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Volume 20, Number 2—February 2014
Research

Fungal Endophthalmitis Associated with Compounded Products

Christina A. Mikosz1, Rachel M. Smith1, Moon Kim, Clara Tyson, Ellen H. Lee, Eleanor Adams, Susanne Straif-Bourgeois, Rick Sowadsky, Shannon Arroyo, Yoran Grant-Greene, Julie Duran, Yvonne Vasquez, Byron F. Robinson, Julie R. Harris, Shawn R. Lockhart, Thomas J. Török, Laurene Mascola, Benjamin J. ParkComments to Author , and for the Fungal Endophthalmitis Outbreak Response Team
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.A. Mikosz, R.M. Smith, Y. Grant-Greene, B.F. Robinson, J.R. Harris, S.R. Lockhart, T.J. Török, and B.J. Park); Los Angeles County Department of Public Health, Los Angeles, California, USA (C.A. Mikosz, M. Kim, C. Tyson, and L. Mascola); New York City Department of Health and Mental Hygiene, New York City, New York, USA (E.H. Lee); New York State Department of Health, Albany, New York, USA (E. Adams); Louisiana Office of Public Health, New Orleans, Louisiana, USA (S. Straif-Bourgeois); Nevada Division of Public and Behavioral Health, Carson City, Nevada, USA (R. Sowadsky); Indiana State Department of Health, Indianapolis, Indiana, USA (S.Arroyo); Illinois Department of Public Health, Springfield, Illinois, USA (Y. Grant-Greene); Colorado Department of Public Health and Environment, Denver, Colorado, USA (J. Duran); City of El Paso Department of Public Health, El Paso, Texas, USA (Y. Vasquez)

Main Article

Table 3

Clinical characteristics of fungal endophthalmitis case-patients, United States, 2012*

Characteristic Exposure cluster†
Brilliant Blue G dye, n = 21 Triamcinolone, n = 19
Demographics
Median age, y (range) 69 (58–86) 67 (53–77)
Female sex
16 (76)
 8 (42)
Concurrent medical conditions
Diabetes mellitus 11 (52) 15 (79)
Hypertension 11 (52) 15 (79)
History of prior eye surgery or procedures
 14 (67)
 13 (68)
Signs and symptoms
Vision loss 21 (100) 18 (95)
Vitreous debris 12 (57) 10 (53)
Floaters 4 (19) 6 (32)
Inflammation 10 (48) 6 (32)
Pain 16 (76) 4 (21)
Hypopyon 9 (43) 3 (16)
Fibrin
 12 (57)
 1 (5)
Treatment
Any antifungal treatment 17 (81) 19 (100)
Intravitreal amphotericin B 2 (12)‡ 8 (42)
Intravitreal voriconazole 17 (100)‡ 11 (58)
Oral voriconazole 6 (35)‡ 11 (58)
Intravenous voriconazole 1 (6)‡ 0
Topical voriconazole 1 (6)‡ 0
Oral fluconazole 1 (6)‡ 0
Combination of antifungal therapies
 10 (59)‡
 9 (47)
Outcome
Median no. days from exposure to diagnosis (range) 78 (60–125)§ 80 (35–185)
Additional surgeries required (range) 20 (95) (1–5) 16 (84) (1–6)
No documentation of resolved infection within follow-up period 3 (14) 8 (42)
Enucleations 0 2 (11)

*Data available for 40 case-patients and are presented as no. (%) unless otherwise indicated.
†Manufactured by Franck’s Compounding Lab, Ocala, Florida, USA.
‡Calculated percentage out of 17 treated case-patients.
§n = 18.

Main Article

1These authors contributed equally to this article and are co–first authors.

2Members of the Fungal Endophthalmitis Outbreak Response Team are listed at the end of this article.

Page created: January 15, 2014
Page updated: January 15, 2014
Page reviewed: January 15, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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