Aspergillus Endophthalmitis in Intravenous-Drug Users --
Kentucky
Since May 1989, three cases of Aspergillus endophthalmitis, a
potential cause of irreversible vision loss, have been reported
in Louisville, Kentucky. All three patients were intravenous-drug
users (IVDUs).
The patients--ages 40, 32, and 24 years--had onsets of illness
in May, August, and September, respectively. Two were male.
Except for IV-drug use, no risk factors for this fungal
endophthalmitis were identified. All three patients were
seronegative for antibody to human immunodeficiency virus.
Infection was unilateral in each patient and responded to
treatment with amphotericin B and flucytosine following
vitrectomy. All patients had some degree of permanent vision
loss. In each case, diagnosis was made by culture of specimens
obtained at vitrectomy; each culture grew Aspergillus flavus.
None of the patients had systemic or other localized signs of
infection.
Two of the patients lived in the same apartment complex. The
third lived approximately 1 mile away. Each denied any contact
with the others. Common IV-injection practices included diluting
drugs with tap water and filtering this mix through cotton or
cigarette filters. All patients injected cocaine and a
combination of pentazocine and tripelennamine.
Reported by: CC Barr, MD, A Walsh, Humana University Hospital, B
Wainscott, MD, Jefferson County Health Dept, Louisville; R
Finger, MD, Acting State Epidemiologist, Dept for Health Svcs,
Kentucky Cabinet for Human Resources. Div of Field Svcs,
Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: Fungal endophthalmitis is a recognized
complication of IV-drug use (1). Infection results from
hematogenous spread after nonsterile injection (2). Fungal
endophthalmitis can develop slowly over weeks and occurs more
frequently with Candida than with Aspergillus (3). Other risk
factors associated with Aspergillus endophthalmitis include the
use of antibiotics, corticosteroids, and immunosuppressive
therapy (3). Vision loss can be limited in some patients by
aggressive antibiotic and surgical treatment (4).
Because Aspergillus species are ubiquitous molds and the
patients reported here used common injection practices, the
source of infection is difficult to determine. However, one
possible explanation for the geographic and temporal clustering
of these cases is a contaminated drug supply. Physicians should
consider the diagnosis of fungal endophthalmitis in IVDUs with
signs of intraocular infection.
References
Elliott JH, O'Day DM, Gutow GS, Podgorski SF, Akrabawi P.
Mycotic endophthalmitis in drug abusers. Am J Ophthalmol
1979;88:66-72.
Sugar HS, Mandell GH, Shalev J. Metastatic endophthalmitis
associated with injection of addictive drugs. Am J Ophthalmol
1971;71:1055-8.
Hirst LW, Thomas JV, Green WR. Endophthalmitis. In: Mandell
GL, Douglas RG Jr, Bennett JE, eds. Principles and practice of
infectious diseases. 2nd ed. New York: Wiley, 1985:760-7.
Roney P, Barr CC, Chun CH, Raff MJ. Endogenous Aspergillus
endophthalmitis. Rev Infect Dis 1986;8:955-8.
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