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Repeat Ophthalmology Candidaemia — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsRepeat Ophthalmology CandidaemiaSCE Infectious Diseases

A 50-year-old man develops catheter-related bloodstream infection with Candida albicans. The catheter is removed and Caspofungin is started. Blood cultures clear by day 2. Ophthalmological examination on day 7 is NORMAL (no endophthalmitis). When should ophthalmological examination be repeated?

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Correct answer: A — In neutropenic patients, repeat when neutrophil count recovers — chorioretinal lesions may only become visible after immune reconstitution; in non-neutropenic patients, a single normal examination is usually sufficient

Candida endophthalmitis may not be visible on fundoscopy during neutropenia (because the inflammatory infiltrate requires functional neutrophils). In neutropenic patients, ophthalmological examination should be repeated after neutrophil recovery (>500/µL) to detect lesions that were previously invisible. In non-neutropenic patients with a normal ophthalmological examination performed ≥5 days after candidaemia onset, a single normal examination is generally sufficient. This nuance is important — missing endophthalmitis in a recovering neutropenic patient would lead to undertreated Candida endophthalmitis.

Reference: ESCMID 2024 – Candida guidelines; IDSA 2016 – Candidiasis