Should all patients with candidaemia have an ophthalmic examination to rule out ocular candidiasis?
OBJECTIVE
To determine the incidence of ocular candidiasis and length of ophthalmic follow-up required to rule out ocular candidiasis in candidemia patients.


METHODS
We prospectively studied patients with candidemia at our institution. Eligibility criteria included a dilated ophthalmological examination within 72 h of fungemia. Patients without ocular candidiasis on initial examination had follow-up dilated ophthalmoscopy performed at 1, 2, 4, 12 and 24 weeks.


RESULTS
Between May 1996 and March 1997 a total of 50 patients with fungemia were identified of whom 31 were included in the study; 15 excluded patients died before an initial examination was performed. The overall incidence of ocular candidiasis was 26% (8/31 patients), all manifested as chorioretinitis. Five patients (16%) had ocular candidiasis on their initial examination. One of 21 patients (5%) without ocular candidiasis on initial examination developed ocular candidiasis within 1 week. Two of 16 patients (13%) without ocular candidiasis on initial examination or at 1 week follow-up developed ocular candidiasis within 2 weeks. No evidence of ocular candidiasis occurred in the 12 patients with follow-up at 4 weeks, the 8 patients with follow-up at 12 weeks and the 4 patients with follow-up at 24 weeks.


CONCLUSIONS
The incidence of ocular candidiasis among hospitalized patients is clinically significant. We recommend ophthalmological follow-up for development of ocular candidiasis for at least 2 weeks after an initial negative eye examination.
Krishna
R
R
Division of Ophthalmology, Cleveland Clinic Foundation, OH 44195, USA.
Amuh
D
D
Lowder
C Y
CY
Gordon
S M
SM
Adal
K A
KA
Hall
G
G
D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000175:diagnosis*; D002825:Chorioretinitis / Q000175:diagnosis* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors