FUNGAL FEEDING-LINE INFECTIONS - BEWARE THE EYES AND TEETH

Twenty-four fungal feeding-line infections occurred in 17 patients dur ing 1984-1992. Thirteen were receiving long-term home parenteral feedi ng and, in them, the first infection occurred after a median of 30 mon ths (range 1-120) continuous feeding with a line that had been in situ for a median of 20 months (range 1-37). Four were receiving short-ter m feeding through a line that had been inserted 1-2 months previously. At the time of the first infection all patients were febrile and most were anaemic (15/16), however a leucocytosis was rare (three of 16). The fungi isolated were Candida albicans(6), Candida parapsilosis(5), Candida glabrata(2), Candida guillermondii(2) and other species (2). I n 16 patients, the feeding-line was removed at the time of the first i nfection and no other treatment was given, and no other complications occurred in eight (50%) of these. In 11, the line was reinserted a med ian of 7 days after removal (range 1-11). Four patients (24%) develope d a Candida infection of the eye 1-8 weeks after the diagnosis, uveiti s (2) and endophthalmitis (2) which, in one patient, led to complete b lindness in one eye. Two patients had recurrent infections which began within a month of dental therapy. In one, the infections stopped afte r dental extractions and, in the other, after a dental clearance. An o phthalmoscopic examination should be performed in all patients with a fungal feeding-line infection. Recurrent candidal infections may have a dental origin.