Aspergillus endophthalmitis: Potential role for vitreous galactomannan testing?

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Aspergillus endophthalmitis: Potential role for vitreous galactomannan testing?

Int J Infect Dis. 2020 Apr 24;:

Authors: Dupont D, Saison J, Miailhes P, Mouchel R, Wallon M, Persat F

Abstract
Eye damage during invasive aspergillosis is rarely described and biological diagnosis remains challenging. Here we report the case of a heart transplant recipient with ocular aspergillosis complicating disseminated aspergillosis. Although voriconazole was rapidly given, a decrease in visual acuity of the right eye was consistent with endophthalmitis, resulting in an emergency vitrectomy. Diagnosis was rapidly confirmed: lab results showed the presence of Aspergillus fumigatus on a vitreous sample. A series of systemic antifungal medication (liposomal amphotericin B, caspofungin and voriconazole), several liposomal amphotericin B ocular injections and pars plana vitrectomy allowed limited positive clinical outcome. Interestingly although standard mycological follow-up procedures were negative, Aspergillus antigen testing gave an index of 5.92 on vitreous humor, thus a new intraocular injection of L-AmB was performed and voriconazole reinitiated. Ten other vitreous samples from patients without fungal infections were also tested, all showing indexes inferior to 0.25. Although larger studies are needed, this case illustrates that galactomannan testing of vitreous humor could be useful for the diagnosis of fungal endophthalmitis if these data are confirmed in other patients, in particular, if standard mycology is negative and PCR is not available.

PMID: 32339725 [PubMed - as supplied by publisher]