Candida albicans Endophthalmitis in Brown Heroin Addicts: Response to Early Vitrectomy Preceded and Followed by Antifungal Therapy

• Published in: Clinical infectious diseases Vol. 27; no. 5; pp. 1130 - 1133
• Main Authors: Martínez-Váquez, C., Fernández-Ulloa, J., Bordón, J., Sopeña, B., de la Fuente, J., Ocampo, A., Rubianes, M.
• Format: Journal Article
• Language: English
• Published: United States The University of Chicago Press 01.11.1998; University of Chicago Press
• Subjects: Adult; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Antifungals; Blindness; Blindness - etiology; Blood; Candida albicans; Candidiasis; Candidiasis - complications; Candidiasis - drug therapy; Candidiasis - surgery; Candidiasis - therapy; Clinical Articles; Combined Modality Therapy; Endophthalmitis; Endophthalmitis - complications; Endophthalmitis - drug therapy; Endophthalmitis - surgery; Endophthalmitis - therapy; Eye Infections, Fungal - complications; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - surgery; Eye Infections, Fungal - therapy; Eyes; Female; Fluconazole - therapeutic use; Heroin; Heroin Dependence - complications; Humans; Infections; Injections, Intravenous; Male; Visual Acuity; Vitrectomy
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/514972

The management of Candida albicans endophthalmitis in intravenous drug abusers (IVDAs) has yet to be established. Early vitrectomy was previously reported as a promising treatment for C. albicans endophthalmitis. In our series, C. albicans endophthalmitis was diagnosed for 15 IVDAs. Funduscopic examinations confirmed severe vitritis in 12 patients and chorioretinitis in three. Blood and vitreal cultures were positive for C. albicans for seven and eight patients, respectively. Patients with vitritis received antifungal therapy before and after vitrectomy. Amphotericin B or fluconazole therapy was given according to the physician's preference. Vitrectomy was defined as early if it was performed within 1 week after the diagnosis of vitritis. All seven patients who underwent early vitrectomy had a favorable response without complications. Two of three patients who underwent late vitrectomy developed blindness or scotoma. Blindness was also described in two patients with vitritis who did not undergo vitrectomy. Early vitrectomy preceded and followed by antifungal therapy seems to be appropriate management of vitritis in IVDAs.