✍️ common causative organism Candida albicans
✍️ higher fungus of the class Blastomycetes.
✍️ yeast-like reproduces by budding
✍️ imperfect with no sexual stage
✍️ commensal of skin, mouth, and vagina
✍️ opportunistic systemic infection may arise from haematogenous spread, notably in
☝️ IV drug abuse
☝️indwelling venous catheters
• haemodialysis
• total parenteral nutrition
☝️immunosuppression
• HIV-positive.
• Post-transplantation (stem cell or solid organ).
• drug immunosuppression for systemic disease( SLE, RA, GCA)
• long term antibiotics abuse
☝️ debilitating disease ( malignancy or DM)
✅ Fungal uveitis Clinical picture
✍️ symptom
☝️ dropped VA
☝️ floaters
☝️ pain (often bilateral)
✍️ signs
☝️Multifocal retinitis (yellow-white fluffy lesions ≥ 1 dd in size)
☝️ ± vitritis( cotton balls may be joined together forming string of pearls)
☝️± anterior uveitis.
✅ Fungal uveitis Complications
☝️ retinal necrosis
☝️ TRD.
✅ Fungal uveitis DD
✍️ non infectious White dot syndromes
✍️ infectious retinochoroiditis
☝️ TB
☝️ syphilis
☝️ toxoplasmosis
☝️ toxocara
☝️ Aspergillosis
☝️ histoplasmosis
✅ Fungal uveitis treatment
✍️ Intravitreal antifungals
☝️5 micrograms amphotericin.
✍️ Systemic antifungals
☝️ collaboration with microbiologist and I nfectious disease specialist
☝️ oral fluconazole (usually 400mg initially, then 200mg twice daily)
☝️ consider IV amphotericin ( usually ≥4wk duration ) if
• known systemic involvement
• resistant cases
✍️ Vitrectomy in severe resistant cases
☝️send whole vitrectomy cassette for microscopy and culture to confirm diagnosis.
✍️ Review frequently
✍️ Hospital admission may be helpful if
• poor compliance
• IV treatment needed .
🛑 Fungal uveitis The core message
☝Uveitis in an IV drug abuser should be considered fungal until proven otherwise
