Lesions of the Vitreous, Choroid, and Retina in Intravenous Drug Users (IDUs) Hospitalized with Bloodstream Infections

Intravenous drug users (IDUs) who are asymptomatic with bacteremia related to IDU may have ophthalmic involvement, according to a study presented by Jessica E Weinstein, MD, MS, of the Wake Forest School of Medicine, at the 37^th ASRS Annual Meeting.

The opioid epidemic has resulted in an augmented in infection complication related to IDU. However, the rate of endophthalmitis in patients with bacteria caused by IDU is to-date “poorly characterized”. Therefore, the researchers of this study aimed to discern the prevalence of lesions, and causative organisms, and to determine if symptoms are linked with ophthalmic involvement.

In this prospective study, single-center study, researchers enrolled 59 patients (49% male, 51%, mean age, 34) admitted to Wake Forest Baptist Medical Center (WFBMC) with documented bloodstream infections to IDU. All participants were 18 years of age or older, and 12.5% had ocular symptoms at the time of exam. Subsequently, researchers performed a dilated retinal exam with 72 hours while documenting ocular symptoms along with visual acuity. All exam findings were documented, and the study team collected fundus photos when necessary to further assess the data.

According to the findings of this study, 18% (7/40) of patients had ocular involvement on exam, and of the patients with ocular involvement, 43% (3/7) were symptomatic. 5% (2/40) had multifocal chorioretinal scars, possibly related to prior infection. The organisms comprised in the study cases included: isolated Candida albicans endophthalmitis in which the patient was symptomatic; MRSA endocarditis and septic pulmonary emboli with subretinal infiltrate and hemorrhage, MSSA endocarditis and sepsis with multiple subretinal lesions and hemorrhage, streptococcus mitis endocarditis causing cotton wool spots and hemorrhage, MRSA with renal and brow abscesses, streptococcus pyogenes with sternoclavicular joint abscess and brachial vein thrombosis with retinal infiltrate and CWS, and MRSA with aortic valve endocarditis, pulmonary nodules and an abducens palsy.

“These results demonstrate that asymptomatic patients with bacteremia related to IDU may have ophthalmic involvement,” the researchers wrote. They added that “further study is needed to better characterize the epidemiology of these infections and to identify risk factors for ocular involvement in this patient population.”

Weinstein J. Lesions of the Vitreous, Choroid, and Retina in Intravenous Drug Users. Presented at the 37^th ASRS Annual Meeting; July 26-30, 2019; Chicago, IL.

Read more (login required): https://meeting2019.asrs.org/ondemand#/ondemand/papers/lesions-of-the-vitreous-choroid-and-retina-in-intravenous-drug-users-idus-h-627