INJECTION DRUG USERS OPHTHALMOLOGIC INFECTIONS

Ophthalmologic Infections in injection drug users
Ophthalmologic infections in the injection drug user are usually the result of hematogenous seeding from a primary source of infection, such as endocarditis, or of opportunistic infections associated with HIV disease.20 Bacterial endophthalmitis often presents acutely, with pain, redness, lid swelling, and decrease in visual acuity.

Inflammation is usually present in both anterior and posterior chambers. White-centered, flame-shaped hemorrhages (Roth spots), cotton wool exudates, and macular holes may be present. S. aureus is the most commonly isolated organism, followed by Streptococcus sp. Treatment involves subconjunctival and systemic antibiotic therapy; surgical intervention may be needed.

Fungal endophthalmitis, usually caused by Candida, is more common than bacterial endophthalmitis. Symptoms include blurred vision, pain, and decreased visual acuity and can progress over days to weeks. White cotton-like lesions are seen on the choroid retina, with vitreous haziness. Uveitis, papillitis, and vitreitis also have been reported. Since 1980, a marked increase in Candida sp. infections has been reported in injection drug users who use brown heroin.

Candida chorioretinitis or endophthalmitis is characterized by the appearance of a high fever, followed in 3 to 4 days by ocular symptoms, cutaneous lesions, and costochondral involvement. Aspergillosis is the second most common fungal cause of endophthalmitis in injection drug users, producing ocular symptoms and signs without cutaneous or musculoskeletal involvement. The prognosis for fungal endophthalmitis depends on prompt diagnosis and treatment.

Fungal endophthalmitis secondary to Torulopsis, Helminthosporium, and Penicillium spp. also has been reported in injection drug users. In injection drug users with HIV, cytomegalovirus, toxoplasmosis retinitis, and choroidal Cryptococcus and Mycobacterium avium intracellulare infections have been reported.