither adjunctive oral ketoconazole nor oral voriconazole has been shown to have added clear benefit to topical treatment.

Summary

Larger international studies with more heterogenous populations are required for future clinical studies which should include patients with contact lens fungal keratitis and those with fungal endophthalmitis. Basic science studies exploring the immunology of fungal eye infections and drug levels to understand the differences in clinical outcomes are encouraged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lalitha P, Prajna NV, Manoharan G, Srinivasan M, Mascarenhas J, Das M, et al. Trends in bacterial and fungal keratitis in South India, 2002-2012. Br J Ophthalmol. 2015;99(2):192–4.

    Article  PubMed  Google Scholar 

  2. Aruljyothi L, Radhakrishnan N, Prajna VN, Lalitha P. Clinical and microbiological study of paediatric infectious keratitis in South India: a 3-year study (2011-2013). Br J Ophthalmol. 2016;100(12):1719–23.

    Article  PubMed  Google Scholar 

  3. Durand ML. Bacterial and fungal endophthalmitis. Clin Microbiol Rev. 2017;30(3):597–613.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schimel AM, Miller D, Flynn HW Jr. Endophthalmitis isolates and antibiotic susceptibilities: a 10-year review of culture-proven cases. Am J Ophthalmol. 2013;156(1):50–2. e1

    Article  PubMed  CAS  Google Scholar 

  5. Kainer MA, Reagan DR, Nguyen DB, Wiese AD, Wise ME, Ward J, et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med. 2012;367(23):2194–203.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Kauffman CA, Pappas PG, Patterson TF. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;368(26):2495–500.

    Article  PubMed  CAS  Google Scholar 

  7. Edison LS, Dishman HO, Tobin-D’Angelo MJ, Allen CR, Guh AY, Drenzek CL. Endophthalmitis outbreak associated with repackaged bevacizumab. Emerg Infect Dis. 2015;21(1):171–3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Rayess N, Rahimy E, Storey P, Shah CP, Wolfe JD, Chen E, et al. Postinjection endophthalmitis rates and characteristics following intravitreal bevacizumab, ranibizumab, and aflibercept. Am J Ophthalmol. 2016;165:88–93.

    Article  PubMed  CAS  Google Scholar 

  9. Forooghian F, Albiani DA, Kirker AW, Merkur AB. Comparison of endophthalmitis rates following intravitreal injection of compounded bevacizumab, ranibizumab, and aflibercept. Can J Ophthalmol. 2017;52(6):616–9.

    Article  PubMed  Google Scholar 

  10. Al-Rashaed S, et al. Incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor: experience in Saudi Arabia. Middle East Afr J Ophthalmol. 2016;23(1):60–3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wani VB, al-Kandari J, Sabti K, Aljassar F, Qali H, Kumar N, et al. Incidence of endophthalmitis after intravitreal bevacizumab using aliquots prepared on-site in 2 operating rooms in Kuwait. Middle East Afr J Ophthalmol. 2016;23(1):64–70.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sheyman AT, Cohen BZ, Friedman AH, Ackert JM. An outbreak of fungal endophthalmitis after intravitreal injection of compounded combined bevacizumab and triamcinolone. JAMA Ophthalmol. 2013;131(7):864–9.

    Article  PubMed  CAS  Google Scholar 

  13. Tirpack AR, Duker JS, Baumal CR. An outbreak of endogenous fungal endophthalmitis among intravenous drug abusers in New England. JAMA Ophthalmol. 2017;135(6):534–40.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1–50.

    Article  PubMed  Google Scholar 

  15. Chen SC, Sorrell TC, Chang CC, Paige EK, Bryant PA, Slavin MA. Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014. Intern Med J. 2014;44(12b):1315–32.

    Article  PubMed  CAS  Google Scholar 

  16. Weinstein AJ, Johnson EH, Moellering RC Jr. Candida endophthalmitis: a complication of candidemia. Arch Intern Med. 1973;132(5):749–52.

    Article  PubMed  CAS  Google Scholar 

  17. Kehrmann J, Chapot V, Buer J, Rating P, Bornfeld N, Steinmann J. Diagnostic performance of blood culture bottles for vitreous culture compared to conventional microbiological cultures in patients with suspected endophthalmitis. Eur J Clin Microbiol Infect Dis. 2018;

  18. Mehta M, Rasheed RA, Duker J, Reichel E, Feinberg E, Husain D, et al. Vitreous evaluation: a diagnostic challenge. Ophthalmology. 2015;122(3):531–7.

    Article  PubMed  Google Scholar 

  19. Li Z, Breitwieser FP, Lu J, Jun AS, Asnaghi L, Salzberg SL, et al. Identifying corneal infections in formalin-fixed specimens using next generation sequencing. Invest Ophthalmol Vis Sci. 2018;59(1):280–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Prajna NV, Krishnan T, Mascarenhas J, Rajaraman R, Prajna L, Srinivasan M, et al. The mycotic ulcer treatment trial: a randomized trial comparing natamycin vs voriconazole. JAMA Ophthalmol. 2013;131(4):422–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Sharma S, Das S, Virdi A, Fernandes M, Sahu SK, Kumar Koday N, et al. Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial. Br J Ophthalmol. 2015;99(9):1190–5.

    Article  PubMed  Google Scholar 

  22. Rajaraman R, Bhat P, Vaidee V, Maskibail S, Raghavan A, Sivasubramaniam S, et al. Topical 5% natamycin with oral ketoconazole in filamentous fungal keratitis: a randomized controlled trial. Asia Pac J Ophthalmol (Phila). 2015;4(3):146–50.

    Article  CAS  Google Scholar 

  23. Prajna NV, Krishnan T, Rajaraman R, Patel S, Srinivasan M, Das M, et al. Effect of oral voriconazole on fungal keratitis in the Mycotic Ulcer Treatment Trial II (MUTT II): a randomized clinical trial. JAMA Ophthalmol. 2016;134(12):1365–72.

    Article  PubMed  PubMed Central  Google Scholar 

  24. FlorCruz NV, Evans JR, Medical interventions for fungal keratitis. Cochrane Database Syst Rev, 2015(4): p. CD004241.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sharon C-A Chen.

Ethics declarations

Conflict of Interest

Christina C. Chang declares no conflict of interest. Sharon C-A Chen has received grant funding from MSD (AUS).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Advances in Diagnosis of Invasive Fungal Infections

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, C.C., Chen, S.CA. Fungal Eye Infections: New Hosts, Novel Emerging Pathogens but No New Treatments?. Curr Fungal Infect Rep 12, 66–70 (2018). https://doi.org/10.1007/s12281-018-0315-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12281-018-0315-z

Keywords

Navigation