Fungal keratitis caused by Metarhizium anisopliae complex

Abstract

PurposeTo report a case of fungal keratitis caused by Metarhizium anisopliae complexMethodsCase reportResultsOur patient presented with a central corneal infiltrate. Fungal culture yielded a Metarhizium species. She was started on antifungal agents with no significant improvement. A therapeutic corneal transplant was performed after perforation. At two years follow up, she was free of infection.ConclusionMetarhizium anisopliae is a very rare cause of keratitis. Although previous reported cases showed clinical improvement with antifungal agents, this case required surgical treatment to control the infection.

Treatment of Metarhizium fungal keratitis in the United Kingdom

“…Despite in vitro sensitivity to voriconazole in the reported susceptibilities, there was little response in our case with clinical deterioration. A similar trend was seen with progression despite voriconazole therapy delivered topically [9] or systemically [2] in other cases. It is established that for filamentous fungi particularly, in vitro MIC values indicating susceptibility do not always correlate with effective host response to treatment [10].…”

“…This report to our knowledge is the ninth worldwide for an ocular infection. The first report was in 1997 from Colombia [3], then subsequent reports emerged from the United States [4,5], Australia [6], Japan [7], France [2,8] and Canada [9]. This is the first report in the United Kingdom.…”

“…This is the first report in the United Kingdom. Of the previous eight cases, four implicated contact lens wear [4,5,7,9], three involved ocular injection of organic material [2,6,8] whilst the initially described case had no identifiable risk factors [3].…”

“…Conversely, two cases progressed to keratoplasty and poor outcome despite natamycin treatment [6,7]. In the two cases where natamycin was unavailable, infection progressed to require therapeutic keratoplasty despite topical and systemic antifungals, one case with corneal perforation at day 11 of treatment [2,9].…”

Two cases of fungal keratitis caused by Metarhizium anisopliae

“…The first reported case occurred in Columbia, South America in 1997 and was a fungal keratitis in an 18-year-old man [3] . There have now been four reported cases of fungal keratitis [3] , [4] , [5] , [6] and two cases of sclerokeratitis [7] , [8] . Here we report two additional cases of Metarhizium keratitis in soft contact lens wearers.…”