title: Ocular manifestations of candidemia.
abstract: BACKGROUND
  Ocular candidiasis is a major complication of candidemia. The incidence, risk factors, and outcome of eye involvement during candidemia are largely unknown. We prospectively studied the ocular manifestations of candidemia in a large, worldwide, randomized multicenter trial that compared voriconazole with amphotericin B followed by fluconazole for the treatment of candidemia.
  
  
  METHODS
  Nonneutropenic patients with blood cultures positive for Candida species were assigned treatment with voriconazole or with amphotericin B followed by fluconazole in a randomized 2:1 ratio. Dilated fundoscopy was performed in each patient at baseline, on day 7, at 2 and 6 weeks after the end of treatment (EOT), and, if clinically indicated, at 12 weeks after EOT.
  
  
  RESULTS
  Of 370 patients, 49 had findings consistent with the diagnosis of ocular candidiasis at baseline, and an additional 11 patients developed abnormalities during treatment, totaling 60 patients with eye involvement (16%). Of these patients, probable Candida eye infection was diagnosed in 40 patients (6 with endophthalmitis, 34 with chorioretinitis), and possible Candida eye infection in 20 (all with chorioretinitis). The duration of candidemia was significantly longer in patients with ocular candidiasis (median, 4 days; range, 1-18 days) compared with patients without ocular involvement (median, 3 days; range 1-26 days; log rank, P = .026). Therapy with either voriconazole (44 cases) or amphotericin B followed by fluconazole (16 cases) was successful in 65% of patients; outcome was not evaluable in 32% and was unfavorable in 3%.
  
  
  CONCLUSIONS
  Ocular involvement occurred in 16% of patients with candidemia; however, endophthalmitis was uncommon (1.6%). Treatment with either voriconazole or amphotericin B followed by fluconazole was successful for ocular candidiasis in most cases with follow-up.
authors.affiliation: Nijmegen Institute for Infection, Inflammation and Immunity, and Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. a.oudelashof@mumc.nl
authors.forename: Astrid M L
authors.initials: AM
authors.lastname: Oude Lashof
authors.forename: Aniki
authors.initials: A
authors.lastname: Rothova
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
authors.forename: Markus
authors.initials: M
authors.lastname: Ruhnke
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.forename: Haran T
authors.initials: HT
authors.lastname: Schlamm
authors.forename: Iwona T
authors.initials: IT
authors.lastname: Oborska
authors.forename: John H
authors.initials: JH
authors.lastname: Rex
authors.forename: Bart Jan
authors.initials: BJ
authors.lastname: Kullberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000150:complications* / Q000188:drug therapy; D009877:Endophthalmitis / Q000453:epidemiology / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011743:Pyrimidines / Q000008:administration & dosage; D012307:Risk Factors; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D015725:Fluconazole; D065819:Voriconazole