Acremonium keratitis: Risk factors, clinical characteristics, management, and outcome in 65 cases

Priyadarshini, Smruti Rekha; Soni, Tanvi; Sahu, Srikant K; Mohanty, Amrita; Sharma, Savitri; Mitra, Sanchita; Ali, Mohammed; Das, Sujata

doi:10.4103/ijo.ijo_659_22

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…Many of these outcome differences can be attributed to the delay seen in diagnosing and treating FK in comparison to BK. Though BK is more common, the number of cases has been declining [ 10 ]. On the other hand, FK incidence has increased over the past 30 years, making it important to include FK as a differential diagnosis of eye infection [ 7 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Though BK is more common, the number of cases has been declining [ 10 ]. On the other hand, FK incidence has increased over the past 30 years, making it important to include FK as a differential diagnosis of eye infection [ 7 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Existing non-surgical interventions are limited for those with severe disease and have a high failure rate [ 6 ]. Antimicrobial peptide, collagen cross-linking, and phage therapies seem promising as noninvasive treatments for FK [ 2 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Fungal Keratitis in a Critically Ill Post-trauma Patient

Pulliam,

Nkangabwa,

Lantz

et al. 2023

Cureus

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Keratitis is the leading cause of corneal blindness in the world. Nearly half the cases are due to a fungal infection known as fungal keratitis (FK). There is much variability in the clinical presentation of FK, so diagnosis can be difficult. With the risks of blindness in disease progression being so high, it is vital to diagnose and treat FK quickly. We present a case of FK due to Candida albicans and Staphylococcus lugdunensis-oxa ss after a motor vehicle accident, its treatment, and the general outcome.A 71-year-old man with a history of hypertension, hyperlipidemia, arthritis, and previous tobacco use presented after a helmeted motorcycle accident with back pain and bilateral lower extremity sensory and motor function loss. He suffered many fractures and was in neurogenic shock. He had nearly daily reduction and fixation of multiple axial spinal fractures while in the surgical intensive care unit and was ultimately unable to be successfully extubated. Between two intubations, he complained to his family of blurry vision, and there was notable purulence and corneal haziness in bilateral eyes.The healthcare team initially suspected the eye infection was due to a bacterial etiology, and he was subsequently diagnosed with Pseudomonas pneumonia on respiratory cultures. However, several days of antibiotics did not improve the ocular exam. A corneal culture was positive for C. albicans and S. lugdunensis-oxa ss, and anti-fungal treatment was initiated with ocular improvement. Unfortunately, the patient succumbed to his injuries and further sepsis at another site. With a progressively poor prognosis and machine dependence, he was made do-not-resuscitate per family wishes and died within two hours after cessation of hemodialysis.One of the greatest barriers to diagnosing FK in the United States is the absence of information regarding the disease. Though novel diagnoses and treatment strategies are in development, the fungal etiology of keratitis should be included in the curricula for not just medical students but also for providers and specialists, as the incidence of FK continues to grow with globalization. We also aim to emphasize the importance of a multidisciplinary team in these cases, as ophthalmology and infectious disease specialists should be involved immediately in order to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fungal Keratitis in a Critically Ill Post-trauma Patient

Pulliam,

Nkangabwa,

Lantz

et al. 2023

Cureus

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Commentary: Acremonium species – A saprophytic fungus causing keratitis

Sridhar

Tripathy

2022

Indian J Ophthalmol

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Immune Mechanisms of Filamentous Fungal Keratitis

Mpakosi,

Kaliouli-Antonopoulou

2024

Cureus

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Filamentous fungal keratitis is a particularly serious eye infection that often results in ulceration, corneal perforation, and blindness. The cornea acts as a natural barrier against harmful agents due to the close connection of its epithelial cells. In addition, on its surface, there is a large number of substances with antiinflammatory and bactericidal properties, such as secretory IgA and mucin glycoproteins, and antimicrobial peptides (AMPs), such as human β-defensin 2 (HBD-2) and LL-37, which are especially increased in filamentous fungal keratitis.The interaction between pathogenic fungi and the host's immune mechanisms is a complex process: pathogen-associated molecular pattern (PAMP) molecules (chitin, β-glucan, and mannan) found in the fungal cell wall are recognized by pattern recognition receptors (PRRs) (toll-like receptors {TLRs}, C-type lectin receptors {CLRs}, nucleotide-binding oligomerization domain-like receptors {NLRs}, and scavenger receptors {SR}) found in host defense cells, triggering the secretion of various types of cytokines, such as interleukins (IL), tumor necrosis factors (TNFs), and chemokines, which recruit macrophages and neutrophils to migrate to the site of infection and activate inflammatory responses.In addition, the interaction of hyphae and corneal epithelial cells can activate cluster of differentiation (CD) 4+ T cells, CD8+ T cells, and B cells and induce secretion of T-helper (Th)-type cytokines 2 (IL-4 and IL-13) and IgG.

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Acremonium keratitis: Risk factors, clinical characteristics, management, and outcome in 65 cases

Cited by 3 publications

References 33 publications

Fungal Keratitis in a Critically Ill Post-trauma Patient

Fungal Keratitis in a Critically Ill Post-trauma Patient

Commentary: Acremonium species – A saprophytic fungus causing keratitis

Immune Mechanisms of Filamentous Fungal Keratitis

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