Orbital mycoses in an adult subtropical population
Autor: | Timothy J. Sullivan, Princeton Lee, Allister Lee, Anthony M. Allworth, Tai Smith |
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Rok vydání: | 2019 |
Předmět: |
Adult
Fungal infection medicine.medical_specialty Antifungal Agents genetic structures Population Disease Neutropenia Malignancy Article 03 medical and health sciences 0302 clinical medicine Amphotericin B Orbital Diseases Medicine Humans education Survival rate Eye diseases Mycosis Retrospective Studies education.field_of_study business.industry Mucormycosis Australia medicine.disease Dermatology eye diseases Ophthalmology Mycoses 030221 ophthalmology & optometry Mucorales business Eye Infections Fungal 030217 neurology & neurosurgery medicine.drug |
Zdroj: | Eye |
ISSN: | 1476-5454 |
Popis: | Background/objectives To report the spectrum of fungal infections involving the orbit encountered in an Australian subtropical population with respect to presentation, host risk factors, involved pathogens, treatment and outcomes. Subjects/methods A retrospective chart review was performed on all adult patients with orbital mycosis treated by the senior author (TJS) from 1986 to 2017 in a tertiary setting. Results Thirty cases of fungal infection involving the orbit were included in this case series. Of these, 26 patients had invasive disease and four patients had non-invasive disease. Causative organisms included mucormycosis (16), aspergillus (8) and other fungi (7). Common risk factors included haematological disorders or malignancy, neutropenia, corticosteroid use and diabetes mellitus. Mucormycosis in three immunocompetent patients was caused by Apophysomyces elegans. Orbital apex syndrome was observed in approximately one third of patients at initial ophthalmological assessment. Amphotericin B was used in most cases of mucormycosis, while there was a more varied spectrum of anti-fungal use in other fungal infections. Seven patients with mucormycosis proceeded to orbital exenteration with a survival rate of 43%. No patients with other orbital fungal infections were exenterated. Conclusions Orbital mycoses are not only opportunistic but true pathogenic infections. While initial symptoms may be varied, the development of orbital apex syndrome should raise suspicion for this condition, regardless of patient immune status or age. Survival and visual outcomes are often poor with invasive disease. Multidisciplinary team management with early orbital specialist involvement is essential. |
Databáze: | OpenAIRE |
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