What condition is endophthalmitis most characteristic of?

Endophthalmitis is Most Characteristic of Systemic Candidiasis

Endophthalmitis is most characteristic of systemic candidiasis (option c), as it is a well-documented ocular manifestation of disseminated Candida infection. 1

Pathophysiology of Candida Endophthalmitis

• Endogenous endophthalmitis in systemic candidiasis occurs when Candida organisms reach the posterior chamber of the eye via hematogenous spread during candidemia, crossing the blood-eye barrier 1
• Candida albicans is the most common causative organism of fungal endophthalmitis 2
• The infection typically develops within three days to two weeks following fungemia 3
• Characteristic ocular findings include chorioretinitis (retina and choroid lesions) and progression to endophthalmitis with extension into the vitreous, forming characteristic "fluffy balls" 3

Evidence Supporting Candida as the Primary Cause

• The Infectious Diseases Society of America specifically recommends that all patients with candidemia should have a dilated retinal examination within the first week of therapy to rule out endophthalmitis 1, 4
• The occurrence of endogenous Candida endophthalmitis in patients with candidemia has been reported to range from 0-45% in published literature 2
• Candida albicans has been recognized as the most common pathogen in endogenous fungal endophthalmitis 5

Differential Diagnosis

• While Aspergillus can cause endophthalmitis, it is less common and typically occurs through direct inoculation after trauma/surgery or by hematogenous spread in specific populations (immunocompromised patients, injection drug users, or patients with Aspergillus endocarditis) 6
• In East Asian nations, particularly Taiwan, Klebsiella pneumoniae can cause endogenous endophthalmitis in association with liver abscess, but this is not as characteristic globally as Candida 7
• Escherichia coli sepsis (option a) is not characteristically associated with endophthalmitis 7
• Toxic shock syndrome (option b) does not typically present with endophthalmitis as a characteristic finding 7
• Facial necrotizing fasciitis (option d) affects soft tissues and is not characteristically associated with endophthalmitis 7

Clinical Implications and Management

• Early identification of Candida endophthalmitis is crucial as it can be sight-threatening and, in critically ill patients, has been associated with increased mortality 2
• Treatment requires systemic antifungal therapy with agents such as amphotericin B, fluconazole, or voriconazole 1, 2
• Chorioretinitis infections can often be treated with systemic antifungal agents alone, while endophthalmitis with vitreal involvement typically requires more aggressive treatment 2
• Pars plana vitrectomy with or without intravitreal amphotericin B injections is often necessary for patients with moderate-to-severe vitritis and substantial vision loss 2
• Management decisions should be made jointly by an ophthalmologist and an infectious diseases physician 1

Clinical Pearls and Pitfalls

• Without a dilated fundus examination in the presence of ocular inflammation, Candida endophthalmitis can easily be misdiagnosed 8
• Ocular findings may often provide the first definitive clue to an underlying systemic Candida infection 5
• Common initial visual symptoms include blurred vision and floaters, which should prompt ophthalmologic evaluation in at-risk patients 3
• Early systemic antifungal treatment at the first evidence of infection in high-risk patients appears to dramatically decrease the incidence of endogenous fungal endophthalmitis 3