Dematiaceous fungi are darkly pigmented, filamentary moulds and are common in the environment as plant saprophytes and pathogens.Incidental reports of corneal ulcers that have been caused by species of this group have appeared in the literature, but the relative importance of this species as potential comeal pathogens has not been appreciated.As a group, second to Fusarium solani and other moniliaceous fungi, we find that dematiaceous fungi comprise the next most common cause of fungal ulcers in south Florida.The successful treatment of Fusarium solani keratitis with Natamycin (Pimaricin) has been reported by Jones, Forster, and Rebell (1972), and we have examined the management of other non-Fusarium solani moniliaceous fungal ulcers. The purpose of this communication is to report our study of I 6 isolates of dematiaceous fungal keratitis, their features, and management including nine cases that were treated with Natamycin, and to stress their relative clinical importance.
Material and methods
PATIENTSWe have studied i6 cases of keratitis caused by dematiaceous fungi. Ten cases were referred to the Bascom Palmer Eye Institute; three were examined before I969 and reported by Jones, Sexton, and Rebell (i969), and seven were included in the 53 isolates seen during the last 4i years. Three cases were examined in Augusta, Georgia, by one of us (LAW) and the isolates were identified and studied at the Bascom Palmer Eye Institute. Three additional isolates from Florida were sent to us; two of the patients received Natamycin, and a third was treated with topical Amphotericin B and was examined by us on completion of treatment.
Opportunistic onychomycosis is defined, when a non-dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche. A review of the published dermatologic literature describing toenail opportunistic onychomycosis by non-dermatophyte fungi has shown toenails with onycholysis, nail bed (NB) keratosis and nail plate surface abnormalities. The appearance of these clinical changes is indistinguishable from the diagnosis of the Asymmetric Gait Nail Unit Signs (AGNUS). AGNUS is produced by the friction of the closed shoe in patients with an asymmetric gait, resulting primarily from the ubiquitous uneven flat feet. Most commonly, species of Acremonium (Cephalosporium), Aspergillus, Fusarium, Scopulariopsis and rarely species of many different fungi genera are capable of surviving and reproducing in a keratinous environment and change the clinical appearance of the involved nail unit. AGNUS toenails predispose to the colonization by the non-dermatophyte opportunistic fungi but not by dermatophyte fungi.
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