Fungal endophthalmitis caused by Paecilomyces variotii following cataract surgery: a presumed operating room air-conditioning system contamination.
OBJECTIVE
To report a case of delayed fungal endophthalmitis by Paecilomyces variotii following uncomplicated cataract surgery. To our knowledge this is the first reported case of postoperative endophthalmitis by this species.


METHODS
We report the longterm clinical follow-up of an 83-year-old female who underwent uncomplicated sutureless, small-incision cataract surgery. She developed recurring uveitis 4 months after surgery. Vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens were performed. Fungi were studied by histopathology and culture.


RESULTS
At histopathological examination, the fungi were found to be closely related with the capsular bag. A few mononuclear inflammatory cells were encountered. At culture, Paecilomyces variotii, a common ubiquitous non-pathogenic saprophyte, was identified. Despite systemic, intravitreal and topical antifungal therapy after vitrectomy the uveitis recurred several times, but no fungal organisms were isolated from the repeat intraocular specimen. At 18 months postoperatively the subject's visual acuity was finger counting at 2 metres. At the time of surgery the operating room air-conditioning system was undergoing repairs. Cases of fungal endophthalmitis after contamination from air-conditioning ventilation systems have been reported before, but none of the cases reported have been caused by P. variotii.


CONCLUSIONS
P. variotii, a non-pathogenic environmental saprophyte, may be disastrous if introduced into the eye. International recommendations on the environmental control of the operating room air-conditioning ventilation system should be strictly followed. No intraoperative surgery should be undertaken while the air-conditioning system is undergoing repairs or service.
Tarkkanen
Ahti
A
Ophthalmic Pathology Laboratory, Helsinki University Eye Hospital, Helsinki, Finland. ahti.tarkkanen@kolumbus.fi
Raivio
Virpi
V
Anttila
Veli-Jukka
VJ
Tommila
Petri
P
Ralli
Reijo
R
Merenmies
Lauri
L
Immonen
Ilkka
I
D000368:Aged; D000369:Aged, 80 and over; D000389:Air Conditioning; D000391:Air Microbiology; D000900:Anti-Bacterial Agents; D003428:Cross Infection; D020878:Device Removal; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004866:Equipment Contamination; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009873:Operating Rooms; D010143:Paecilomyces / Q000302:isolation & purification*; D018918:Phacoemulsification; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents