Грибковая инфекция глаза может протекать как экзогенный процесс, так и эндогенный. Экзогенный микоз обычно наблюдается после травм, инокуляции инфекции растворами, плохо обработанными линзами. Эндогенный микоз характерен для недоношенных, дистрофичных и иммунокомпрометированных пациентов. Грибковую офтальмопатию следует исключать у пациентов группы риска. К ней относятся лица с онкологическими заболеваниями, нейтропенией 500/мл и менее, устойчивой к антибиотикам лихорадкой неясного генеза, после тяжелых хирургических вмешательств, на внутривенном питании, при концентрации в крови b-D-глюкана 20 пг и более. Диагностика основывается на офтальмологическом осмотре с учетом анамнеза и общего статуса больного, подтверждается неинвазивной визуализацией, микробиологическими и молекулярно-биологическими исследованиями. Лечение грибковой офтальмопатии должно начинаться рано, проводиться интенсивно системными противогрибковыми препаратами. Возможно оперативное удаление очага инфекции. Прогноз грибковой офтальмопатии серьезен.
Fungal infection of the eye may occur as an exogenous process, so more difficult as endogenous. Exogenous fungal infection usually occurs after trauma, infection inoculation solutions, poorly treated lenses. Endogenous mycosis are characteristic of prematurity, dystrophic patients immunocompromised. Fungal ophthalmopathy (FO) should be ruled out in patients at risk. This includes patients with cancer, neutropenia ≤500/ml, antibiotic-resistant fever of unknown origin, after heavy surgery, on intravenous feeding, at a concentration in the blood b-D-glucan ≥20 pg. Diagnosis is based on ophthalmologic examination in view of the history and general status of the patient, confirmed by noninvasive imaging, microbiological and molecular biological research. FO treatment should begin early, held nitensiv wuth systemic antifungal drugs, possible surgical removal of the source of infection. Forecast of FO is serious.
Key words: fungal infection of the eye, diagnosis, treatment.
1. Leber T. Keratomycosis aspergillina als Ursache von hypopyonkeratitis. Vortrag von Proff. Th. Leber in Göttingen. Graefes Arch Ophthal 1879; 25: 285–301.
2. Chick E, Conant N. Mycotic ulcerative keratitis: a review of 148 cases from the literature. Invest Ophthalmol Vis Sci 1962; 1: 419–20.
3. Shah C, McKey J, Spirn M, Maguire J. Ocular candidiasis: a review. Br J Ophthalmol 2008; 92 (4): 466–8.
4. Klotz S, Penn C, Negvesky G, Butrus S. Fungal and parasitic infections of the eye. Clin Microbiol Rev 2000; 13 (4): 662–85.
5. Mikosz C, Smith R, Kim M et al. Fungal endophthalmitis associated with compounded products. Emerg Infect Dis 2014; 20 (2): 248–56.
6. Schiedler V, Scott I, Flynn H et al. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 2004; 137 (4): 725–31.
7. Ando N, Takator K. Fungal flora of the conjunctival sac. Am J Ophthalmol 1982; 94 (1): 67–74.
8. Wilson L, Ahearn D, Jones D, Sexton R. Fungi from the outer eye. Am J Ophthalmol 1969; 67 (1): 52–6.
9. Essman T, Flynn H, Smiddy W et al. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers 1997; 28 (3): 185–94.
10. Lalwani G, Flynn H, Scott I et al. Acute-onset endophthalmitis after clear corneal cataract surgery (1996–2005). Clinical features, causative organisms, and visual acuity outcomes. Ophthalmology 2008; 115 (3): 473–6.
11. Griffin J, Pettit T, Fishman L, Foos R. Blood-borne Candida endophthalmitis. A clinical and pathologic study of 21 cases. Arch Ophthalmol 1973; 89 (6): 450–6.
12. Anand A, Therese K, Madhavan H. Spectrum of aetiological agents of postoperative endophthalmitis and antibiotic susceptibility of bacterial isolates. Indian J Ophthalmol 2000; 48 (2): 123–8.
13. Henderson D, Hockey L, Vukakic L, Edwards J. Effect of immunosuppression on the development of experimental hematogenous Candida endophthalmitis. Infect Immun 1980; 27 (2): 628–31.
14. Omuta J, Uchida K, Yamaguchi H, Shibuya K. Histopathological study on experimental endophthalmitis induced by bloodstream infection with Candida albicans. Jpn J Infect Dis 2007; 48 (2): 123–8.
15. Blanco J, Hontacillos R, Bouza E et al. Correlation beween the elastasae activity index end invasiveness of clinical isolates of Aspergillus fumigatus. J Clin Microbiol 2002; 40 (50): 1811–3.
16. Aboul-Naser M, Zohri A, Amer E. Enzymatic and toxigenic ability of opportunistic fungi contaminating intensive car units and operation rooms at Asint Univercity hospitals, Egypt. Springerplus 2013; 2 (347). eCollection, 2013.
17. Lundquist O, Osterlin S. Glucose concentration in the vitreous of nondiabetic and diabetic human eyes. Graefes Arch Clin Exp Ophthalmol 1994; 232 (2): 71–4.
18. Donahue S, Greven C, Zuravleff J et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology 1994; 101 (7): 1302–9.
19. Javey G, Zuravleff J, Yu V. Fungal infections of the eye. In: Anaissie E, McGinnis M, Pfaller M (Eds.) Clinical Mycology, Second Edition, Elsevier, 2009. Chapter 30; p. 623–41.
20. Behlan J. Fungal Infections and Eye. In: D.Albert, I.Miller, D.Azar et al (Eds). Albert & Jakobiec's Principles & Practice of Ophthalmology, Third Edition. W.B Saunders Company, 2008, Chapter 342; p. 4717–49.
21. Kloess P, Stulting R, Waring G, Wilson L. Bacterial and fungal endophthalmitis after penetrating keratoplasty. Am J Ophthalmol 1993; 115 (4): 309.
22. Norregaard J, Thoning H, Bernth-Petersen P et al. Risk of endophthalmitis after cataract extraction: results from the International Cataract Surgery Outcome Study. Br J Ophthalmol 1997; 81 (12): 102–6.
23. D’Amico D, Noorily S. Postoperative endophthalmitis. In: D.Albert, F.Jakobiec (Eds). Principles and Practice of Ophthalmology. Philadelphia: WB Saunders, 1994; p. 1159.
24. Anand A, Madhavan H, Neelam V, Lily T. Use of polymerase chain reaction in the diagnosis of fungal endophthalmitis. Ophthalmology 2001; 108 (2): 326–30.
25. Tanaka M, Kobayashi Y, Takebyashi H et al. Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12 year study of 79 eyes of 46 patients. Retina 2001; 21 (3): 203–9.
26. Zakka K, Foos R, Brown W. Intraocular coccidioidomycosis. Surv Ophthalmol 1978; 22 (5): 313–21.
27. Wykoff C, Flynn W, Miller D et al. Exogenous fungal endophthalmitis: microbiology and clinical outcomes. Ophthalmology 2008; 115 (9): 1501–7.
28. McMillan B, Miller G, Nguyen J. Rare case of exogenous Candida dublieniensis endophthalmitis: a case report and brief review of the literature. J Ophthalmic Inflamm Infect 2014; 2 (4): 11; doi: 10.1186/1869-5760-4-11. eCollection 2014.
29. Okhravi N, Adamson P, Mant R et al. Polymerase chain reaction and restriction fragment length polymorphism mediated detection and speciation of Candida spp causing intraocular infection. Invest Ophthalmol Vis Sci 1998; 39 (6): 859–66.
30. Sakai T, Kohzaki K, Watanabe A et al. Use of DNA microarray analysis in diagnosis of bacterial and fungal endophthalmitis. Clin Ophthalmol 2012; 6: 321–6.
31. Brod R, Flynn H, Clarkson J et al. Endogenous Candida endophthalmitis. Management without intravenous amphotericin B. Ophthalmology 1990; 97 (5): 666–72; disc: 672–4.
32. Nayak N. Fungal infections of the eye – laboratory diagnosis and treatment. Nepal Med Coll J 2008; 10 (1): 48–63.
33. Barlett J, Jaanus S. Clinical ocular Pharmacology. Second Edition, Reed Publisching (USA) Inc., 2013.
34. Sridhar J, Flynn H, Kuriyan A et al. Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections. J Ophthalmic Inflamm Infect 2013; 3 (1): 60; doi: 10.1186/1869-5760-3-60.
________________________________________________
1. Leber T. Keratomycosis aspergillina als Ursache von hypopyonkeratitis. Vortrag von Proff. Th. Leber in Göttingen. Graefes Arch Ophthal 1879; 25: 285–301.
2. Chick E, Conant N. Mycotic ulcerative keratitis: a review of 148 cases from the literature. Invest Ophthalmol Vis Sci 1962; 1: 419–20.
3. Shah C, McKey J, Spirn M, Maguire J. Ocular candidiasis: a review. Br J Ophthalmol 2008; 92 (4): 466–8.
4. Klotz S, Penn C, Negvesky G, Butrus S. Fungal and parasitic infections of the eye. Clin Microbiol Rev 2000; 13 (4): 662–85.
5. Mikosz C, Smith R, Kim M et al. Fungal endophthalmitis associated with compounded products. Emerg Infect Dis 2014; 20 (2): 248–56.
6. Schiedler V, Scott I, Flynn H et al. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 2004; 137 (4): 725–31.
7. Ando N, Takator K. Fungal flora of the conjunctival sac. Am J Ophthalmol 1982; 94 (1): 67–74.
8. Wilson L, Ahearn D, Jones D, Sexton R. Fungi from the outer eye. Am J Ophthalmol 1969; 67 (1): 52–6.
9. Essman T, Flynn H, Smiddy W et al. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers 1997; 28 (3): 185–94.
10. Lalwani G, Flynn H, Scott I et al. Acute-onset endophthalmitis after clear corneal cataract surgery (1996–2005). Clinical features, causative organisms, and visual acuity outcomes. Ophthalmology 2008; 115 (3): 473–6.
11. Griffin J, Pettit T, Fishman L, Foos R. Blood-borne Candida endophthalmitis. A clinical and pathologic study of 21 cases. Arch Ophthalmol 1973; 89 (6): 450–6.
12. Anand A, Therese K, Madhavan H. Spectrum of aetiological agents of postoperative endophthalmitis and antibiotic susceptibility of bacterial isolates. Indian J Ophthalmol 2000; 48 (2): 123–8.
13. Henderson D, Hockey L, Vukakic L, Edwards J. Effect of immunosuppression on the development of experimental hematogenous Candida endophthalmitis. Infect Immun 1980; 27 (2): 628–31.
14. Omuta J, Uchida K, Yamaguchi H, Shibuya K. Histopathological study on experimental endophthalmitis induced by bloodstream infection with Candida albicans. Jpn J Infect Dis 2007; 48 (2): 123–8.
15. Blanco J, Hontacillos R, Bouza E et al. Correlation beween the elastasae activity index end invasiveness of clinical isolates of Aspergillus fumigatus. J Clin Microbiol 2002; 40 (50): 1811–3.
16. Aboul-Naser M, Zohri A, Amer E. Enzymatic and toxigenic ability of opportunistic fungi contaminating intensive car units and operation rooms at Asint Univercity hospitals, Egypt. Springerplus 2013; 2 (347). eCollection, 2013.
17. Lundquist O, Osterlin S. Glucose concentration in the vitreous of nondiabetic and diabetic human eyes. Graefes Arch Clin Exp Ophthalmol 1994; 232 (2): 71–4.
18. Donahue S, Greven C, Zuravleff J et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology 1994; 101 (7): 1302–9.
19. Javey G, Zuravleff J, Yu V. Fungal infections of the eye. In: Anaissie E, McGinnis M, Pfaller M (Eds.) Clinical Mycology, Second Edition, Elsevier, 2009. Chapter 30; p. 623–41.
20. Behlan J. Fungal Infections and Eye. In: D.Albert, I.Miller, D.Azar et al (Eds). Albert & Jakobiec's Principles & Practice of Ophthalmology, Third Edition. W.B Saunders Company, 2008, Chapter 342; p. 4717–49.
21. Kloess P, Stulting R, Waring G, Wilson L. Bacterial and fungal endophthalmitis after penetrating keratoplasty. Am J Ophthalmol 1993; 115 (4): 309.
22. Norregaard J, Thoning H, Bernth-Petersen P et al. Risk of endophthalmitis after cataract extraction: results from the International Cataract Surgery Outcome Study. Br J Ophthalmol 1997; 81 (12): 102–6.
23. D’Amico D, Noorily S. Postoperative endophthalmitis. In: D.Albert, F.Jakobiec (Eds). Principles and Practice of Ophthalmology. Philadelphia: WB Saunders, 1994; p. 1159.
24. Anand A, Madhavan H, Neelam V, Lily T. Use of polymerase chain reaction in the diagnosis of fungal endophthalmitis. Ophthalmology 2001; 108 (2): 326–30.
25. Tanaka M, Kobayashi Y, Takebyashi H et al. Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12 year study of 79 eyes of 46 patients. Retina 2001; 21 (3): 203–9.
26. Zakka K, Foos R, Brown W. Intraocular coccidioidomycosis. Surv Ophthalmol 1978; 22 (5): 313–21.
27. Wykoff C, Flynn W, Miller D et al. Exogenous fungal endophthalmitis: microbiology and clinical outcomes. Ophthalmology 2008; 115 (9): 1501–7.
28. McMillan B, Miller G, Nguyen J. Rare case of exogenous Candida dublieniensis endophthalmitis: a case report and brief review of the literature. J Ophthalmic Inflamm Infect 2014; 2 (4): 11; doi: 10.1186/1869-5760-4-11. eCollection 2014.
29. Okhravi N, Adamson P, Mant R et al. Polymerase chain reaction and restriction fragment length polymorphism mediated detection and speciation of Candida spp causing intraocular infection. Invest Ophthalmol Vis Sci 1998; 39 (6): 859–66.
30. Sakai T, Kohzaki K, Watanabe A et al. Use of DNA microarray analysis in diagnosis of bacterial and fungal endophthalmitis. Clin Ophthalmol 2012; 6: 321–6.
31. Brod R, Flynn H, Clarkson J et al. Endogenous Candida endophthalmitis. Management without intravenous amphotericin B. Ophthalmology 1990; 97 (5): 666–72; disc: 672–4.
32. Nayak N. Fungal infections of the eye – laboratory diagnosis and treatment. Nepal Med Coll J 2008; 10 (1): 48–63.
33. Barlett J, Jaanus S. Clinical ocular Pharmacology. Second Edition, Reed Publisching (USA) Inc., 2013.
34. Sridhar J, Flynn H, Kuriyan A et al. Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections. J Ophthalmic Inflamm Infect 2013; 3 (1): 60; doi: 10.1186/1869-5760-3-60.
1 ФГБУ Федеральный научно-клинический центр детской гематологии, онкологии и иммунологии им. Д.Рогачева Минздрава России. 117997, Россия, Москва, ул. Саморы Машела, д. 1;
2 ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
3 ФГБУ Российская детская клиническая больница Минздрава России. 117997, Россия, Москва, Ленинский пр-т, д. 117
*delyagin-doktor@yandex.ru
1 D.Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Samory Mashela, d. 1;
2 N.I.Pirogov Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
3 Russian Children's Clinical Hospital of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, Leninskii pr-t, d. 117
*delyagin-doktor@yandex.ru