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Fungal endophthalmitis associated with compounded products

Christina A Mikosz et al. Emerg Infect Dis. 2014 Feb.

Abstract

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.

Keywords: Bipolaris hawaiiensis; Franck’s; Fusarium incarnatum-equiseti; compounding; disease outbreaks; endophthalmitis; eye infections; fungal; fungi; mold.

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Figures

Figure 1
Figure 1
Confirmed and probable cases of postprocedural fungal endophthalmitis, by state, United States, 2011–2012. Infections occurred after exposure to a product from Franck’s Compounding Lab (Ocala, FL, USA), though March 2012, when the implicated product was recalled. *In California, cases were associated with exposure to each product.
Figure 2
Figure 2
Epidemic curve of confirmed and probable cases of postprocedural fungal endophthalmitis, by week of procedure, United States.
See this image and copyright information in PMC

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