Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid.
OBJECTIVE
To report fungal endophthalmitis in nonimmunocompromised patients, each of whom received a single intravenous administration of presumably contaminated dextrose infusion fluid for minor ailments in rural settings.


METHODS
This noncomparative case series included 12 nonimmunocompromised patients (12 eyes) with culture-positive fungal endophthalmitis. All eyes underwent initial vitreous tap with injection of intravitreal antibiotics. Eleven eyes required pars plana vitrectomy and oral fluconazole or itraconazole for 4 to 6 weeks. One patient with panophthalmitis was treated with intravenous amphotericin B. To support the hypothesis that contaminated intravenous fluid was the possible risk factor, samples from 72 sealed bottles of 5% dextrose were subjected to fungal culture.


RESULTS
Patients presented 1 to 11 weeks (mean, 4.6 weeks) after the intravenous infusion. All eyes had a positive smear and cultures for fungi. Aspergillus specimen was isolated in nine eyes, Candida in two eyes, and Mucor in one eye. Final visual acuity was 20/80 or better in 8 (66.6%) eyes. Eleven of the 72 samples from dextrose bottles were culture-positive for fungi: six for Aspergillus fumigatus, three for Aspergillus niger, and two for Candida albicans.


CONCLUSIONS
A presumed contaminated intravenous infusion administered in a rural setting was found as a new risk factor for development of endogenous fungal endophthalmitis. These patients were successfully treated with pars plana vitrectomy and oral fluconazole and itraconazole therapy.
Gupta
A
A
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Gupta
V
V
Dogra
M R
MR
Chakrabarti
A
A
Ray
P
P
Ram
J
J
Patnaik
B
B
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D004340:Drug Contamination; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005947:Glucose / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects*; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009089:Mucor / Q000302:isolation & purification; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D012307:Risk Factors; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole; D005947:Glucose