title: Inpatient Ophthalmology Consultation for Fungemia: Prevalence of Ocular Involvement and Necessity of Funduscopic Screening.
abstract: OBJECTIVE
  To determine the generalizability of recent data assessing the necessity of ophthalmic consultation for fungemic patients, we examined the prevalence, microbial profile, and treatment of fungal chorioretinitis and endophthalmitis among patients with positive fungal cultures referred for ophthalmologic consultation at a tertiary care medical center.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  All inpatient ophthalmology consultations from Wills Eye Hospital at Thomas Jefferson University between January 1, 2006 and December 31, 2012 were retrospectively reviewed and cross-referenced to a microbiologic database of positive fungal blood cultures. This included 227 adult consecutive inpatients with positive fungal blood cultures (n = 215) or suspected fungemia (n = 12). Clinical data were extracted from records held by the microbiology laboratory and inpatient records. Patients were deemed to have ocular fungal involvement if dilated fundus examination demonstrated evidence of chorioretinitis or endophthalmitis.
  
  
  RESULTS
  Two hundred and twenty-seven consultations were requested to evaluate patients for ocular manifestations of fungemia. Eleven patients (4.8%, 95% CI 2.4%-8.5%) were diagnosed with fungal chorioretinitis or endophthalmitis. Of these 11 patients, 5 had visual symptoms, 2 were asymptomatic, and 4 were unable to communicate. A total of 5 patients (2.2%) received intravitreal injections following funduscopic screening. An additional 11 patients (4.8%) had nonspecific fundus lesions considered to be inconsistent with ocular fungal involvement. The most common fungal species identified were Candida albicans (n = 85), Candida glabrata (n = 63), and Candida parapsilosis (n = 44).
  
  
  CONCLUSIONS
  The current study found a low rate of disseminated ocular involvement in patients with positive fungal cultures referred for ophthalmologic consultation. However, 2 patients with ocular fungal involvement denied visual symptoms and over half of affected patients were asymptomatic or unable to communicate. As the presence and severity of ocular involvement in fungemic patients may dictate the mode and duration of antifungal treatment, funduscopic screenings may still have an important role.
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania. Electronic address: murtaza.adam@gmail.com.
authors.forename: Murtaza K
authors.initials: MK
authors.lastname: Adam
authors.affiliation: Sidney Kimmel Medical College - Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Sina
authors.initials: S
authors.lastname: Vahedi
authors.affiliation: Sidney Kimmel Medical College - Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Nichols
authors.affiliation: Barnet Dulaney Perkins Eye Center, Phoenix, Arizona.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Fintelmann
authors.affiliation: Francis I. Proctor Foundation at University of California San Francisco, San Francisco, California.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Sunir J
authors.initials: SJ
authors.lastname: Garg
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Hsu
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Maguire
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Spirn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D009877:Endophthalmitis / Q000175:diagnosis* / Q000453:epidemiology; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult