micafungin and Endophthalmitis

Topics: Adult; Antifungal Agents; Candida tropicalis; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Humans; Male; Micafungin; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retinal Neoplasms; Vitrectomy

Abstract An 88-year-old man underwent uneventful phacoemulsification and aspiration with an implantation of a preloaded acrylic intraocular lens. Six months later, he developed endophthalmitis with negative aqueous cultures, and the inflammation was refractory to conventional antibacterial therapies. He was treated successfully with vitrectomy and removal of the IOL and the entire lens capsule. A combination of intravitreal voriconazole and systemic micafungin were prescribed, and the inflammation was resolved. As best we know, this is the first case of Aspergillus tubingenesis endophthalmitis that followed the implantation of a preloaded intraocular lens.

Topics: Aged, 80 and over; Antifungal Agents; Aspergillosis; Aspergillus; Device Removal; Drug Therapy, Combination; Echinocandins; Endophthalmitis; Eye Infections, Fungal; Humans; Intravitreal Injections; Lens Implantation, Intraocular; Lipopeptides; Male; Micafungin; Phacoemulsification; Postoperative Complications; Pyrimidines; Triazoles; Visual Acuity; Vitrectomy; Voriconazole

Eight eyes of 7 patients with fungal disease received intravenous injections of 150 to 300 mg micafungin, and samples of blood, cornea, retina-choroid, aqueous humor, and vitreous humor were collected. The micafungin levels in all collected samples exceeded the MICs; however, the levels in the vitreous and aqueous humors were lower. Our findings suggest that intravenous micafungin should be given in combination with intravitreal antifungal agents after vitrectomy in severe cases of intraocular fungal diseases.

Topics: Aged; Aged, 80 and over; Antifungal Agents; Aqueous Humor; Aspergillus; Candida; Cornea; Echinocandins; Endophthalmitis; Female; Humans; Injections, Intraocular; Lipopeptides; Male; Micafungin; Vitrectomy; Vitreous Body

We report findings for a 74-year-old woman with Candida tropicalis endophthalmitis for whom an increase in b-D-glucan level and worsening of endophthalmitis were observed after intravenous injection of micafungin, an echinocandin antifungal agent. Endogenous endophthalmitis caused by C. tropicalis developed in both eyes. On the basis of her surgical history, laboratory data,and lesions, tentative diagnosis of fungal endophthalmitis was made. She was then treated with fluconazole and itraconazole, but the b-D-glucan level did not decrease, and there was no improvement of the endophthalmitis. The fluconazole was discontinued and replaced by micafungin.Unexpectedly, the level of b-D-glucan increased and endophthalmitis did not improve. The micafungin was immediately stopped and replaced by intravenous fluconazole with amphotericin B syrup, but the itraconazole was continued. Marked resolution of the vitreous inflammation was observed in both eyes, and the serum b-D-glucan level was reduced. Because active macular infiltrates were observed in the right eye, vitrectomy was performed. The micafungin minimum inhibitory concentration against the C. tropicalis strain isolated from our patient was 0.03 lg/ml. This paradoxical effect of micafungin should be remembered, and b-D-glucan level should be frequently monitored after intravenous injection of micafungin.

Topics: Aged; Antifungal Agents; beta-Glucans; Candida tropicalis; Candidiasis; Echinocandins; Endophthalmitis; Female; Fundus Oculi; Humans; Itraconazole; Lipopeptides; Micafungin

To investigate the penetration of micafungin, a new class of echinocandin antifungal agent, into the aqueous humor and vitreous after an intravenous administration.. Endogenous endophthalmitis caused by Candida albicans developed bilaterally in a 67-year-old man. Three hours before vitrectomy, the patient received an intravenous injection of 300 mg micafungin. Samples of aqueous and vitreous were collected during the vitrectomy approximately 60 min after the intravenous injection. The concentration of micafungin in both bodies was determined by high-performance liquid chromatography.. The concentration of micafungin was 25.36 μg/mL in the serum, 0.026 μg/mL in the aqueous, and 0.043 μg/mL in the vitreous. The micafungin minimum inhibitory concentration (MIC) against the C. albicans strain isolated from our patient was 0.03 μg/mL. Thus, the micafungin reached the MIC in the vitreous.. We suggest that intravenous micafungin should be considered in mild cases of endogenous fungal endophthalmitis, or be given in combination with other intravitreal antifungal agents with vitrectomy in more severe cases.

Topics: Aged; Antifungal Agents; Aqueous Humor; Candida albicans; Candidiasis; Chromatography, High Pressure Liquid; Echinocandins; Endophthalmitis; Eye Infections, Fungal; Humans; Injections, Intravenous; Lipopeptides; Male; Micafungin; Microbial Sensitivity Tests; Vitrectomy; Vitreous Body

The ocular distribution of micafungin (MCFG), which has antifungal activity against Candida and Aspergillus species, was followed after the systemic administration of MCFG in rabbits. After MCFG (10 mg/kg) plus fluconazole (FLCZ; 10 mg/kg) was administered intravenously, the rabbits were killed, and MCFG and FLCZ concentrations in retina-choroid, vitreous humor, and plasma were determined by high performance liquid chromatography or liquid chromatography/mass spectrometry. The mean concentrations of MCFG in the retina-choroid at 0.25, 0.75, 4, 8, and 24 h after administration were 20.18, 15.97, 13.19, 6.27, and 0.75 microg/g, respectively, and were comparable with the MCFG plasma concentrations. The MCFG concentrations in retina-choroid and plasma exceeded the minimal antifungal inhibitory concentrations for endophthalmitis, although MCFG was not detected in the vitreous humor. These results suggest that the intravenous administration of MCFG is an effective treatment for endogenous fungal endophthalmitis when the causative fungus is localized in the retina and choroid.

Topics: Animals; Antifungal Agents; Echinocandins; Endophthalmitis; Eye; Female; Fluconazole; Infusions, Intravenous; Lipopeptides; Lipoproteins; Micafungin; Rabbits

This study was conducted to evaluate the effectiveness of a new antifungal drug, micafungin, and standard antifungal drugs against endophthalmitis induced in a rabbit by intravitreal injection of Aspergillus fumigatus, an important fungal pathogen. Effectiveness was evaluated by the preservation of b-wave amplitude at 72 h after injection of the fungus relative to the b-wave amplitude at baseline before any intravitreal injections. A 0.06 ml inoculum of 10(6) conidia of A. fumigatus was injected into the vitreous of the right eye of all rabbits; and, 12 h later, a 0.06 ml solution containing one of 3 antifungal drugs or saline was injected into the vitreous of both eyes. All three antifungal drugs produced significant b-wave preservation at 72 h in infected eyes compared to that in infected eyes receiving saline injections. There was no statistically significant difference between the effects of micafungin and amphotericin B in the right eyes with fungal endophthalmitis, and both produced significantly more preservation of b-wave amplitude than voriconazole. Amphotericin B, but neither micafungin nor voriconazole produced significant reduction of the b-wave amplitude in the left eyes.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Disease Models, Animal; Echinocandins; Electroretinography; Endophthalmitis; Eye Infections, Fungal; Follow-Up Studies; Lipopeptides; Lipoproteins; Micafungin; Ophthalmoscopy; Peptides, Cyclic; Pyrimidines; Rabbits; Retina; Triazoles; Vitreous Body; Voriconazole