title: Outbreak of fungal endophthalmitis due to Fusarium oxysporum following cataract surgery.
abstract: Outbreak of exogenous Fusarium endophthalmitis after cataract surgery was evaluated. Twenty patients developed postoperative endophthalmitis. In 19 eyes, pars plana vitrectomy (PPV) was performed, in 14 cases (74 %) with primary intraocular lens explantation. In one case, the PPV was not performed because of poor general condition of the patient. Symptoms of endophthalmitis (damaged vision, iritis, tyndallization in anterior chamber, hypopyon) occurred at intervals of 16-79 days (mean 31.3 days). Fungal etiology was documented in 12 eyes (60 %). Fusarium oxysporum was evidenced by culture and/or microscopy and confirmed by PCR and sequencing analysis. Eighteen (90 %) patients were treated with oral voriconazole (400 mg/day) for a period of 4-6 weeks. The final visual acuity was 6/15 in 1 case (5 %), 6/60 and worse in 17 eyes (85 %), and in 2 cases (10 %), enucleation had to be performed. Viscoelastic filling material was suggested the most likely source of infection. Endophthalmitis caused by Fusarium spp. are a potentially big threat for patients with serious impact on vision. Successful management of the infection is highly dependent on early diagnosis including species identification and antifungal susceptibility testing, and on aggressive and long-term treatment.
authors.affiliation: Department of Clinical Microbiology, University Hospital and Charles University Medical Faculty, Sokolska 581, 500 05, Hradec Kralove, Czech Republic, vladimir.buchta@fnhk.cz.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Buchta
authors.forename: Alena
authors.initials: A
authors.lastname: Feuermannová
authors.forename: Martin
authors.initials: M
authors.lastname: Váša
authors.forename: Lenka
authors.initials: L
authors.lastname: Bašková
authors.forename: Radka
authors.initials: R
authors.lastname: Kutová
authors.forename: Alena
authors.initials: A
authors.lastname: Kubátová
authors.forename: Marcela
authors.initials: M
authors.lastname: Vejsová
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002387:Cataract Extraction / Q000009:adverse effects*; D004196:Disease Outbreaks; D009877:Endophthalmitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy; D005260:Female; D060585:Fusariosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005670:Fusarium / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology*; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014821:Vitrectomy; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole