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Fungal Infections- PSD B14

Terms in this set (24)

In order of most to least common, what is the prevalence of the following types of ocular infections- bacterial, fungal, Protozoal, viral?
Bacterial > viral > protozoal (other than toxoplasmosis) > fungal
*What is the most common causative organism of a fungal endophthalmitis? And is it usually exogenous or endogenous?*
Candida; usually from an endogenous source
What are some things that make a patient more susceptible to develop fungal endophthalmitis?
It is associated with catheters, parenteral nutrition, IV drug abuse, chronic lung disease, and immunosuppression.
Describe the process of developing fungal endophthalmitis. Where does it initially begin and end up?
There is an endogenous source of infection that can usually be identified (original infection elsewhere). The infection spreads through the bloodstream to the choroid. The original choroidal infiltrate may extend through the retina into the vitreous (retinitis —> endophthalmitis).
True or false- Bacterial infections progress faster than fungal infections.
True- fungal retinitis/endophthalmitis progresses slowly in contrast to bacterial infections. Therefore, an anterior chamber infection will occur later with fungal infections.
What are signs of fungal retinitis/endophthalmitis?
One or more creamy white chorioretinal lesions with an overlying vitritis and often seen with vitreous colonies ("cotton balls")
What might fungal endophthalmitis/retinitis progress to?
It may progress to retinal necrosis and detachment (associated with proliferative vitreoretinopathy).
If a patient has vitritis secondary to fungal retinitis/endophthalmitis, what is the preferred treatment?
Vitreous involvement often necessitates vitrectomy and injection of intravitreal medications.
If a patient presents with fungal retinitis and no sign of vitreous involvement, what is the preferred treatment?
Systemic anti-fungal in non-resistant cases
*What condition is characterized by a stalk connecting the two vitreous opacities, and is otherwise known as a "string of pearls"?*
Fungal endophthalmitis (Candida)- endogenous infection
What condition is usually bilateral, is caused by an immune mediated response to inhalation of a soil mold endemic to Mississippi River valleys, and causes multiple foci of granulomatous inflammation?
Presumed Ocular Histoplasmosis Syndrome (POHS)
What are the three classic signs of Ocular Histoplasmosis?
1. "Punched out" chorioretinal scars (histo) spots
2. Peripapillary atrophy (variable)
3. NO vitritis (toxoplasmosis); instead we see choroiditis
What is a late stage finding seen in histoplasmosis?
CNV may occur late (<5%); often within the macula
What is the appropriate treatment for active histo lesions?
Active lesions are usually treated with oral steroids.
What are patients with histoplasmosis given to take home? What is the purpose of this?
They are to monitor their vision at home with an Amsler grid. The purpose of this is to monitor their vision for development of CNV. If CNV develops, refer to a retinal specialist for appropriate treatment.
What is a systemic infection caused by a yeast found in soil contaminated by pigeon droppings that may result in CNS involvement, eye and vision problems?
Cryptococcosis
What is the most important of the multiple organ systems that may be affected with cryptococcosis?
CNS involvement is the most important of multiple organ systems which may be affected.
What are 4 ocular manifestations of meningitis?
Papilledema, EOM palsies, ptosis, and optic neuropathy
What is the treatment for cryptococcosis?
IV and oral anti-fungals ; sight-threatening ocular lesions receive similar systemic treatment
What is the most common life threatening FUNGAL infection people with HIV can get?
Cryptococcosis
What ocular disease is characterized by many areas of the choroid showing splotchy, lightly colored areas and retinal infiltrates with distinct margins?
Multifocal cryptococcal choroiditis
What is the most common systemic opportunistic infection in those with AIDS?
P. jirovecii pneumonia
What ocular condition is characterized by a multifocal choroiditis with little or no vitreal inflammation, a history of immune suppression, and is the result of ocular dissemination from a pulmonary infection?
Choroidal pneumocystosis
What is the treatment of choroidal pneumocystosis?
It is effectively treated with IV and/or oral antimicrobials
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