Endophthalmitis after Lasiodiplodia theobromae corneal abscess

Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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“…Endophthalmitis (37) and panophthalmitis (356); criteria for diagnosis include recovery from multiple ocular tissues and positive microscopy.…”

Section: Morphology In Culturementioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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“…For example, ITS sequencing identified Histoplasma capsulatum (from bronchoalveolar lavage [BAL]), and although clinical correlation was not possible, the significance of this pathogen is well recognized. Similarly, we identified pathogens such as Schizophyllum commune (3, 10), Coniothyrium (6, 7), Coprinus (8,13), and Botrysphaeria rhodina (1,14), which can be considered emerging pathogens capable of causing disease when there is histopathological or other corroborating evidence. For many isolates identified by ITS sequencing, we classified them as environmental fungi because these microorganisms are commonly encountered in the clinical laboratory and usually have no clinical importance in healthy subjects (12).…”

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confidence: 97%

Discovering Potential Pathogens among Fungi Identified as Nonsporulating Molds

et al. 2007

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Fungal infections are increasing, particularly among immunocompromised hosts, and a rapid diagnosis is essential to initiate antifungal therapy. Often fungi cannot be identified by conventional methods and are classified as nonsporulating molds (NSM).We sequenced internal transcribed spacer regions from 50 cultures of NSM and found 16 potential pathogens that can be associated with clinical disease. In selected clinical settings, identification of NSM could prove valuable and have an immediate impact on patient management.Fungal infections are increasing, particularly among immunocompromised hosts, and a rapid, accurate diagnosis is essential for the initiation of targeted antifungal therapy. Diagnosis of fungal infections usually depends on recovery of fungi from culture of clinical specimens, and their identification requires the presence of reproductive structures. Often fungi cannot be characterized fully because the mold does not sporulate, making identification by microscopic morphology not possible and potentially increasing the time to report an inconclusive result to 21 days. While many laboratorians and clinicians assume that these fungal isolates are environmental organisms and not clinically significant, to our knowledge no study has systematically attempted to classify these previously unidentifiable fungi in a clinical microbiology laboratory.Amplification and sequencing of target regions within the ribosomal DNA gene complex has emerged as a useful, adjunctive tool for the identification of fungi and does not depend on mold sporulation for identification (3,5,9,11). The internal transcribed spacer (ITS) regions 1 and 2 located between the highly conserved small (18S) and large (28S) ribosomal subunit genes in the rRNA operon are known to have sufficient sequence variability to allow identification to the species level for many fungi (2,3,5,9,11,15). The goals of this study were to determine if sequencing the ITS 1 and 2 regions of nonsporulating molds (NSM) could identify fungi that were not identifiable by conventional methods and could serve as an approach to detect clinically relevant pathogens.Sample selection. Identification of molds directly from a specimen or submitted as an isolated culture to Associated Regional and University Pathologists, Inc., Laboratories (ARUP Laboratories) was attempted by growth on inhibitory mold agar, modified Sabouraud agars, or potato dextrose agar. Microscopic structures were observed on tease or tape preparations and slide cultures for up to 21 days. NSM were defined as molds without reproductive structures and that could not be further characterized.

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“…There has been a single case of human subcutaneous hyalohyphomycosis reported to have been caused by C. gloeosporioides (15) and another caused by C. crassipes (6). A number of other coelomycetes have been reported to occasionally cause similar mycoses in humans (2,4,7,19,21,25,38). Coelomycetes are increasing in importance, especially in the severely immunocompromised human host, and there is a growing list of implicated species (29,37).…”

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confidence: 99%

Disseminated Mycotic Infection Caused by Colletotrichum acutatum in a Kemp's Ridley Sea Turtle ( Lepidochelys kempi )

et al. 2002

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Colletotrichum acutatum is a cosmopolitan plant pathogen with a wide host range. While the organism's phytopathogenic potential has been well documented, it has never been reported as an etiologic agent of disease in either animals or humans. In this case, a juvenile Kemp's ridley sea turtle, Lepidochelys kempi, probably with immune compromise following cold stunning (extended hypothermia), developed a disseminated mycotic infection in the lungs and kidneys. Prophylactic treatment with oral itraconazole did not prevent or cure the infection. This report of a Colletotrichum acutatum infection in an animal extends the range of disease caused by this organism beyond that of a phytopathogen.

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Endophthalmitis after Lasiodiplodia theobromae corneal abscess

Abstract: The use of topical steroids may worsen the outcome of the infection.

Cited by 39 publications

References 4 publications

Current Perspectives on Ophthalmic Mycoses

Current Perspectives on Ophthalmic Mycoses

Discovering Potential Pathogens among Fungi Identified as Nonsporulating Molds

Disseminated Mycotic Infection Caused by Colletotrichum acutatum in a Kemp's Ridley Sea Turtle ( Lepidochelys kempi )

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