Orbital fungal infections often misdiagnosed
Fungal infection of the orbit is rare in the U.S., which may lead to misdiagnosis, according to a study presented at the virtual American Society of Ophthalmic Plastic and Reconstructive Surgery annual meeting.
“One of the things we learned is that we have a high rate of misdiagnosis when it comes to this disease entity,” Brittany A. Simmons, MD, said.
In a retrospective chart review at two large tertiary care centers in the U.S. spanning 20 years, presentation, exam, clinical course, treatment data and patient outcomes for 49 cases of confirmed fungal infections of the orbit were evaluated. Of these, 67.3% were misdiagnosed, with bacterial cellulitis and sinusitis each accounting for 24.5% of misdiagnoses. Inflammatory processes such as giant cell arteritis, nonspecific idiopathic orbital inflammation and optic neuritis were diagnosed in 18.4% of cases, Simmons said.
Heuristic tendencies and other cognitive biases are possible explanations for the high rate of misdiagnoses, Simmons said, because physicians are biased toward previous experience.
“If we see a lot of bacterial cellulitis, we will retrieve bacterial cellulitis before we get to fungal, and we will treat as we did for our previous experiences that we have had with bacterial cellulitis,” Simmons said.
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Simmons BA, et al. Misdiagnosis of fungal infections of the orbit in the United States. Presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery annual meeting; Nov. 20-22, 2020 (virtual meeting).
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