Keratomycosis due to Tintelnotia destructans refractory to common therapy treated successfully with systemic and local terbinafine in combination with polyhexamethylene biguanide

Abstract

Terbinafine might be considered as a therapeutic option in severe cases of fungal keratitis refractory to common antifungal therapy.

Fungal keratitis: An overview of clinical and laboratory aspects

“…Combination therapy, at least in specific cases, seems to be more effective than monotherapy as it has been reported by some authors . There are some in vitro studies which provide evidence for a synergistic effect between antifungal drugs and even nonantifungal drugs against fungi isolated from patients with keratomycosis (Table ).…”

“…Accordingly, although the clinical treatment is not routinely based on the results of antifungal susceptibility testing, in vitro determination of the susceptibility profile or the efficacy of drug combinations, at least in cases of clinically resistant keratomycosis, could provide helpful data. Similarly, in cases due to uncommon pathogens, antifungal susceptibility testing could be of great importance …”

Contact lens associated keratitis due to Tintelnotia destructans

“…Fungi of the novel genus, Tintelnotia , have recently been recognised to cause ocular and nail infections in humans [[8], [9], [10]]. Tintelnotia destructans is named for its ability to destroy human nails [9] Tintelnotia belong to the class Coelomycetes, order Pleosporales and family Phaeosphaeriaceae [9].…”

“…The first reported case of T. destructans keratitis also involved a contact lens wearer [8,9] who had progressive infection on standard antifungal therapy and eventually improved after seven weeks of oral terbinafine, daily intracameral voriconazole and amphotericin B. Treatment was continued with polyhexamethylene biguanide and topical terbinafine 2-hourly for another 2 months as well as a weaning regimen of topical prednisolone [8,9]. The second case of T. destructans keratitis occurred after ocular trauma and the patient was treated successfully with oral and topical voriconazole for at least five months following penetrating keratoplasty [10].…”

“…There are more than 100 different fungal species that have been documented to cause fungal keratitis [5]. Tintelnotia destructans associated keratitis was described for the first time in 2016, with two previous cases published in the literature [[8], [9], [10]]. We describe here the first case of Tintelnotia destructans associated keratitis in Australia.…”