Fungal Endophthalmitis - StatPearls - NCBI Bookshelf The use of polimerase chain reaction (PCR) techniques has increased the yield of detection (up to 100%) [48] and has reduced the time necessary for etiological diagnosis. ; Revankar, S.G.; Chandrasekar, P.H. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Fungal endophthalmitis - PubMed The most important shortcoming of PCRthe limited number of pathogens that can be simultaneously searched formay be overcome by newer techniques, such as next-generation sequencing. An accurate clinical diagnosis for endophthalmitis confirmed by laboratory techniques is essential for early treatment with antifungal drugs, such as amphotericin B, imidazoles, and other antifungals. Review of Intraocular Pharmacokinetics of Anti-Infectives Commonly Used in the Treatment of Infectious Endophthalmitis. Dave, V.P. Bethesda, MD 20894, Web Policies Identification of hub genes and pathways of ferroptosis in. ; Zacks, D.N. All authors have reported high rates of anatomical success (75% to 100%). However, most ophthalmologists prefer to treat endophthalmitis with intravitreal antibiotics while awaiting microbiological diagnosis (simply because bacterial endophthalmitis is more prevalent that FE). ; Pappuru, R.R. Anatomical success rate was high, but that of functional success was low (especially in cases caused by molds) [3,9]. Culture-Independent Molecular Methods for Detection of Antifungal Resistance Mechanisms and Fungal Identification. ; Baumal, C.R. Castanheira, M.; Deshpande, L.M. Similar outcomes were found by Zhuang et al., in a cohort of patients from eastern China diagnosed with post-traumatic FE: 5.7% of eyes were finally enucleated, while 34.3% achieved a visual acuity 20/400 [25]. Among the 15 patients, 14 (93%) had anal . Acute retinal necrosis in a patient on immunosuppressive treatment for COVID-19 pneumonia: a case report. and transmitted securely. Maling S., King C., Davies N. A British Ophthalmological Surveillance Unit Study on metastatic endogenous endophthalmitis. However, most FE do not begin in an acute manner. Danielescu, C.; Stanca, H.T. For susceptible Candida strains, fluconazole may be preferable to voriconazole because it is less hepatotoxic [63]. Endophthalmitis is a rare but severe disease of ocular inflammation involving vitreous or aqueous fluids and other intraocular tissues that can result in blindness. McKeating, C.; White, P.L. Mir T.A., Papudesu C., Fang W., Hinkle D.M. Papudesu C., Mir T., Fang W., Thompson J., Hinkle D.M. ; Thompson, G.R. Is routine ophthalmoscopy really necessary in candidemic patients? Dichtl, K.; Forster, J.; Ormanns, S.; Horns, H.; Suerbaum, S.; Seybold, U.; Wagener, J. Pillai, G.S. Risk Factors, Treatment Strategies, and Outcomes of Endophthalmitis Associated with Severe Fungal Keratitis. ; methodology, C.D., V.P., H.T.S., D.-M.D. Candida was the organism found in most cases of endogenous FE. In. ; Mulvey, M.R. Recently, there have been a few reports of cases of FE in patients hospitalized for COVID-19 pneumonia [31,32,33]. Fungi also gain access to the host tissues by penetrating trauma or surgical interventions (cataract, glaucoma surgery, intravitreal injections). Endophthalmitis means bacterial or fungal infection inside the eye, involving the vitreous and/or aqueous humors. Editors Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. In another very recent proof-of-concept study, Huang et al., have used nanopore targeted sequencing (NTS) in aqueous humor and vitreous fluid samples from presumed cases of infectious endophthalmitis [, A major critic for the use of genetic sequencing in the purpose of identifying pathogens is the lack of information about susceptibility to antimicrobial treatments. Typically, after positioning the trocars, with the infusion cannula still closed, the surgeon will place the tip of the vitrector behind the lens (or in the center of the vitreous cavity). ; Tan, A.L. Haseeb A.A., Elhusseiny A.M., Siddiqui M.Z., Ahmad K.T., Sallam A.B. Management of recurrent postoperative fungal endophthalmitis. Silpa-Archa, S.; Ponwong, A.; Preble, J.M. ; Chhablani, J.; Gupta, V.; Khatri, M.; Nirmal, J.; Pavesio, C.; Agrawal, R. A Review of the Role of Intravitreal Corticosteroids as an Adjuvant to Antibiotics in Infectious Endophthalmitis. In those cases many ophthalmologists perform a vitreous needle tap and intravitreal injection, typically with antibiotics such as vancomycin and ceftazidime. However, fungi may have a fastidious nature that makes them difficult to grow in culture (or, in some cases, unculturable). Sheyman A.T., Cohen B.Z., Friedman A.H., Ackert J.M. Europe PMC is an archive of life sciences journal literature. Endophthalmitis associated with fungal keratitis and penetrating injuries in North China. In a series of patients with posttraumatic FE, lensectomy was performed in all cases, together with pars plana vitrectomy [25]. ; Clancy, C.J. https://creativecommons.org/licenses/by/4.0/, 3830 cases (culture proven endophthalmitis), 347 cases (culture proven post-traumatic endophthalmitis), 151 cases (culture-proven endophthalmitis associated with intraocular foreign bodies-IOFB), 256 cases (culture-proven post-traumatic endophthalmitis), 117 patients endogenous endophthalmitis (EE), 30 patients with intravenous drug abuse-related EE, Intravenous micafungin (only in chorioretinitis without vitritis) *, Intravenous amphotericin B associated with oral fluconazole, i.v. ; validation, writingoriginal draft, writingreview and editing, C.D., V.P., H.T.S., D.-M.D. 1. ; Manku, K.; Pacheco, P.A. In Fusarium endophthalmitis there have been a few reports of successful treatment with systemic voriconazole (with or without amphotericin B) and intravitreal voriconazole [70,71]. Duan, F.; Yang, Y.; Yuan, Z.; Zheng, Y.; Cheng, Z.; Lin, X. Chen et al., reported the testing of BDG in samples of intraocular fluids as a meaning of raising a high suspicion of FE (although the BDG concentrations in intraocular fluids of healthy individuals have not been established) [45]. Those conditions include: Weakened immune system. When the laboratory has identified an etiologic agent, but its susceptibility to antifungals it yet to be determined, the clinician may use the suggestions of antifungal therapy presented in Table 3. Exogenous Fungal Endophthalmitis: Clues to Aspergillus Aetiology with a Pharmacological Perspective. Chen L., Tao Y., Hu X. Huang Q., Fu A., Wang Y., Zhang J., Zhao W., Cheng Y. Microbiological diagnosis of endophthalmitis using nanopore targeted sequencing. Elsevier; Amsterdam, The Netherlands: 2018. pp. Patterson T.F., Thompson G.R., Denning D.W., Fishman J.A., Hadley S., Herbrecht R., Kontoyiannis D.P. ; Hadley, S.; Herbrecht, R.; Kontoyiannis, D.P. J. 2023 Apr 21;102(16):e33585. Endophthalmitis - UpToDate For azole-resistant Candida species, a combination of choice is intravenous amphotericin with oral flucytosine [58]. Dib, B.; Morris, R.E. ; Schmidt, L.; Antonation, K.S. Outbreak linked to procedures with epidural anesthesia in Matamoros Mexico, 2023. Wan, L.; Cheng, J.; Zhang, J.; Chen, N.; Gao, Y.; Xie, L.X. The usual antifungal doses are presented in Table 4. Endogenous endophthalmitis: diagnosis, management, and prognosis The aim is to provide a snapshot of some of the The most important shortcoming of PCR-the limited number of pathogens that can be simultaneously searched for-may be overcome by newer techniques, such as next-generation sequencing. Prior antimicrobial therapy is frequently incriminated for culture-negative endophthalmitis (while the microorganism may be dead, its DNA is still detectable). ; Avadhani, K.; Gupta, V.; Gupta, A.; Chakrabarti, A. Endophthalmitis is a bacterial or fungal infection that affects tissues inside the eye. 16, 700115 Iasi, Romania, Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Strada Dionisie Lupu No. The causative organism may be directly inoculated into the eye (exogenous endophthalmitis, usually posttraumatic or post intraocular surgery) or may enter through hematogenous spread from distant foci (endogenous endophthalmitis). No special Kuo, G.; Lu, Y.A. As late as 2016, the Infectious Disease Society of America recommended a screening ophthalmological examination of all patients with candidemia [58]. Ching Wen Ho, D.; Agarwal, A.; Lee, C.S. 2023 Jan 31;13:1103471. doi: 10.3389/fcimb.2023.1103471. and transmitted securely. ; Marr, K.A. -, Das T., Agarwal M., Anand A.R., Behera U.C., Bhende M., Das A.V., Dasgupta D., Dave V.P., Gandhi J., Gunasekaran R., et al. They have recommended that an ophthalmologic consultation should be performed in a patient with signs or symptoms suggestive of ocular infection, regardless of Candida septicemia [61]. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. Disclaimer/Publishers Note: The statements, opinions and data contained in all publications are solely Lupia T., Corcione S., Fea A.M., Reibaldi M., Fallico M., Petrillo F., Galdiero M., Scabini S., Polito M.S., Ciabatti U., et al. The Diagnosis and Treatment of Fungal Endophthalmitis: An Update. Blood samples have a low diagnostic yield. The Diagnosis and Treatment of Fungal Endophthalmitis: An Update. Vinekar A., Dogra M.R., Avadhani K., Gupta V., Gupta A., Chakrabarti A. Targeted High-Throughput Sequencing Identifies Predominantly Fungal Pathogens in Patients with Clinically Infectious, Culture-Negative Endophthalmitis in South India. Duan F., Yang Y., Yuan Z., Zheng Y., Cheng Z., Lin X. Editors select a small number of articles recently published in the journal that they believe will be particularly Sng, E.C.Y. For endophthalmitis caused by fungi other than Candida or Aspergillus there are very limited data regarding the immediate treatment, when the clinician has no information on the antifungals susceptibility. Teng X, Xiong X, Sha X, Lei Y, Diao Y, Liu J, Tian Y, Liu L, Zhong J. In a review of several series of patients with endogenous FE, the predominant microorganisms were yeasts (71.4% to 76.1%), most frequently Candida species (50% to 65%), while Aspergillus was the most frequent mold (in 11.7% to 16.4% of cases) [9]. 2021 Nov 22;7(11):996. doi: 10.3390/jof7110996. In the largest retrospective study of patients with FE, which took place in India, 39.0% were caused by Aspergillus species, 15.1% by Candida species, 15.9% by Fusarium species, and 30.0% by other fungi [3]. Mir, T.A. Before Volume 3. All articles published by MDPI are made immediately available worldwide under an open access license. Sowmya P., Madhavan H.N. ; Andes, D.R. The most common systemic risk factors were: prematurity, respiratory disorders, intraventricular hemorrhage, birth trauma, necrotizing enterocolitis, intrauterine hypoxia and birth asphyxia. ; Iorga, R.-E.; Darabus, D.-M.; Potop, V. J Fungi (Basel). In cases of infantile endogenous endophthalmitis, Candida species have been characterized as the primary responsible organisms in multiple case series and reports in the United States [34]. Without proper treatment, the condition can permanently. Papudesu, C.; Mir, T.; Fang, W.; Thompson, J.; Hinkle, D.M. official website and that any information you provide is encrypted In endophthalmitis the internal structures of the eye are invaded by replicating microorganisms, resulting in an inflammatory response [1]. Thus, microbiological culture remains the gold standard for the diagnosis of most intraocular infections. In a retrospective study on eyes suspected of endophthalmitis or infectious uveitis, cultures of aqueous humor or vitreous had 17% sensitivity, while PCR had 85% (remaining relatively inexpensive) [ ]. Exogenous Fungal Endophthalmitis: Clues to Aspergillus Aetiology with a Pharmacological Perspective. McKeating C., White P.L., Posso R., Palmer M., Johnson E., McMullan R. Diagnostic accuracy of fungal PCR and beta-d-glucan for detection of candidaemia: A preliminary evaluation. Candida was the organism found in most cases of endogenous FE. Endophthalmitis: Pathogenesis, clinical presentation, management, and Relhan N., Pathengay A., Schwartz S.G., Flynn H.W., Jr. ; Wiederhold, N.P. Chronic endogenous fungal endophthalmitis: diagnostic and treatment ; Avetisjan, J.; Walsh, T.J.; Shaya, F.S. Epidemiology, clinical manifestations, and diagnosis of fungal ; Pathengay, A.; Gupta, R.; Joseph, J.; Sharma, S.; Das, T. Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes. Antimicrobial guide to posterior segment infections. FE has a particularly high prevalence in tropical regions, and today the best source of information regarding this pathology is provided by authors from Asia. * Intravenous echinocandins (micafungin, anidulafungin, caspofungin) may be effective in chorioretinal fungal infiltrates, but have low-moderate vitreous penetration. An important concern is that corticosteroids may impair the efficacy of antifungals and interfere with the immunogenic response. Biswas, C.; Chen, S.C.; Halliday, C.; Martinez, E.; Rockett, R.J.; Wang, Q.; Timms, V.J. However, once it would become a routine test, Desmukh et al. ; Das, T. Infectious endophthalmitis leading to evisceration: Spectrum of bacterial and fungal pathogens and antibacterial susceptibility profile. Clinical Features and Visual Acuity Outcomes in Culture-Positive Endogenous Fungal Endophthalmitis in Southern China. Risk Factors, Treatment Strategies, and Outcomes of Endophthalmitis Associated with Severe Fungal Keratitis. Fungal diseases can affect anyone. official website and that any information you provide is encrypted 400 mg BID, two doses, then 300 mg/day (or oral 200 mg BID), i.v. Deshmukh, D.; Joseph, J.; Chakrabarti, M.; Sharma, S.; Jayasudha, R.; Sama, K.C. This review aims to provide the reader with the latest published information regarding FE, focusing on recent diagnostic techniques and on the advances in the use of antifungal drugs in ophthalmology. Front Cell Infect Microbiol. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy. In a retrospective report of 24 patients from India, diagnosed with COVID-19 and endogenous endophthalmitis, 78.5% were of fungal etiology [31]. Role of intravitreal dexamethasone in exogenous fungal endophthalmitis. Tyler A.D., Mataseje L., Urfano C.J., Schmidt L., Antonation K.S., Mulvey M.R., Corbett C.R. Patients that present the first symptoms weeks after an ocular surgery or trauma (or have risk factors for endogenous endophthalmitis), a clinical examination that reveals focal vitreous opacities or choroidal lesions, the prevalence of fungal infections in a certain geographical area are factors that should increase the level of suspicion, but fungi have to be taken into account as potential etiology in all cases. The Diagnosis and Treatment of Fungal Endophthalmitis: An Update Correct predisposing factors where possible. Tirpack, A.R. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. and R.-E.I. Ammar, M.J.; Carroll, R.; Kolomeyer, A.; Ying, G.S. ; Wang, W. Diagnostic Utility of Quantitative Polymerase Chain Reaction versus Culture in Endophthalmitis and Uveitis. Careers. and V.P. ; validation, writingoriginal draft, writingreview and editing, C.D., V.P., H.T.S., D.-M.D. Emerging techniques such as next-generation sequencing (also termed high-throughput sequencing) and nanopore targeted sequencing come with the promise of detecting virtually all DNA sequences present in a sample, and we hope that they will become more available (and the cost will decrease). Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance. Tirpack A.R., Duker J.S., Baumal C.R. Candida chorioretinitis without vitritis (which can occur in a setting of endogenous FE) can be treated with systemic therapy, without intravitreal injections [58]. The ophthalmologist confronted with a possible diagnosis of endophthalmitis should perform an anterior chamber and/or vitreous tap before initiating treatment. Regan, K.A. Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. William, A.; Spitzer, M.S. 1Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Strada Universitatii No. The main advantage of culture techniques is that they are available in any hospital and the laboratories have extensive experience using them. Bookshelf Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. The authors declare no conflict of interest. It provides easier downstream analysis and lower cost by allowing more samples to be tested in one run. Fungal infections are caused by hundreds of fungi that exist in our everyday environment. ; Kumar, A. Pathobiology of Aspergillus Fumigatus Endophthalmitis in Immunocompetent and Immunocompromised Mice. interesting to readers, or important in the respective research area. Vena A., Muoz P., Padilla B., Valerio M., Sanchez M.I., Bouza E. CANDIPOP Project, GEIH-GEMICOMED (SEIMC), and REIPI. /oral 800 mg loading dose, then 400800 mg/day [, i.v. Suggested initial therapy in fungal endophthalmitis (FE) cases were an etiologic agent has been identified, but antifungal susceptibility is yet unknown. Haseeb, A.A.; Elhusseiny, A.M.; Siddiqui, M.Z. Fungal endophthalmitis: Analysis of 730 consecutive eyes from seven tertiary eye care centers in India. Tabatabaei S.A., Aminzade S., Ahmadraji A., Soleimani M., Sefidan B.B., Kasaee A., Cheraqpour K. Early and complete vitrectomy versus tap and inject in acute post cataract surgery endophthalmitis presenting with hand motion vision; a quasi-experimental study. Sen et al., reported that 35.3% obtained a visual acuity of 6/60 or better, corneal involvement in addition to endophthalmitis and the presence of Aspergillus terreus being poor prognostic markers [89]. Behera U.C., Budhwani M., Das T., Basu S., Padhi T.R., Barik M.R., Sharma S. Role of early vitrectomy in the treatment of fungal endophthalmitis. ; Munteanu, M. Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020. In a retrospective cohort of 44 eyes with endogenous Candida endophthalmitis, Sallam et al., found that performing an early vitrectomy reduced significantly the risk of retinal detachment [85]. Other conditions, such as psoriasis, can mimic a fungal infection of the nail. Clinical Features and Visual Acuity Outcomes in Culture-Positive Endogenous Fungal Endophthalmitis in Southern China. Guest, J.M. It happens inside the tissues or fluids of the eye due to a bacterial or fungal infection. Liu M.Y., Zhang L., Yin X.L., Sun S.Y. Vinekar, A.; Dogra, M.R. ; Sharma, S.; Karolia, R.; Joseph, J.; Pathengay, A.; Pappuru, R.R. There are exciting perspectives for culture-independent, molecular-based identification not only of pathogen fungi, but also of their antifungal resistance mechanisms [, In summary, the clinician that suspects a diagnosis of FE should perform a vitreous tap (or vitrectomy) and ask for microscopical examination and cultures for bacteria and fungi (we prefer initial seeding on blood culture bottles). Luaces-Rodrguez A., Gonzlez-Barcia M., Blanco-Teijeiro M.J., Gil-Martnez M., Gonzalez F., Gmez-Ulla F., Lamas M.J., Otero-Espinar F.J., Fernndez-Ferreiro A. Candida endophthalmitis can develop following trauma or eye surgery or through hematogenous seeding of the retina and choroid as a complication of candidemia. Fungal Endophthalmitis Treatment & Management ; Siegel, N.H. Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study. After the first drops are aspirated, the surgeon withdraws the vitrector and the assistant continues to draw all the drops from the tubing into the syringe, while the infusion is turned on. In another series of patients from northern China, 73.3% of FE associated with fungal keratitis were caused by Fusarium species [27]. Unable to load your collection due to an error, Unable to load your delegates due to an error. ; Remadevi, K.K. Candida dubliniensis endophthalmitis: first case in North America. ; project administration, C.D. 16, 700115 Iasi, Romania; or.isaifmu@ucseleinad.nairpic, 2Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Strada Dionisie Lupu No. ; visualization, C.D. However, Aspergillus was the most prevalent (29.7%) and Candida species followed closely (26.6%) in the largest retrospective study from India [3]. ; Papakostas, T.D. Ocul Immunol Inflamm. Lupia, T.; Corcione, S.; Fea, A.M.; Reibaldi, M.; Fallico, M.; Petrillo, F.; Galdiero, M.; Scabini, S.; Polito, M.S. Dupont D., Saison J., Miailhes P., Mouchel R., Wallon M., Persat F. Aspergillus endophthalmitis: Potential role for vitreous galactomannan testing? Many presumed FE cases remain culture-negative, and there is a lot of interest in the use of PCR assays to obtain etiological diagnosis. Use your own towel. Visit our dedicated information section to learn more about MDPI. J. Ophthalmol. Pappas P.G., Kauffman C.A., Andes D.R., Clancy C.J., Marr K.A., Ostrosky-Zeichner L., Reboli A.C., Schuster M.G., Vazquez J.A., Walsh T.J., et al. Ophthalmic Surg Lasers. ; Hajrasouliha, A.; Kaplan, H.J. PMC The rate of positive cultures in presumed FE has varied largely, between 30% and 70% [, Galactomannan (GM) is a cell wall carbohydrate that is mostly specific for, The use of polimerase chain reaction (PCR) techniques has increased the yield of detection (up to 100%) [, To date, the T2Candida panel (from T2 Biosystems) is the only commercial PCR assay platform with extensive clinical validation for the detection of, While authors were able to detect bacterial or fungal DNA in many cases of culture-negative endophthalmitis, the results have to be regarded with caution, and the clinician must balance the clinical and laboratory data while observing the response to therapy. Isavuconazole is a second-generation broad-spectrum triazole, noninferior to voriconazole for invasive aspergillosis and suitable for stepdown therapy in cases of invasive candidiasis [78]. Other possible explanations are: the presence of fastidious microorganisms, scant (undetectable) bacterial pathogens or even true sterile endophthalmitis associated with antigenic response to a non-infectious pathogen [, While PCR techniques impose a limit on the number of pathogens that can be simultaneously searched for, next-generation sequencing (NGS) does not target specific species; it can detect all the different bacteria or fungi that are present in a sample, in one single assay. In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). The detecting and interpreting of millions of sequences in order to identify the pathogen is highly challenging [, Targeted NGS uses a selective amplification of specific regions of interest inside the genome, prior to massive parallel sequencing. This research received no external funding. [6]. Candida Endophthalmitis Treated Successfully with Isavuconazole: A Case Report. 3: 679. The Diagnosis and Treatment of Fungal Endophthalmitis: An Update Guest J.M., Singh P.K., Revankar S.G., Chandrasekar P.H., Kumar A. Isavuconazole for treatment of experimental fungal endophthalmitis caused by Aspergillus fumigatus. ; supervision, V.P. Boast, A.; Curtis, N.; Cranswick, N.; Gwee, A. Voriconazole dosing and therapeutic drug monitoring in children: Experience from a paediatric tertiary care centre. Originates from sources within the body; Infectious extraocular focus can be found in 90% of the cases, such as tooth abscess, pneumonia, endocarditis, liver abscess . Treatment of fungal infections | DermNet 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. Please note that many of the page functionalities won't work as expected without javascript enabled. Dimacali, V.G. ; Joseph, J. 10.3 Diagnosis; 10.4 Treatment [10] 11 Conclusions; 12 References; . Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive Fungal endophthalmitis due to yeasts (eg, Candida albicans) differs from that due to molds (eg, Aspergillus or Fusarium spp). Keep the affected skin clean and dry. Fungal diseases in the lungs are often similar to other illnesses such as bacterial or viral pneumonia. An official website of the United States government. A simple 10x or 15x magnifying hand lens used properly can reveal a lot more than looking unassisted. 2021;7:996. doi: 10.3390/jof7110996. The authors concluded that the visual acuity improved significantly in the immediate vitrectomy group [86]. predicted that a 48 h turnaround time would be feasible. ; Dasgupta, D.; Dave, V.P. Fluconazole is preferred to voriconazole in children, because it is difficult to attain target voriconazole concentration and to monitor the serum levels. Dave V.P., Pathengay A., Panchal B. 62 (4):409-17. Dimacali V.G., Lim Bon Siong R. Infectious endophthalmitis at a Philippine tertiary hospital: A ten-year retrospective study. ; methodology, C.D., V.P., H.T.S., D.-M.D. Nail fungus - Diagnosis and treatment - Mayo Clinic Intravenous drug abuse was also a frequent risk factor, present in 15.4% to 28.6% of fungal FE [9]. ; Papudesu, C.; Fang, W.; Hinkle, D.M. Fifteen (28%) patients with CD were complicated by anal fistulae. Diagnosis. ; Sun, S.Y. Diagnostic and Management Strategies of Aspergillus Endophthalmitis: Current Insights. The common causes for endogenous FE, post-traumatic FE and FE secondary to keratitis are Candida albicans, Aspergillus niger and Fusarium solani, res