Clinical profile of pythium keratitis: perioperative measures to reduce risk of recurrence

Agarwal, Shweta; Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Mamta; Kumar, Shobha Panchalam Sampath; Therese, Lily

doi:10.1136/bjophthalmol-2017-310604

Cited by 50 publications

(92 citation statements)

References 19 publications

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“…This might be considered as being related to the combination of preoperative antifungal-sensitive drugs and the total eradication of lesions. At present, there are no effective treatment for Pythium insidiosum keratitis, antifungal therapy or surgery is still the main treatment method used in other countries, but a icted patients face prolonged recovery often requiring multiple keratoplasty, and the fungal recurrence rate after surgery is high [24,30,31]. In our study, four cases of Pythium insidiosum keratitis were ineffective in antifungal therapy, and three cases (75%) showed fungal recurrence after corneal transplantation.…”

Section: Discussionmentioning

confidence: 60%

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Clinical manifestations and treatment outcomes of rare genera fungal keratitis in China

Wang¹,

Lu²,

Li³

et al. 2020

Preprint

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Background: Fungal keratitis is a common cause of blindness, and although major fungal genera in China have been widely reported, little is known regarding rare genera of fungal keratitis. This study is aimed at investigating the clinical manifestations and treatment outcomes of rare genera of fungal keratitis and improving clinicians’ understanding of these genera in China.Methods: A retrospective analysis was performed at Shandong Eye Hospital from October 2008 to December 2017. The clinical manifestations, risk factors, confocal microscopic images, histopathological features, in vitro drug sensitivity tests, and treatment outcomes of 16 patients with 8 rare fungal genera were evaluated.Results: Slit lamps were used to observe Rhizopus, Pythium insidiosum, and Purpureocillium lilacinum, which presented with endothelial plaque and hypopyon. Curvularia crescentulum keratitis mainly presents with feathered edges. Cases of Colletotrichum, Exserohilum, and Bipolaris also showed these feathered edges extending to the periphery, while Sarocladium keratitis only showed obvious edema and infiltration. The mean age was 54.75±12.70 years with an increase in male preponderance. Plant trauma and foreign body scratching caused ten cases (62.5%), and six cases (37.5%) were caused without inducement. In 2/3 cases, Curvularia crescentulum keratitis was cured with antifungal medication, while in 14/16 cases (87.5%), surgery was required. An exception occurred in three cases of Pythium insidiosum, where patients with fungal recurrence and final evisceration was performed; no recurrence of infection occurred in the rest of the patients. The best-corrected visual acuity (BCVA, LogMAR) of 13 cases was 1.48 ±0.85 before treatment and 0.60 ±0.45 after treatment, and the difference was found to be statistically significant [(95 % CI, 0.33–1.43) (P=0.003)].Conclusions: We report on the rare fungal genera collected in China in order to improve the knowledge of clinicians. In our study, Curvularia crescentulum seems to respond well to antifungal drugs. Patients affected by Pythium insidiosum often need long-term recovery and multiple keratoplasty, and postoperative fungal recurrence rate is high. For fungal keratitis, the combination of early sensitive antifungal drugs and necessary surgical treatment may still be a beneficial factor in treatment.

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Section: Discussionmentioning

confidence: 60%

“…For Pythium insidiosum keratitis, antifungal medication combined with antimicrobial therapy has been used in other countries and has achieved certain effects [31]. Agarwal et al reported cryotherapy or absolute alcohol might prove bene cial [30]. These adjunctive measures may be bene cial to the treatment Pythium insidiosum keratitis.…”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations and treatment outcomes of rare genera fungal keratitis in China

Wang¹,

Lu²,

Li³

et al. 2020

Preprint

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“…Patients with Pythium keratitis usually present with typical clinical manifestations, including multiple, linear, tentacle-like infiltrates and dot-like or pinhead-shaped infiltrates, involving the subepithelial, anterior stromal, and midstromal layers in surrounding cornea and radiating in a reticular pattern from the central area of the lesion towards the limbus (Fig. 3) (Lekhanont et al, 2009;Lelievre et al, 2015;Bagga et al, 2018;Chatterjee & Agrawal, 2018;Agarwal et al, 2019;He et al, 2016;Thanathanee et al, 2013;Sharma et al, 2015;Agarwal et al, 2018). Radial keratoneuritis has been observed in some cases (Lekhanont et al, 2009;He et al, 2016).…”

Section: Ocular Pythiosismentioning

confidence: 99%

“…An extensive and aggressive infiltration of P . insidiosum could result in corneal perforation, anterior chamber, limbal and scleral invasions, or endophthalmitis in a few days or weeks (Lekhanont et al, 2009;Lelievre et al, 2015;Rathi et al, 2018;Agarwal et al, 2019;Badenoch et al, 2001;He et al, 2016;Maeno et al, 2019;Ros Castellar et al, 2017;Thanathanee et al, 2013;Sharma et al, 2015;Agarwal et al, 2018).…”

Section: Ocular Pythiosismentioning

confidence: 99%

Recent update in diagnosis and treatment of human pythiosis

Chitasombat

Jongkhajornpong

Lekhanont

et al. 2020

PeerJ

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Human pythiosis is an infectious condition with high morbidity and mortality. The causative agent is the oomycete microorganism Pythium insidiosum. The pathogen inhabits ubiquitously in a wet environment, and direct exposure to the pathogen initiates the infection. Most patients with pythiosis require surgical removal of the affected organ, and many patients die from the disease. Awareness of pythiosis among healthcare personnel is increasing. In this review, we summarized and updated information on the diagnosis and treatment of human pythiosis. Vascular and ocular pythiosis are common clinical manifestations. Recognition of the typical clinical features of pythiosis is essential for early diagnosis. The definitive diagnosis of the disease requires laboratory testing, such as microbiological, serological, molecular, and proteomic assays. In vascular pythiosis, surgical intervention to achieve the organism-free margin of the affected tissue, in combination with the use of antifungal drugs and P. insidiosum immunotherapy, remains the recommended treatment. Ocular pythiosis is a serious condition and earliest therapeutic penetrating keratoplasty with wide surgical margin is the mainstay treatment. Thorough clinical assessment is essential in all patients to evaluate the treatment response and detect an early sign of the disease recurrence. In conclusion, early diagnosis and proper management are the keys to an optimal outcome of the patients with pythiosis.

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“…Data on the epidemiology of pythiosis is limited. Since the rst case in 1985, human pythiosis has been increasingly reported from all over Thailand [2,10,[13][14][15][16][17][18][19], where P. insidiosum is ubiquitous in the environment [3,4]. A seroprevalence study estimated that ~32,000 Thai people have been exposed to the pathogen [20].…”

Section: Introductionmentioning

confidence: 99%

An initial survey of 150 horses from Thailand for anti-Pythium insidiosum antibodies

Htun

Laikul

Pathomsakulwong

et al. 2020

Preprint

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Objectives: Pythium insidiosum causes a deadly condition, called pythiosis, in humans and other animals. The organism has been identified in tropical and subtropical environments worldwide. Since 1985, human pythiosis has been increasingly reported from Thailand. Seroprevalence studies estimated that ~32,000 Thai people have been exposed to the pathogen. In 2018, the first animal pythiosis case in Thailand was diagnosed in a horse. In this study, we surveyed anti-P. insidiosum antibodies in a sample of the Thai equine population. Results: Serum samples were available from 150 out of 6,353 registered horses distributed across Thailand. ELISA detected the anti-P. insidiosum antibodies in three horses. Immunochromatography and Western blot confirmed the presence of the antibodies in one of the ELISA-positive horses. Based on one positive out of 150 tested, the Pythium seroprevalence in the Thai equine population was 0.7%, which is 10 times higher than that of the Thai human population. The seroprevalence of the anti-P. insidiosum antibodies in a small sample of horses suggests a higher incidence of pythiosis in horses than in humans. Larger studies will be necessary to obtain the full picture of the epidemiology of animal pythiosis in Thailand.

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Clinical profile of pythium keratitis: perioperative measures to reduce risk of recurrence

Abstract: This series highlights the need to be aware of this entity in the management of refractory fungal keratitis. It also brings to fore the adjunctive measures that could have a beneficial role in the management of pythium keratitis.

Cited by 50 publications

References 19 publications

Clinical manifestations and treatment outcomes of rare genera fungal keratitis in China

Clinical manifestations and treatment outcomes of rare genera fungal keratitis in China

Recent update in diagnosis and treatment of human pythiosis

An initial survey of 150 horses from Thailand for anti-Pythium insidiosum antibodies

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