{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:18:06Z","timestamp":1784297886043,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>An outbreak of endogenous fungal endophthalmitis (EFE) caused by contaminated intravenous infusion was identified in immunocompetent individuals. We aimed to describe its clinical characteristics and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series included all patients referred with EFE and had a history of intravenous infusions at the same rural clinic, between May 1st, 2024 and November 30th, 2024, to Ophthalmology Department of Ningde Municipal Hospital. Demographic and clinical data were collected. Whole-genome sequencing (WGS) and SNP-based phylogenetic analysis were performed on 7 culture-positive Candida albicans vitreous isolates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The inclusion criteria were met in 26 eyes of 17 patients. All were healthy and immunocompetent. On average, patients presented after 24.3 days of symptoms. Presenting best corrected visual acuity (BCVA) ranged from 20\/25 to no light perception (NLP). All patients were initially treated with pars plana vitrectomy (PPV) and intravitreal voriconazole injection followed by systemic voriconazole therapy. Vitreous cultures obtained during PPV were positive in 19 eyes, all showing growth of Candida albicans. Three months after treatment, patients\u2019 BCVA improved significantly from a mean of 20\/100 to 20\/50 (p = 0.00011). All sequenced isolates clustered tightly in SNP-based phylogenetic analysis, supporting a clonal outbreak. Two patients with a final BCVA of NLP were initially misdiagnosed with noninfectious uveitis and treated with an intravitreal steroid injection at other hospitals. Since the closure of the rural clinic, no new cases have been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Primary PPV followed by systemic and intravitreal antifungal therapy and an epidemiological investigation could be effective in finding the infectious source of an EFE outbreak and achieving favorable visual outcomes. Misuse of intravitreal steroids due to incorrect diagnosis could lead to severe vision loss in individuals with EFE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1718140","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:42:27Z","timestamp":1777009347000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["An outbreak of endogenous fungal endophthalmitis in immunocompetent individuals caused by presumed intravenous infusion contamination"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiaohan","family":"Zhang","sequence":"first","affiliation":[{"name":"Shengli Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]},{"name":"Ningde Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Ningde Municipal Hospital","place":["Ningde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulong","family":"Huang","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chishan","family":"Kang","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Ningde Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Ningde Municipal Hospital","place":["Ningde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Ningde Municipal Hospital","place":["Ningde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinping","family":"Xue","sequence":"additional","affiliation":[{"name":"Ningde Centers for Disease Control and Prevention","place":["Ningde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Lin","sequence":"additional","affiliation":[{"name":"Ningde Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Ningde Municipal Hospital","place":["Ningde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Wu","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical College of Fujian Medical University, Department of Ophthalmology, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1111\/ceo.13820","article-title":"Fungal endophthalmitis: A 20-year experience at a tertiary referral centre","volume":"48","author":"Bhullar","year":"2020","journal-title":"Clin. Exp. Ophthalmol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3126","DOI":"10.1021\/acsinfecdis.4c00442","article-title":"Pathobiology of fungal endophthalmitis: A major review","volume":"10","author":"Bihaniya","year":"2024","journal-title":"ACS Infect. Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/icb.0000000000000238","article-title":"The role of early vitrectomy in the treatment of fungal endogenous endophthalmitis","volume":"10","author":"Birnbaum","year":"2016","journal-title":"Retin cases Brief Rep."},{"key":"B4","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.ajo.2024.01.018","article-title":"Endogenous fungal endophthalmitis: A single-center retrospective study and review of the literature","volume":"262","author":"Burton","year":"2024","journal-title":"Am. J. Ophthalmol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1097\/iae.0b013e318185e943","article-title":"Fungal endophthalmitis: Fourteen years\u2019 experience from a center in India","volume":"28","author":"Chakrabarti","year":"2008","journal-title":"Retina"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/jof8060641","article-title":"Endogenous fungal endophthalmitis: Causative organisms, treatments, and visual outcomes","volume":"8","author":"Chen","year":"2022","journal-title":"J. Fungi (Basel)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1136\/bmj.287.6396.861","article-title":"Disseminated candidiasis: Evidence of a distinctive syndrome in heroin abusers","volume":"287","author":"Collignon","year":"1983","journal-title":"Br. Med. J. (Clin Res. Ed)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8869590","article-title":"Endogenous endophthalmitis: A review of case series published between 2011 and 2020","volume":"2020","author":"Danielescu","year":"2020","journal-title":"J. Ophthalmol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.oret.2021.09.006","article-title":"Fungal endophthalmitis: Analysis of 730 consecutive eyes from 7 tertiary eye care centers in India","volume":"6","author":"Das","year":"2022","journal-title":"Ophthalmol. Retina"},{"key":"B10","doi-asserted-by":"publisher","first-page":"593","DOI":"10.4103\/ijo.ijo_695_17","article-title":"Presumably contaminated intravenous infusion-induced Aspergillus terreus endogenous endophthalmitis presenting with posterior hypopyon","volume":"66","author":"Dogra","year":"2018","journal-title":"Indian J. Ophthalmol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1097\/00006982-200003000-00007","article-title":"Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid","volume":"20","author":"Gupta","year":"2000","journal-title":"Retina"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1097\/iae.0000000000001630","article-title":"Spectral domain optical coherence tomography findings in endogenous Candida endophthalmitis and their clinical relevance","volume":"38","author":"Invernizzi","year":"2018","journal-title":"Retina"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajoc.2020.100681","article-title":"Posterior hypopyon in fungal endogenous endophthalmitis secondary to presumably contaminated dextrose infusion","volume":"18","author":"Karkhur","year":"2020","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13030199","article-title":"Fungal endophthalmitis: Clinical characteristics, pathogens, and factors affecting visual outcome","volume":"13","author":"Li","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.ajo.2011.06.020","article-title":"Endogenous fungal endophthalmitis: Causative organisms, management strategies, and visual acuity outcomes","volume":"153","author":"Lingappan","year":"2012","journal-title":"Am. J. Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1086\/514972","article-title":"Candida albicans endophthalmitis in brown heroin addicts: Response to early vitrectomy preceded and followed by antifungal therapy","volume":"27","author":"Mart\u00ednez-V\u00e1zquez","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.oret.2016.10.013","article-title":"Intravenous drug use-associated endophthalmitis","volume":"1","author":"Modjtahedi","year":"2017","journal-title":"Ophthalmol. Retina"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.1097\/iae.0000000000000084","article-title":"Endogenous endophthalmitis associated with intravenous drug abuse","volume":"34","author":"Patel","year":"2014","journal-title":"Retina"},{"key":"B20","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1001\/jamaophthalmol.2016.0015","article-title":"Bilateral endogenous endophthalmitis caused by Candida albicans after breast implant surgery","volume":"134","author":"Querques","year":"2016","journal-title":"JAMA Ophthalmol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/s1201-9712(02)90284-5","article-title":"Endogenous Aspergillus endophthalmitis: Report of 3 cases and review of the literature","volume":"81","author":"Riddell","year":"2002","journal-title":"Med. (Baltimore)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1093\/cid\/ciq204","article-title":"Treatment of endogenous fungal endophthalmitis: Focus on new antifungal agents","volume":"52","author":"Riddell","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/icb.0b013e318196b26c","article-title":"Bilateral simultaneous endogenous Aspergillus endophthalmitis in an immunocompetent patient","volume":"4","author":"Sachdev","year":"2010","journal-title":"Retin cases Brief Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1097\/iae.0b013e31822d3a34","article-title":"Factors determining visual outcome in endogenous Candida endophthalmitis","volume":"32","author":"Sallam","year":"2012","journal-title":"Retina"},{"key":"B25","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/j.ajo.2003.11.013","article-title":"Culture-proven endogenous endophthalmitis: Clinical features and visual acuity outcomes","volume":"137","author":"Schiedler","year":"2004","journal-title":"Am. J. Ophthalmol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1080\/09273940802689396","article-title":"Vitrectomy for endogenous fungal endophthalmitis","volume":"17","author":"Shen","year":"2009","journal-title":"Ocul. Immunol. Inflamm."},{"key":"B27","doi-asserted-by":"publisher","first-page":"894","DOI":"10.3928\/23258160-20171030-04","article-title":"Optical coherence tomography findings in endogenous fungal chorioretinitis, retinitis, and endophthalmitis","volume":"48","author":"Stephens","year":"2017","journal-title":"Ophthalmic Surg. Lasers Imaging Retina"},{"key":"B28","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1007\/s00417-005-0182-5","article-title":"Relation between stage of endogenous fungal endophthalmitis and prognosis","volume":"244","author":"Takebayashi","year":"2006","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jiac.2015.12.001","article-title":"Study of ocular candidiasis during nine-year period","volume":"22","author":"Tanaka","year":"2016","journal-title":"J. Infect. Chemother."},{"key":"B30","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1001\/jamaophthalmol.2017.0650","article-title":"An outbreak of endogenous fungal endophthalmitis among intravenous drug abusers in New England","volume":"135","author":"Tirpack","year":"2017","journal-title":"JAMA Ophthalmol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1038\/s41433-024-03474-7","article-title":"The diagnosis and treatment progress of infectious endophthalmitis","volume":"39","author":"Wang","year":"2025","journal-title":"Eye (Lond)"},{"key":"B32","doi-asserted-by":"publisher","first-page":"239","DOI":"10.3109\/09273948.2015.1115080","article-title":"Outcomes of primary transconjunctival 23-gauge vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis","volume":"25","author":"William","year":"2017","journal-title":"Ocul. Immunol. Inflamm."},{"key":"B33","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1097\/00006982-200509000-00010","article-title":"Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis","volume":"25","author":"Zhang","year":"2005","journal-title":"Retina"},{"key":"B34","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s12886-020-01337-9","article-title":"Optical coherence tomography features of retinal lesions in Chinese patients with endogenous Candida endophthalmitis","volume":"20","author":"Zhuang","year":"2020","journal-title":"BMC Ophthalmol."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1718140\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:42:28Z","timestamp":1777009348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1718140\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":34,"alternative-id":["10.3389\/fcimb.2026.1718140"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1718140","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"article-number":"1718140"}}