Fungal endophthalmitis associated with compounded products.
Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck's Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products.
Christina A
CA
Mikosz
Rachel M
RM
Smith
Moon
M
Kim
Clara
C
Tyson
Ellen H
EH
Lee
Eleanor
E
Adams
Susanne
S
Straif-Bourgeois
Rick
R
Sowadsky
Shannon
S
Arroyo
Yoran
Y
Grant-Greene
Julie
J
Duran
Yvonne
Y
Vasquez
Byron F
BF
Robinson
Julie R
JR
Harris
Shawn R
SR
Lockhart
Thomas J
TJ
Török
Laurene
L
Mascola
Benjamin J
BJ
Park
D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D056736:Drug Recalls; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D015821:Eye Infections, Fungal / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D005260:Female; D005670:Fusarium / Q000472:pathogenicity / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000009:adverse effects*; D012160:Retina / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D012394:Rosaniline Dyes / Q000009:adverse effects*; D004718:Saccharomycetales / Q000472:pathogenicity / Q000502:physiology; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D014822:Vitreous Body / Q000382:microbiology / Q000473:pathology / Q000601:surgery
D009883:Ophthalmic Solutions; D012394:Rosaniline Dyes; D014222:Triamcinolone Acetonide; C004692:coomassie Brilliant Blue
Bipolaris hawaiiensis; Franck’s; Fusarium incarnatum-equiseti; compounding; disease outbreaks; endophthalmitis; eye infections; fungal; fungi; mold