Fungal feeding-line infections: beware the eyes and teeth.
Twenty-four fungal feeding-line infections occurred in 17 patients during 1984-1992. Thirteen were receiving long-term home parenteral feeding and, in them, the first infection occurred after a median of 30 months (range 1-120) continuous feeding with a line that had been in situ for a median of 20 months (range 1-37). Four were receiving short-term feeding through a line that had been inserted 1-2 months previously. At the time of the first infection all patients were febrile and most were anaemic (15/16), however a leucocytosis was rare (three of 16). The fungi isolated were Candida albicans(6), Candida parapsilosis(5), Candida glabrata(2), Candida guillermondii(2) and other species (2). In 16 patients, the feeding-line was removed at the time of the first infection and no other treatment was given, and no other complications occurred in eight (50%) of these. In 11, the line was reinserted a median of 7 days after removal (range 1-11). Four patients (24%) developed a Candida infection of the eye 1-8 weeks after the diagnosis, uveitis (2) and endophthalmitis (2) which, in one patient, led to complete blindness in one eye. Two patients had recurrent infections which began within a month of dental therapy. In one, the infections stopped after dental extractions and, in the other, after a dental clearance. An ophthalmoscopic examination should be performed in all patients with a fungal feeding-line infection. Recurrent candidal infections may have a dental origin.
Nightingale
J M
JM
St Mark's Hospital, London, UK.
Simpson
A J
AJ
Towler
H M
HM
Lennard-Jones
J E
JE
D002177:Candidiasis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004866:Equipment Contamination; D015821:Eye Infections, Fungal / Q000209:etiology*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000295:instrumentation*; D012008:Recurrence; D014076:Tooth Diseases / Q000628:therapy*