PEDIATRICS Vol. 90 No. 3 September 1992, pp. 451-457
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Screening for Fungal Endophthalmitis in Children at Risk

Robert W. Enzenauer MD, MPH1, Alex V. Levin MD1, James E. Elder MD1, J. Donald Morin MD, FRCS(C)1, and Stan Calderwood MD2

1 From the Department of Ophthalmology, The Hospital for Sick Children, Toronto, Ontario
2 From the Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario

To evaluate the efficacy of screening ophthalmologic examinations in high-risk children, we reviewed the medical records for all patients hospitalized from 1985 through 1989 at The Hospital for Sick Children, Toronto, Ontario, who underwent ophthalmological consultation to rule out endogenous fungal endophthalmitis (n = 176). The patients were divided into groups: Group 1 (n = 47), those with deep-tissue fungal infection, and Group 2 (n = 129), those at risk for invasive fungal disease. Group 2 was subdivided further into two subgroups: Group 2a (n = 48), those with evidence of superficial fungal colonization (positive fungal culture) but no deep-tissue involvement, and Group 2b (n = 81), those with no evidence of fungal colonization (negative fungal culture). Of these 176 patients, 7 were diagnosed with endogenous fungal endophthalmitis: 6 from Group 1, 1 from Group 2a, and 0 from Group 2b. We found a significant association between the development of endogenous fungal endophthalmitis and the status of the fungal culture result (P < .005). The odds ratio indicated the risk of endogenous fungal endophthalmitis in Group 1 patients with deep-tissue infection was at least 19 times that of Group 2 at-risk patients. The risk of endogenous fungal endophthalmitis in Group 1 patients was at least 7 times that of Group 2a colonized patients and 12 times that of Group 2b patients with no positive fungal culture. Our study confirms the necessity of careful dilated ophthalmoscopic examination in patients with invasive fungal disease and suggests screening for those at-risk patients with superficial fungal colonization. Our results, however, do not document the value of routine ophthalmoscopic consultation in at-risk children without evidence of any fungal colonization.

Key Words: Fungal endophthalmitis • screening • fungemia • dilated ophthalmoscopy • neutropenia • amphotericin B • aspergillosis • candidiasis • fever

Submitted on June 5, 1991
Accepted on April 17, 1992




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