Alternaria Keratitis: Clinical Presentation and Resolution With Topical Fluconazole or Intrastromal Voriconazole and Topical Caspofungin

Tu, Elmer Y.

doi:10.1097/ico.0b013e31818225f8

Cited by 72 publications

(89 citation statements)

References 30 publications

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“…Use of voriconazole has become more common, with topical preparations well described (211), but published cases involving dematiaceous fungi are infrequent (564). A series of Alternaria keratitis cases that were refractory to natamycin responded to topical azoles (758). A recent analysis of clinical trials involving fungal keratitis suggested that none of the available agents was highly effective (247).…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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“…Clinically, caspofungin is administered mostly intravenously (1,4,6,9,19,20) or intravitreally (24) for ocular mycosis. The successful use of topical caspofungin alone (13) or in combination with voriconazole (22) has been reported for two patients. However, the utility of topical caspofungin in fungal keratitis remains unknown, partly due to limited data on its penetration into human aqueous humor after topical administration.…”

mentioning

confidence: 99%

“…As fungal keratitis will generally compromise the corneal epithelium's integrity, topical caspofungin could achieve concentrations above the MIC 90 in patients with keratitis, but this remains to be demonstrated. Clinical resolution with topical caspofungin has been demonstrated for keratitis caused by Fusarium species in rabbit models (18) and keratitis caused by Alternaria (22) or Candida (13) species in patients. Arm 1 participants had higher caspofungin concentrations with greater variability than Arm 2 participants.…”

mentioning

confidence: 99%

“…Side effects associated with systemic administration are unlikely, given that each topically administered dose (50 l) of 0.5% caspofungin contains only 0.25 mg caspofungin. Following the 2-hourly regimen (22), the total daily topical caspofungin dose is 3 mg, which is 6% of a standard 50 mg intravenous dose. There was no toxicity on human ocular cells after 1 month of treatment with 75 g/ml caspofungin (14).…”

mentioning

confidence: 99%

“…Caspofungin eye drops (0.5%) (11,13,22) were prepared aseptically; 10.5 ml of water for injection was added to a 50-mg vial of caspofungin. All eye drops were freshly prepared and used within 24 h (7).…”

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Penetration of Topically Administered 0.5-Percent Caspofungin Eye Drops into Human Aqueous Humor

Neoh

Leung

Misra

et al. 2011

Antimicrob Agents Chemother

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Ten participants attending elective anterior segment eye surgery received 0.5% caspofungin eye drops either 1 drop hourly for 4 h or 1 drop an hour before surgery. The eye drops were generally well tolerated. In the absence of inflammation or corneal abrasion, topical caspofungin does not achieve clinically relevant concentrations.Fungal keratitis is a potentially blinding condition, with Candida, Aspergillus, and Fusarium spp. (2, 21) being the common pathogens. Current treatment for fungal keratitis is inadequate (8); thus, alternatives are needed.Caspofungin has activity against a wide range of fungi, with MIC 90 values ranging from 60 to 2,000 ng/ml (15, 23). Caspofungin eye drops are effective for treatment of fungal keratitis in rabbits (11, 18) and have good penetration into animal eyes with inflammation or previous corneal abrasion (10, 23). Clinically, caspofungin is administered mostly intravenously (1,4,6,9,19,20) or intravitreally (24) for ocular mycosis. The successful use of topical caspofungin alone (13) or in combination with voriconazole (22) has been reported for two patients. However, the utility of topical caspofungin in fungal keratitis remains unknown, partly due to limited data on its penetration into human aqueous humor after topical administration. This study aimed to investigate the ocular penetration of 0.5% caspofungin eye drops into human aqueous humor.

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Successful Topical Application of Caspofungin in the Treatment of Fungal Keratitis Refractory to Voriconazole

Hurtado-Sarrió¹

2010

Arch Ophthalmol

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RESEARCH LETTERSSuccessful Topical Application of Caspofungin in the Treatment of Fungal Keratitis Refractory to Voriconazole F ungal keratitis is an important ophthalmic problem because it leads to corneal blindness and sometimes to loss of the eye. 1,2 There is no agreed protocol for the treatment of suspected fungal keratitis. Topical and oral voriconazole have now been reported to be effective. 3 However, some cases do not respond to this treatment. New antifungal agents such as caspofungin acetate, 0.5%, are promising alternatives.Report of a Case. A 60-year-old woman with a history of penetrating keratoplasty in her right eye due to corneal herpetic infection 1 year earlier was admitted be-

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Alternaria Keratitis: Clinical Presentation and Resolution With Topical Fluconazole or Intrastromal Voriconazole and Topical Caspofungin

Cited by 72 publications

References 30 publications

Melanized Fungi in Human Disease

Melanized Fungi in Human Disease

Penetration of Topically Administered 0.5-Percent Caspofungin Eye Drops into Human Aqueous Humor

Successful Topical Application of Caspofungin in the Treatment of Fungal Keratitis Refractory to Voriconazole

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