What condition is endophthalmitis most characteristic of?

Endophthalmitis is Most Characteristic of Systemic Candidiasis

Endophthalmitis is most characteristic of systemic candidiasis (option C), as Candida albicans is the species most commonly responsible for endogenous endophthalmitis. 1, 2

Pathophysiology of Endophthalmitis in Systemic Candidiasis

• Endogenous endophthalmitis occurs when pathogens reach the posterior chamber of the eye via hematogenous spread during candidemia, crossing the blood-eye barrier 1, 2
• Candida albicans is the most frequent causative organism, though non-albicans Candida species are increasingly reported 2, 3
• The infection typically manifests as chorioretinitis (retina and choroid lesions) with or without extension into the vitreous, where it forms characteristic "fluffy balls" 4
• Ocular candidiasis typically develops between three days and two weeks following fungemia 4

Clinical Presentation and Diagnosis

• Visual symptoms include blurred vision and floaters, though early cases may be asymptomatic 4
• Ophthalmoscopic examination reveals characteristic lesions:
  • Candida chorioretinitis: retina and choroid lesions without vitreal involvement 4
  • Candida endophthalmitis: chorioretinitis with extension into the vitreous with characteristic fluffy balls 4
• Optical coherence tomography (OCT) shows a typical "rain-cloud" sign that has improved diagnostic capability 2
• All patients with candidemia should have a dilated retinal examination, preferably by an ophthalmologist, within the first week of therapy 1

Differential Diagnosis Among the Options

• Systemic candidiasis (C): Strongly associated with endophthalmitis due to hematogenous spread of Candida species 1, 2
• Escherichia coli sepsis (A): While E. coli can cause endogenous endophthalmitis, it is much less common than Candida. E. coli is mentioned as a potential causative agent but is not characteristic 1
• Toxic shock syndrome (B): Not typically associated with endophthalmitis 1
• Facial necrotizing fasciitis (D): Not typically associated with endophthalmitis; involves soft tissue infection rather than intraocular spread 1

Management Considerations

• Treatment requires systemic antifungal therapy, primarily with fluconazole or amphotericin B 2, 4
• Sight-threatening lesions near the macula or invasion into the vitreous may require:
  • Intravitreal injection of antifungal agents (amphotericin B deoxycholate or voriconazole)
  • Vitrectomy in cases with significant vitreous involvement 1, 2
• Decisions regarding antifungal treatment and surgical intervention should be made jointly by an ophthalmologist and an infectious diseases physician 1
• Early treatment of candidemia appears to dramatically decrease the incidence of endogenous fungal endophthalmitis 4

Risk Factors for Candida Endophthalmitis

• Recent surgical interventions
• Diabetes mellitus
• Immunosuppression
• Prolonged hospitalization
• Indwelling catheters
• Intravenous drug use 2, 5

In conclusion, while endophthalmitis can occur in various systemic infections, it is most characteristically associated with systemic candidiasis, making option C the correct answer.