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. 2024 Nov 7;11(12):ofae663.
doi: 10.1093/ofid/ofae663. eCollection 2024 Dec.

Do Patients With Candidemia Need an Ophthalmologic Examination?

Alice Lehman  1 , Katelyn M Tessier  2 , Victoria Sattarova  3 , Sandra Rocio Montezuma  3 , Susan Kline  1 , Serin Edwin Erayil  1
Affiliations

Do Patients With Candidemia Need an Ophthalmologic Examination?

Alice Lehman et al. Open Forum Infect Dis. .

Abstract

Background: The Infectious Diseases Society of America recommends a screening dilated retinal examination by an ophthalmologist for all patients with candidemia. Conversely, the American Academy of Ophthalmology recommends against routine screening in patients with candidemia without symptoms.

Methods: In a collaborative effort between infectious diseases and ophthalmology, we examined the incidence of ocular complications in 308 patients with candidemia and subsequently measured the rate of fundoscopic examinations, risk factors for ocular complications, management changes, and outcomes.

Results: Among those who received fundoscopic exams, findings suspicious for ocular candidiasis were found in 12 patients (8%, 12/148). After independent review by ophthalmology and infectious diseases, 3 patients were found to have alternate pathologies that explained their ocular findings. Nine patients (6%, 9/148) were adjudicated as having presumed Candida chorioretinitis. Of these 9 patients, 4 (44%) were asymptomatic, and 2 (22%) were unable to declare symptoms. No patients were definitively determined to have Candida endophthalmitis. Ocular candidiasis was not found to have a statistically significant association with symptoms or comorbidities. Ocular candidiasis was more likely to be found at ophthalmology exams >7 days from first positive Candida blood culture. The number needed to screen to detect presumed Candida chorioretinitis among asymptomatic patients was 20.

Conclusions: Based on the available evidence and high risk of morbidity of eye involvement, continued ophthalmological screens seem prudent, but a definitive consensus was found to be challenging given a lack of outcome data. Additional investigations are warranted. Ophthalmology screenings have a higher sensitivity at >7 days from positive blood culture.

Keywords: Candida endophthalmitis; candidemia; chorioretinitis; ocular candidiasis; ophthalmology screening.

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Conflict of interest statement

Potential conflicts of interest. All authors: no reported conflicts of interest.

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References

    1. Tsay S, Williams S, Mu Y, et al. National burden of candidemia, United States. Open Forum Infect Dis 2018; 5(Suppl 1):S142–3.
    1. Donahue SP, Greven CM, Zuravleff JJ, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology 1994; 101:1302–9. - PubMed
    1. O’Donnell M, Eller AW, Waxman EL, Clancy CJ, Nguyen MH. Screening for ocular candidiasis among patients with candidemia: is it time to change practice? Clin Infect Dis 2022; 75:1092–6. - PubMed
    1. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1–50. - PMC - PubMed
    1. Breazzano MP, Bond JB 3rd, Bearelly S, et al. American Academy of Ophthalmology recommendations on screening for endogenous Candida endophthalmitis. Ophthalmology 2022; 129:73–6. - PubMed