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Fortuny-Clanchet M, Anaya C, Cairó M, Fenollosa-Romero E, González A, Costa D. Prevalence of anterior uveitis in cases of systemic inflammatory response syndrome in dogs and cats. Vet Ophthalmol 2024. [PMID: 38701003 DOI: 10.1111/vop.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To determine the prevalence of anterior uveitis in dogs and cats hospitalized with a diagnosis of systemic inflammatory response syndrome (SIRS). ANIMALS STUDIED Dogs and cats hospitalized between May 2020 and January 2021 were prospectively included. PROCEDURES Patients were categorized into two different groups: The first group included patients diagnosed with SIRS, and the second group included patients hospitalized without SIRS as a control group. Daily physical and ophthalmological examinations were conducted during hospitalization. Diagnosis of anterior uveitis was made based on the presence of aqueous flare, low intraocular pressure, and other associated ocular signs such as episcleral injection and miosis. A multinomial logistic regression analysis was conducted to investigate factors associated with SIRS and anterior uveitis development. RESULTS The study comprised 42 patients with SIRS and 26 patients without SIRS. Among those with SIRS, 38% developed anterior uveitis, whereas only 7.7% of patients without SIRS showed signs of anterior uveitis. The prevalence of uveitis was significantly higher in animals with SIRS compared to those without SIRS (p < .05). CONCLUSION Anterior uveitis is more prevalent in patients with SIRS than patients without SIRS. Therefore, complete ophthalmic examination is recommended in all patients presenting with this syndrome.
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Affiliation(s)
| | | | | | | | | | - Daniel Costa
- Veterinary Specialty Hospital of Hong Kong, Wan Chai, Hong Kong
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2
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Visioli G, Zeppieri M, Iannucci V, Manni P, Albanese GM, Salati C, Spadea L, Pirraglia MP. From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections. J Clin Med 2023; 12:7216. [PMID: 38068267 PMCID: PMC10707096 DOI: 10.3390/jcm12237216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/23/2024] Open
Abstract
In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.
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Affiliation(s)
- Giacomo Visioli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Valeria Iannucci
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Priscilla Manni
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Giuseppe Maria Albanese
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
- Eye Clinic, Policlinico Umberto I University Hospital, 00161 Rome, Italy
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3
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Mehta S, Jiandani P, Prabhudesai P. Fundus findings in patients admitted with post COVID-19 sepsis in an intensive care unit. Indian J Ophthalmol 2022; 70:3362-3365. [PMID: 36018121 DOI: 10.4103/ijo.ijo_854_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose COVID-19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post-COVID-19 systemic secondary infections in a tertiary intensive care unit. Methods Retrospective observational study based on chart review. Results A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre-existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long-term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non-proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan-retinal photocoagulation. Conclusion Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post-COVID-19 systemic infections.
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Affiliation(s)
- Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Bandra Reclamation, Bandra (West), Mumbai, Maharashtra, India
| | - Prakash Jiandani
- Department of Critical Care, Lilavati Hospital and Research Center, Bandra Reclamation, Bandra (West), Mumbai, Maharashtra, India
| | - Prahlad Prabhudesai
- Department of Chest Medicine, Lilavati Hospital and Research Center, Bandra Reclamation, Bandra (West), Mumbai, Maharashtra, India
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Bhikoo R, Ingram PR, Cunningham W, Gounder P, Host B, Chen FK. Risk of Klebsiella pneumoniae Endogenous Endophthalmitis during Bacteremia: Implications for Screening. Infect Chemother 2021; 53:381-383. [PMID: 34216132 PMCID: PMC8258283 DOI: 10.3947/ic.2021.0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/25/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Riyaz Bhikoo
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paul Robert Ingram
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Department of Infectious Diseases and Microbiology, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - William Cunningham
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pavindran Gounder
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Benjamin Host
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Fred K Chen
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Perth, Western Australia, Australia
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5
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Giraldo Herrera CE. Shamanic Microscopy: Cellular Souls, Microbial Spirits. ANTHROPOLOGY OF CONSCIOUSNESS 2018. [DOI: 10.1111/anoc.12087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jung H, Kim SW, Chang HH, Lee SA, Kim Y, Hwang S, Kim SJ, Lee JM. Analysis of Klebsiella as a Prognostic Factor of Ocular Outcomes in Endogenous Endophthalmitis with Decision Tree Analysis. Infect Chemother 2018; 50:238-251. [PMID: 30270583 PMCID: PMC6167506 DOI: 10.3947/ic.2018.50.3.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/10/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endogenous endophthalmitis (EE) is a fulminant ocular disease. This study was conducted to explore frequent pathogens and significant prognostic factors associated with poor ocular outcomes. MATERIALS AND METHODS A retrospective analysis was performed in a tertiary hospital in Korea. Thirty-nine patients, treated between January 2000 and June 2017, were eligible for the analysis. Ocular outcomes were classified as follows: 1) no light perception (NLP), 2) light perception (LP), 3) hand motion (HM), 4) counting fingers (CF), and 5) 20/200 or better. Logistic regression and decision tree analyses were used to identify risk factors that were associated with poor outcomes. RESULTS Pathogens were identified in 23 (58.9%) samples from blood, liver aspirate, and/or vitreous humor. Klebsiella pneumoniae was the most frequent organism (12/39, 30.8%), followed by Candida species (3/39, 8.3%). The most common combined infection was liver abscess (16/39, 41.0%). Acute pyelonephritis occurred in 30.8% of cases (12/39). Final ocular outcomes were as follows: 35.9% (14/39) NLP, 15.4% (6/39) LP, 15.4% (6/39) HM, 7.7% (3/39) CF, and 25.6% (10/39) 20/200 or better. K. pneumoniae was a poor prognostic factor in univariate (odds ratio [OR], 13.3; 95% confidence interval [CI], 2.1-130.9) and multivariate (OR, 17.5; 95% CI, 2.1-398.8) regression analyses (NLP and LP vs. HM, CF, and 20/200 or better). Other factors did not reach statistical difference. Decision tree analysis identified K. pneumoniae as a node that divided ocular outcomes (P = 0.017). CONCLUSIONS In conclusion, K. pneumoniae is the most frequent causative pathogen of EE. Considering the poor prognosis and rapid progression of K. pneumoniae EE, physicians should test for K. pneumoniae EE in patients who experience acute systemic infections with ocular signs and symptoms.
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Affiliation(s)
- Hyejin Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
| | - Hyun Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sang Ah Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Yoonjung Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Soyoon Hwang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Su Jeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Myung Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
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Nagasako Y, Inagaki K, Serizawa S, Hamada M, Echizen N, Takahashi O, Deshpande GA, Ohkoshi K. Risk Factors Associated with Retinal Lesions Resulting from Widespread Systemic Infection. Ophthalmol Retina 2017; 1:333-338. [PMID: 31047520 DOI: 10.1016/j.oret.2016.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To clarify the prevalence, microbiologic features, and risk factors of endogenous intraocular infections in patients with positive fungal or bacterial blood culture results. DESIGN Retrospective case series. PARTICIPANTS Inpatients (n = 433) with positive blood culture results who underwent an ophthalmology consultation between January 2006 and September 2012 in Japan. METHODS We retrospectively reviewed the ophthalmology consultations of 433 inpatients with positive blood culture results. Clinical features of patients with confirmed chorioretinitis or endophthalmitis were analyzed through descriptive statistical methods and univariate and multivariate models. MAIN OUTCOME MEASURES Correlation of clinical features with retinal lesions of disseminated bacteremia or fungemia. RESULTS Among 433 inpatients with positive blood culture results, 116 (26.8%) were unresponsive and 27 (6.2%) had subjective ocular symptoms. Eighty-four (19.4%) had candidemia, including 16 (3.7%) with retinal lesions. Additionally, 34 patients (7.8%) had chorioretinitis or endophthalmitis in 1 eye (17 patients [3.9%]) or both eyes (17 eyes [3.9%]; 51 eyes total). Of these 34 patients, 20 (58.8%) and 17 (50%) had systemic bacterial and fungal infections, respectively (both infections were noted in 3 patients [8.8%]). Staphylococcus aureus was the most common bacteria. Candida albicans was the most common fungus, followed by Candida glabrata. Catheter-related bloodstream infections were the most common source of infection among the 34 patients with chorioretinitis or endophthalmitis, followed by infective endocarditis, urinary tract infection, and soft-tissue and bone disease. Among the 114 bacteremic patients who underwent an ophthalmology consultation because of suspicion of infective endocarditis, only 16 (14%) had infective endocarditis, of whom only 1 (0.88%) had retinal lesions. Nineteen of 34 patients (55.9%) with retinal lesions survived sepsis. Among them, only 1 patient (5.3%) with bacteremia lost significant vision (no light perception), and the remaining 18 patients (94.7%) regained vision. No patient with candidemia had vision loss. Multivariate analysis revealed that candidemia, infective endocarditis, broad-spectrum antibiotic use, and eye symptoms were independent predictors of retinal lesions (all P < 0.05). CONCLUSIONS An ophthalmology consultation may be useful for patients with candidemia, infective endocarditis, broad-spectrum antibiotic use, or ocular symptoms. However, routine ophthalmologic evaluation may be less efficient for bacteremic patients without definitive infective endocarditis lacking other risk factors.
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Affiliation(s)
- Yuki Nagasako
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Keiji Inagaki
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan; St. Luke's International University, Tokyo, Japan
| | - Satoshi Serizawa
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Masafumi Hamada
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Nariaki Echizen
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Osamu Takahashi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Gautam A Deshpande
- Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan; St. Luke's International University, Tokyo, Japan
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8
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Sung L, Dix D, Cellot S, Gillmeister B, Ethier MC, Roslin NM, Johnston DL, Feusner J, Mitchell D, Lewis V, Aplenc R, Yanofsky R, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Traubici J, Allen U, Beyene J, den Hollander N, Paterson AD. Single nucleotide polymorphism in IL1B is associated with infection risk in paediatric acute myeloid leukaemia. Clin Microbiol Infect 2016; 22:563.e9-563.e17. [PMID: 26932518 DOI: 10.1016/j.cmi.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
We evaluated single nucleotide polymorphisms (SNPs) associated with infection risk in children with newly diagnosed acute myeloid leukaemia (AML). We conducted a multicentre, prospective cohort study that included children aged ≤18 years with de novo AML. DNA was isolated from blood lymphocytes or buccal swabs, and candidate gene SNP analysis was conducted. Primary outcome was the occurrence of microbiologically documented sterile site infection during chemotherapy. Secondary outcomes were Gram-positive and -negative infections, viridans group streptococcal infection and proven/probable invasive fungal infection. Interpretation was guided by consistency in risk alleles and microbiologic agent with previous literature. Over the study period 254 children and adolescents with AML were enrolled. Overall, 190 (74.8%) had at least one sterile site microbiologically documented infection. Among the 172 with inferred European ancestry and DNA available, nine significant associations were observed; two were consistent with previous literature. Allele A at IL1B (rs16944) was associated with decreased microbiologically documented infection, and allele G at IL10 (rs1800896) was associated with increased risk of Gram-positive infection. We identified SNPs associated with infection risk in paediatric AML. Genotype may provide insight into mechanisms of infection risk that could be used for supportive-care novel treatments.
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Affiliation(s)
- L Sung
- Division of Haematology/Oncology, Ontario, Canada; Child Health Evaluative Sciences, Ontario, Canada.
| | - D Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - S Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, Quebec, Canada
| | | | - M C Ethier
- Child Health Evaluative Sciences, Ontario, Canada
| | - N M Roslin
- Program in Genetics and Genome Biology, Ontario, Canada
| | - D L Johnston
- Hematology Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - J Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center, Oakland, CA, USA
| | - D Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - V Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Aplenc
- Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Yanofsky
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - C Portwine
- Hematology/Oncology, Chedoke-McMaster Hospitals, Canada
| | - V Price
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - S Zelcer
- Hematology/Oncology, London Health Sciences, Victoria Hospital, London, Ontario, Canada
| | - M Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - L Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - B Michon
- Pediatric Hematology/OncologyCentre, Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - K Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J Traubici
- Department of Diagnostic Imaging, Ontario, Canada
| | - U Allen
- Division of Infectious Diseases, Ontario, Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - N den Hollander
- Histocompatibility Laboratory, University Health Network, Ontario, Canada
| | - A D Paterson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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9
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Dix D, Aplenc R, Bowes L, Cellot S, Ethier MC, Feusner J, Gillmeister B, Johnston DL, Lewis V, Michon B, Mitchell D, Portwine C, Price V, Silva M, Stobart K, Yanofsky R, Zelcer S, Beyene J, Sung L. Impact of registration on clinical trials on infection risk in pediatric acute myeloid leukemia. Int J Cancer 2015; 138:1785-91. [PMID: 26515793 DOI: 10.1002/ijc.29905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/18/2015] [Accepted: 09/22/2015] [Indexed: 11/11/2022]
Abstract
Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML.
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Affiliation(s)
- David Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Richard Aplenc
- Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lynette Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, NFLD, Canada
| | - Sonia Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, QC, Canada
| | - Marie-Chantal Ethier
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jim Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA
| | - Biljana Gillmeister
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donna L Johnston
- Hematology Oncology, Children's Hospital of Eastern Ontario, Otawa, ON, Canada
| | - Victor Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Bruno Michon
- Pediatric Hematology/Oncology Centre, Hospitalier Universitaire De Quebec, Laval, QC, Canada
| | - David Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Carol Portwine
- Hematology/Oncology, Chedoke-McMaster Hospitals, Hamilton, ON, Canada
| | | | - Mariana Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Kingston, ON, Canada
| | - Kent Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada
| | | | - Shayna Zelcer
- Hematology/Oncology, London Health Sciences, London, ON, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Vaziri K, Pershing S, Albini TA, Moshfeghi DM, Moshfeghi AA. Risk factors predictive of endogenous endophthalmitis among hospitalized patients with hematogenous infections in the United States. Am J Ophthalmol 2015; 159:498-504. [PMID: 25486541 DOI: 10.1016/j.ajo.2014.11.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections. DESIGN Retrospective cross-sectional study. METHODS MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections. RESULTS Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P < .0001), bacterial meningitis (OR = 3.8; CI, 1.2-12.0; P = .023), fungal meningitis (OR = 59.1; CI, 14.1-247.8; P < .0001), internal organ abscess (OR = 2.9; CI, 1.2-6.4; P = .02), lymphoma/leukemia (OR = 2.9; CI, 1.6-5.3; P < .0001), skin abscess/cellulitis (OR = 1.75; CI, 1.1-2.8; P = .02), pyogenic arthritis (OR = 4.2; CI, 1.8-9.6; P = .001), diabetes with ophthalmic manifestations (OR = 7.0; CI, 1.7-28.3; P = .006), and urinary tract infection (OR = 0.04; CI, 0.3-0.9; P = .023) were each significantly associated with a diagnosis of endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P < .0001), and 55-64 years (OR = 2.9; CI, 1.8-4.8; P < .0001); those having length of stay of 3-10 days (OR = 1.9; CI, 1.1-3.3; P = .01), 11-30 days (OR = 3.1; CI, 1.8-5.5; P < .0001), and 31+ days (OR = 5.3; CI, 2.7-10.4; P < .0001); and those with intensive care unit/neonatal intensive care unit (ICU/NICU) admissions (OR = 1.5; CI, 1.4-1.6; P < .0001) were all more likely to be diagnosed with endogenous endophthalmitis. CONCLUSIONS Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission.
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Affiliation(s)
- Kamyar Vaziri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Palm Beach Gardens, Florida
| | - Suzann Pershing
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, Calfornia.
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Palm Beach Gardens, Florida
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Andrew A Moshfeghi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Palm Beach Gardens, Florida; Retina Associates of Kentucky, Lexington, Kentucky
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Chanchalani G, Jiandani P, Ansari AS, Mehta S. THE PREVALENCE OF RETINAL LESIONS IN SEPTIC ICU PATIENTS - A CROSS-SECTIONAL, OBSERVATIONAL STUDY. Intensive Care Med Exp 2015. [PMCID: PMC4797140 DOI: 10.1186/2197-425x-3-s1-a875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tran TH, Mitchell D, Dix D, Cellot S, Ethier MC, Gillmeister B, Hitzler J, Lewis V, Yanofsky R, Johnston DL, Portwine C, Price V, Zelcer S, Silva M, Michon B, Bowes L, Stobart K, Brossard J, Beyene J, Sung L. Infections in children with down syndrome and acute myeloid leukemia: a report from the Canadian infections in AML research group. Infect Agent Cancer 2013; 8:47. [PMID: 24289042 PMCID: PMC4174901 DOI: 10.1186/1750-9378-8-47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/30/2013] [Indexed: 12/02/2022] Open
Abstract
Background Children with Down syndrome (DS) are at high risk of infectious toxicity when treated with acute lymphoblastic leukemia chemotherapy protocols optimized in children without DS. Our objective was to determine if children with DS and acute myeloid leukemia (AML) have a different risk of infection when treated with chemotherapy protocols developed for children with DS compared to AML treatment protocols developed for children without DS. Methods We conducted a retrospective, population-based cohort study that included DS children ≤ 18 years of age with de novo, non-M3 AML diagnosed between January 1995 and December 2004, and treated at 15 Canadian centers. Patients were monitored for infection from initiation of AML treatment until recovery from the last cycle of chemotherapy, conditioning for hematopoietic stem cell transplantation, relapse, persistent disease or death (whichever occurred first). Trained research associates abstracted all information from each site. Results There were 31 children with DS included; median age was 1.7 (range 0.1-11.1) years. Eleven were treated according to a DS-specific protocol while 20 were treated with non-DS specific protocols. A total of 157 courses of chemotherapy were delivered. Microbiologically documented sterile site infection occurred in 11.9% and 14.3% of DS-specific and non-DS specific AML treatment courses respectively. Sepsis was rare and there were no infection-related deaths. In multiple regression, treatment with a DS-specific protocol was independently associated with a reduction in microbiologically documented sterile site infection (adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42-0.99; P = 0.044), and clinically documented infection (adjusted OR 0.36, 95% CI 0.14-0.91; P = 0.031) but not bacteremia (adjusted OR 0.73, 95% CI 0.44-1.22; P = 0.231). Conclusions Our study suggests that children with DS do not experience excessive infectious toxicity during treatment for AML compared to children without DS. Incorporation of DS-specific AML treatment protocols is associated with a more favorable infection profile for children with DS-AML.
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Affiliation(s)
- Thai Hoa Tran
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Cellot S, Johnston D, Dix D, Ethier MC, Gillmeister B, Mitchell D, Yanofsky R, Lewis V, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Brossard J, Beyene J, Sung L. Infections in pediatric acute promyelocytic leukemia: from the Canadian infections in acute myeloid leukemia research group. BMC Cancer 2013; 13:276. [PMID: 23735034 PMCID: PMC3679857 DOI: 10.1186/1471-2407-13-276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
Background It is not known whether children with acute promyelocytic leukemia (APL) have an infection risk similar to non- APL acute myeloid leukemia. The objective was to describe infectious risk in children with newly diagnosed APL and to describe factors associated with these infections. Methods We conducted a retrospective, population-based cohort study that included children ≤ 18 years of age with de novo APL treated at 15 Canadian centers. Thirty-three children with APL were included; 78.8% were treated with APL -specific protocols. Results Bacterial sterile site infection occurred in 12 (36.4%) and fungal sterile site infection occurred in 2 (6.1%) children. Of the 127 chemotherapy courses, 101 (79.5%) were classified as intensive and among these, the proportion in which a sterile site microbiologically documented infection occurred was 14/101 (13.9%). There was one infection-related death. Conclusions One third of children with APL experienced at least one sterile site bacterial infection throughout treatment and 14% of intensive chemotherapy courses were associated with a microbiologically documented sterile site infection. Infection rates in pediatric APL may be lower compared to non- APL acute myeloid leukemia although these children may still benefit from aggressive supportive care during intensive chemotherapy.
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Dix D, Cellot S, Price V, Gillmeister B, Ethier MC, Johnston DL, Lewis V, Michon B, Mitchell D, Stobart K, Yanofsky R, Portwine C, Silva M, Bowes L, Zelcer S, Brossard J, Traubici J, Allen U, Beyene J, Sung L. Association Between Corticosteroids and Infection, Sepsis, and Infectious Death in Pediatric Acute Myeloid Leukemia (AML): Results From the Canadian Infections in AML Research Group. Clin Infect Dis 2012; 55:1608-14. [PMID: 22955431 DOI: 10.1093/cid/cis774] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gavidia R, Fuentes SL, Vasquez R, Bonilla M, Ethier MC, Diorio C, Caniza M, Howard SC, Sung L. Low socioeconomic status is associated with prolonged times to assessment and treatment, sepsis and infectious death in pediatric fever in El Salvador. PLoS One 2012; 7:e43639. [PMID: 22928008 PMCID: PMC3425537 DOI: 10.1371/journal.pone.0043639] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/23/2012] [Indexed: 11/18/2022] Open
Abstract
Background Infection remains the most common cause of death from toxicity in children with cancer in low- and middle-income countries. Rapid administration of antibiotics when fever develops can prevent progression to sepsis and shock, and serves as an important indicator of the quality of care in children with acute lymphoblastic leukemia and acute myeloid leukemia. We analyzed factors associated with (1) Longer times from fever onset to hospital presentation/antibiotic treatment and (2) Sepsis and infection-related mortality. Method This prospective cohort study included children aged 0–16 years with newly diagnosed acute leukemia treated at Benjamin Bloom Hospital, San Salvador. We interviewed parents/caregivers within one month of diagnosis and at the onset of each new febrile episode. Times from initial fever to first antibiotic administration and occurrence of sepsis and infection-related mortality were documented. Findings Of 251 children enrolled, 215 had acute lymphoblastic leukemia (85.7%). Among 269 outpatient febrile episodes, median times from fever to deciding to seek medical care was 10.0 hours (interquartile range [IQR] 5.0–20.0), and from decision to seek care to first hospital visit was 1.8 hours (IQR 1.0–3.0). Forty-seven (17.5%) patients developed sepsis and 7 (2.6%) died of infection. Maternal illiteracy was associated with longer time from fever to decision to seek care (P = 0.029) and sepsis (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.09–8.63; P = 0.034). More infectious deaths occurred in those with longer travel time to hospital (OR 1.36, 95% CI 1.03–1.81; P = 0.031) and in families with an annual household income <US$2,000 (OR 13.90, 95% CI 1.62–119.10; P = 0.016). Interpretation Illiteracy, poverty, and longer travel times are associated with delays in assessment and treatment of fever and with sepsis and infectious mortality in pediatric leukemia. Providing additional education to high-risk families and staying at a nearby guest house during periods of neutropenia may decrease sepsis and infectious mortality.
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Affiliation(s)
- Ronald Gavidia
- Pediatric Oncology, Benjamin Bloom National Children’s Hospital, San Salvador, El Salvador
| | - Soad L. Fuentes
- Pediatric Oncology, Benjamin Bloom National Children’s Hospital, San Salvador, El Salvador
| | - Roberto Vasquez
- Pediatric Oncology, Benjamin Bloom National Children’s Hospital, San Salvador, El Salvador
| | - Miguel Bonilla
- Pediatric Oncology, Benjamin Bloom National Children’s Hospital, San Salvador, El Salvador
| | - Marie-Chantal Ethier
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Caroline Diorio
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Miguela Caniza
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
- International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
| | - Scott C. Howard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
- International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
- * E-mail:
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Cornut PL, Chiquet C. [Endogenous bacterial endophthalmitis]. J Fr Ophtalmol 2010; 34:51-7. [PMID: 21145128 DOI: 10.1016/j.jfo.2010.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 08/19/2010] [Indexed: 11/17/2022]
Abstract
Endogenous bacterial endophthalmitis, also called metastatic bacterial endophthalmitis, remains a diagnostic and therapeutic challenge. It is a rare and potentially sight-threatening ocular infection that occurs when bacteria reach the eye via the bloodstream, cross the blood-ocular barrier, and multiply within the eye. It usually affects immunocompromised patients and those suffering from diabetes mellitus, malignancy, or cardiac disease, but has also been reported after invasive procedures or in previously healthy people. In most cases, the ocular symptoms occur after the diagnosis of septicemia or systemic infection. Ocular symptoms include decreased vision, redness, discharge, pain, and floaters. The ocular inflammatory signs may be anterior and/or posterior. Bilateral involvement occurs in nearly 25% of cases. A wide range of microorganisms are involved, with differences in their frequency according to geography as well as the patient's age and past medical history, because of variations in the predisposing conditions and the source of the sepsis. The majority of patients are initially misdiagnosed, and ophthalmologists should be aware of this because prompt local and general management is required to save the eye and/or the patient's life.
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Affiliation(s)
- P-L Cornut
- Service d'ophtalmologie, hôpital Édouard-Herriot, CHU de Lyon, hospices civils de Lyon, université Claude-Bernard Lyon-I, 5, place d'Arsonval, 69437 Lyon cedex 3, France
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Singhi S, Deep A. Invasive candidiasis in pediatric intensive care units. Indian J Pediatr 2009; 76:1033-44. [PMID: 19907936 DOI: 10.1007/s12098-009-0219-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 08/27/2008] [Indexed: 01/28/2023]
Abstract
Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.
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Affiliation(s)
- Sunit Singhi
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Karmisholt MK, Hjort U, Knudsen LL, Schønheyder HC. Candidaemia and risk of intraocular infection: A Danish hospital-based cohort study. ACTA ACUST UNITED AC 2009; 40:241-6. [PMID: 17852897 DOI: 10.1080/00365540701642120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Intraocular infection is a feared complication in patients with candidaemia. We therefore assessed the current risk and prognosis in Danish candidaemia patients. Candidaemia patients at a Danish university hospital were identified prospectively during a 10-y period, 1995-2004, and ophthalmologic records were retrieved retrospectively. Among 203 incident cases of candidaemia, 86 (42%) were examined at least once by an ophthalmologist. Nine patients had retinitis and 1 patient had endophthalmitis; eye involvement was bilateral in 8 and monocular in 2 patients. Lesions were generally mild and progression was observed in only 1 patient. Surgical treatment was not indicated and the median duration of systemic antifungal therapy was 19 d. The median survival time was 77 d for candidaemia patients with eye involvement, 480 d in candidaemia patients without such an involvement, and only 9 d in candidaemia patients without an ophthalmologic examination. In conclusion, the cumulative rate of intraocular infection was 11.6%, but we suspect an underestimation due to the circumstances of the eye examinations and the rapid death of many patients. We continue to recommend eye examinations for candidaemia patients, but timing seems not to be critical if overt signs of infection are absent, thereby facilitating the use of improved diagnostic methods.
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Bouza E, Loeches B, Muñoz P. Fever of Unknown Origin in Solid Organ Transplant Recipients. Infect Dis Clin North Am 2007; 21:1033-54, ix-x. [DOI: 10.1016/j.idc.2007.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Najmi NG, Song HF, Ober RR. Presumed Candida endogenous fungal endophthalmitis: a case report and literature review. ACTA ACUST UNITED AC 2007; 78:454-9. [PMID: 17765856 DOI: 10.1016/j.optm.2007.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Revised: 02/15/2007] [Accepted: 02/28/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endogenous fungal endophthalmitis (EFE) is a rare intraocular infection that has recently increased in incidence over the last few decades. The most common causative organism of endogenous endophthalmitis is Candida albicans. Treatment generally is initiated with an antifungal drug systemically and, depending on the ocular findings, may also include a vitrectomy with the injection of an intraocular antifungal agent. Specific predisposing factors may make a patient more at risk for development of an ocular infection. CASE REPORT We present a case of presumed Candida endogenous endophthalmitis in an 83-year-old white man with a Candida albicans urinary tract infection and describe the general characteristics, treatment, and management of this condition. CONCLUSION Endogenous fungal endophthalmitis is a potentially blinding condition that can signal an underlying systemic infection. Without a dilated fundus examination in the presence of ocular inflammation, the condition easily can be misdiagnosed. Fungal infection may lead to retinal and vitreal lesions that can be visually debilitating if left untreated. Prognosis for visual outcome is dependent on timely diagnosis and initiation of treatment.
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Affiliation(s)
- Neeka G Najmi
- Southern Arizona VA Health Care System, Tucson, Arizona 85723, USA.
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Celik I, Cihangiroglu M, Yilmaz T, Kohle U, Akbulut A. The prevalence of bacteraemia-related retinal lesions in seriously ill patients. J Infect 2006; 52:97-104. [PMID: 15904970 DOI: 10.1016/j.jinf.2005.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2004] [Accepted: 04/01/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In this study, we investigated the frequency and aetiology of retinal lesions in bacteraemic and septic patients and the risk factors involved. METHODS A total of 150 adult patients in our hospital were included in the study. After consultation with the infectious diseases specialist, the following details were recorded: demographic data, area of admission, underlying diseases, Winston's clinical condition, Charlson's co-morbidity index, McCabe's criteria for underlying disease, APACHE II scoring, community or nosocomial acquisition of bacteraemia, and micro-organism responsible. Blood cultures were obtained from all the patients at least three times. All patients were examined for ocular lesions by the same ophthalmologist 48-72 h after the first examination. Some long-term hospitalized patients were evaluated more than once. RESULTS Patients were divided into six groups: 18 (12%) were bacteraemic non-septic; 31 (20.7%) were septic bacteraemic; 43 (28.7%) were septic non-bacteraemic; 19 (12.7%) had systemic inflammatory response syndrome (SIRS); 16 (10.7%) were non-septic non-bacteraemic but infectious; and 23 (15.3%) were controls. We found bacteraemia-related retinal lesions (BRRLs) in 22/150 (14.7%) of the patients, 19 of whom (86.4%) were in the septic-bacteraemic group while 3 (13.6%) were in the septic non-bacteraemic group. BRRLs were observed in 19/31 (61.3%) patients in the septic-bacteraemic group. Winston and APACHE II scores were found to be higher in patients with BRRLs than in others. BRRLs were more prevalent in septic or bacteraemic patients with central nervous system (CNS) diseases (31.8%) or cancer (27.3%) than in patients with other diseases. The organism most frequently responsible for bacteraemia in patients with BRRLs was Pseudomonas aeruginosa (27.3%), and the second most common was Staphylococcus aureus (22.7%). CONCLUSION BRRLs are most frequent in bacteraemic-septic patients (61.3%). The underlying diseases predisposing most to BRRLs are diseases of the CNS and cancers. Ocular examination appears to be a useful aid to diagnosis of bacteraemia or sepsis.
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Affiliation(s)
- Ilhami Celik
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Firat University, 23119 Elazig, Turkey.
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Eggimann P, Garbino J, Pittet D. Management of candidiasis Management of Candida species infections in critically ill patients. THE LANCET. INFECTIOUS DISEASES 2003; 3:772-85. [PMID: 14652203 DOI: 10.1016/s1473-3099(03)00831-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive candidiasis is a feared infection with mortality similar to that of septic shock (40-60%). Improved knowledge of its pathophysiology and the availability of new compounds for antifungal therapy and prophylaxis have contributed to improving the prognosis of severe candidal infections among immunosuppressed patients at the possible cost of the emergence of non-albicans strains of candida with lower susceptibility to azoles. This review focuses on the management of invasive deep-seated candidiasis in critically ill, non-immunocompromised patients. We discuss antifungal use, indications, potential benefit, and main secondary effects. Prevention strategies include pre-emptive antifungal therapy and azole-based prophylaxis. For patients at lower initial risk, pre-emptive therapy should be based on a management strategy that takes into account the presence of definite risk factors and the dynamics of candida colonisation. Among critically ill patients, azole prophylaxis is effective and is not associated with acquisition of resistance; it must be restricted to highly selected groups of patients at high risk only.
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Affiliation(s)
- Philippe Eggimann
- Medical Clinic II and Intensive Care Unit, and the Infection Control Programme, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
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Jackson TL, Eykyn SJ, Graham EM, Stanford MR. Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 2003; 48:403-23. [PMID: 12850229 DOI: 10.1016/s0039-6257(03)00054-7] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endogenous bacterial endophthalmitis is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. We provide an overview of endogenous bacterial endophthalmitis by reviewing 267 reported cases and integrating this with our experience of an additional 19 cases. The majority of patients with endogenous bacterial endophthalmitis are initially misdiagnosed and many have an underlying disease known to predispose to infection. This condition is often previously undiagnosed. Blood cultures are the most frequent means of establishing the diagnosis. The most common Gram positive organisms are Staphylococcus aureus, group B streptococci, Streptococcus pneumoniae,and Listeria monocytogenes. The most common Gram negative organisms are Klebsiella spp., Escherichia coli, Pseudomonas aeruginosa, and Neisseria meningitidis. Gram negative organisms are responsible for the majority of cases reported from East Asian hospitals, but Gram positive organisms are more common in North America and Europe. The visual outcome is poor with most cases leading to blindness in the affected eye. Many patients have extraocular foci of infection, with an associated mortality rate of 5%. The outcome of endogenous bacterial endophthalmitis has not improved in 55 years and clinicians need to have a high level of awareness of this commonly misdiagnosed condition.
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Affiliation(s)
- Timothy L Jackson
- Academic Department of Ophthalmology, Medical Eye Unit, St Thomas' Hospital, London, UK
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Rodríguez-Adrián LJ, King RT, Tamayo-Derat LG, Miller JW, Garcia CA, Rex JH. Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology. Medicine (Baltimore) 2003; 82:187-202. [PMID: 12792305 DOI: 10.1097/01.md.0000076008.64510.f1] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Invasive bacterial and candidal infections are known to involve the retina, but the natural history of the retinal lesions and the utility of ophthalmologic consultation in the critical care setting as a diagnostic tool are not well understood. We 1) performed weekly funduscopic examinations on 77 medical and surgical patients in intensive care units (ICUs), 2) analyzed results of serial ocular examinations in 180 non-neutropenic patients with candidemia, and 3) reviewed the English literature on the association of retinal lesions with disseminated bacterial or candidal infection (DBCI). We found that 15 (19%) of the ICU patients had retinal lesions consistent with DBCI. Of these 15, 1 had clearly sepsis-related retinal lesions, while 13 (87%) had 1 or more systemic disease that could have explained their retinal findings (6 diabetic retinopathy; 2 human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) retinopathy; 2 hypertensive retinopathy; 1 hemolytic uremic syndrome, and 1 leukemia). Multivariate analysis revealed that systemic disease (odds ratio 8.37, 95% confidence intervals: 3.24-21.56) independently correlated with the presence of retinal lesions while DBCI, trauma, hyperalimentation, and transfusion of blood products were not independently predictive in any analysis. Twenty of the 180 (15%) candidemic patients had retinal lesions. Two (1%) had classic 3-dimensional white lesions with vitreal extension, and 5 (2.7%) had chorioretinal lesions without vitreal haziness. Notably, 10% of patients had superficial retinal hemorrhages and/or cotton wool spots that could have been due to either candidemia or a systemic disease (diabetes, hypertension, renal failure, closed head trauma). Concurrent bacteremia occurred in 3 of the 27 patients with eye lesions. Retinal lesions resolved in a mean of 33 days. None of the patients had symptoms at the time of the retinal finding. We found 3 studies that prospectively assessed retinal lesions in bacteremic patients. The frequency of retinal lesions in these series varied from 12% to 26%, with the most common lesions being cotton wool spots followed by superficial retinal hemorrhages. White-centered hemorrhages were seen in about 15% +/- 2 of bacteremic patients. Five studies prospectively evaluated candidemic patients for Candida endophthalmitis. These studies observed rates from 0% to 78% for lesions consistent with candidal endophthalmitis. Most studies performed recently found that nonspecific lesions such as cotton wool spots or superficial retinal hemorrhages occurred with a frequency of 11% to 20%. The availability of less toxic antifungal agents, more frequent use of empirical therapy, and the trend to early treatment may be altering the frequency of this complication. Observation of a classic 3-dimensional retina-based vitreal inflammatory process is virtually diagnostic of endogenous endophthalmitis due to Candida spp., but such lesions are relatively uncommon. Conversely, nonspecific lesions that could be due to bacterial or candidal endophthalmitis (cotton wool spots, retinal hemorrhages, and Roth spots) are seen frequently. These lesions are most often due to an underlying systemic disease rather than an infection. Serial examinations provide the best evidence that a given lesion is due to an intercurrent infection. The current low rate of vitreal extension of retinal process appears to be due to the high rate of empirical or therapeutic use of antifungal agents in high-risk patient groups. Ophthalmoscopy should be performed in patients with known candidemia. However, ophthalmoscopic examination seems to have little value in assisting with the discovery of occult disseminated candidiasis or bacterial infection.
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Abstract
The incidence of invasive candidiasis is on the rise because of increasing numbers of immunocompromised hosts and more invasive medical technology. Recovery of Candida spp from several body sites in a critically ill or immunocompromised patient should raise the question of disseminated disease. Although identification to the species level and antifungal susceptibility testing should guide therapy, at this time amphotericin B preparations are the usual initial therapy for severe life-threatening disease. Azole therapy has an expanding body of evidence that proves it is as effective as and safer than amphotericin B therapy. Some forms of candidiasis (e.g., those with ocular, bone, or heart involvement) require a combined medical and surgical approach.
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Affiliation(s)
- Luis Ostrosky-Zeichner
- Division of Infectious Diseases, University of Texas-Houston Medical School, 6431 Fannin, JFB 1.728, Houston, TX 77030, USA.
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