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Differences in clinical ocular outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix: a systematic review of published literature
  1. Max Carlos Ramírez Soto1,2
  1. 1Medicine School, Universidad Nacional Mayor de San Marcos, Lima, Peru
  2. 2Fondo Nacional de Desarrollo Científico y Tecnológico y de Innovación Tecnológica (FONDECYT), CONCYTEC, Lima, Peru
  1. Correspondence to Max Carlos Ramírez Soto, Medicine School, Universidad Nacional Mayor de San Marcos, Lima 1, Peru; maxcrs22{at}gmail.com

Abstract

Background Sporotrichosis is an implantation mycosis caused by Sporothrix species prevalent worldwide, which occasionally can also result in intraocular infection presenting as an exogenous or endogenous infection (disseminated sporotrichosis). Knowledge in its clinical recognition and management is limited.

Aims To systematically review and analyse data from published literature with a view to comparing clinical outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix.

Methods Case reports of intraocular sporotrichosis, published from 1960 to 2016, were retrieved from MEDLINE, Embase, Cochrane, LILACS and SciELO databases. The entire data set was divided into two patient groups: (1) exogenous endophthalmitis and (2) endogenous endophthalmitis. Primary outcomes were differences in ocular findings and clinical ocular outcomes between the two groups.

Results From 16 publications retrieved, a total of 8 eyes of 8 patients with exogenous endophthalmitis and 13 eyes of 10 patients with endogenous endophthalmitis were identified. Compared with exogenous endophthalmitis, endogenous endophthalmitis was more common in patients infected with HIV (p=0.001) and those from hyperendemic areas (p=0.036). Anterior uveitis (p=0.015) and posterior uveitis (p=0.04) were more common in the exogenous and endogenous endophthalmitis groups, respectively. The majority of patients with endogenous endophthalmitis had partial or full clinical resolution of ocular lesions with systemic amphotericin B alone or in combination with an oral antifungal, whereas patients with exogenous endophthalmitis had poor outcomes with irreversible vision loss, enucleation and evisceration.

Conclusions Anterior uveitis is more common in exogenous endophthalmitis with worse overall outcomes and complications, compared with endogenous endophthalmitis where posterior uveitis is the most common clinical manifestation, especially in patients infected with HIV and those from hyperendemic areas. Sporothrix infection should be included in the differential diagnosis for ocular inflammation, regardless of the presence or absence of autoimmune comorbidities and whether the patient resides in an endemic area or not. Ophthalmologists should consider intravitreal and systemic antifungal therapy for exogenous and endogenous endophthalmitis caused by Sporothrix.

  • endophthalmitis
  • sporotrichosis
  • infection
  • inflammation
  • Sporothrix

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Footnotes

  • Contributors MCRS: study concept and design, acquisition of data, analyses and interpretation of data, drafting and critical revision of the manuscript.

  • Disclaimer The findings and conclusions in this report are those of the author.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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