Abstract:Abstract. We describe a patient with Pseudallescheria boydii keratitis. The treatment of mycotic keratitis remains difficult. This case demonstrates that identification and susceptibility testing should be rapidly performed. In cases of indolent keratitis, the possibility of fungal infection should be kept in mind. J Pediatr Ophthalmol Strabismus 2006;43:114-115.
“…There are other reports of successful treatment using topical voriconazole, miconazole, nystatin, and amphotericin B. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 This organism has septate, thin-walled, branching hyphae and an angioinvasive tendency. 14 There is not any report of confocal scanning of this type of fungal keratitis in the literature.…”
PurposeTo report two rare cases of filamentous fungal keratitis.MethodsTwo non-consecutive patients presented with suspicious fungal keratitis. After performing the smear and culture, medical therapy was started for them. They underwent slit photography and in vivo confocal microscopy (IVCM) in their follow-up visits.ResultsThe patients were 33-year-old and 56-year-old farmer men. They both mentioned a history of ocular trauma by plants. During their follow-up visits, corneal infiltration density and fungal hyphae density decreased in slit-lamp biomicroscopy and IVCM, respectively. The corresponding organisms were Pseudallescheria boydii (P. boydii) and Colletotrichum coccodes.ConclusionsIt is important to be aware of these rare organisms and their antibiotic susceptibility. There was not any specific confocal feature for the presented fungal keratitis that was different from other filamentous fungal hyphae; however, confocal scan is a good choice to follow the response to the treatment.
“…There are other reports of successful treatment using topical voriconazole, miconazole, nystatin, and amphotericin B. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 This organism has septate, thin-walled, branching hyphae and an angioinvasive tendency. 14 There is not any report of confocal scanning of this type of fungal keratitis in the literature.…”
PurposeTo report two rare cases of filamentous fungal keratitis.MethodsTwo non-consecutive patients presented with suspicious fungal keratitis. After performing the smear and culture, medical therapy was started for them. They underwent slit photography and in vivo confocal microscopy (IVCM) in their follow-up visits.ResultsThe patients were 33-year-old and 56-year-old farmer men. They both mentioned a history of ocular trauma by plants. During their follow-up visits, corneal infiltration density and fungal hyphae density decreased in slit-lamp biomicroscopy and IVCM, respectively. The corresponding organisms were Pseudallescheria boydii (P. boydii) and Colletotrichum coccodes.ConclusionsIt is important to be aware of these rare organisms and their antibiotic susceptibility. There was not any specific confocal feature for the presented fungal keratitis that was different from other filamentous fungal hyphae; however, confocal scan is a good choice to follow the response to the treatment.
“…Internal transcribed spacer (ITS) gene sequencing establishes a rapid and prompt diagnosis of fungal keratitis in refractory cases[ 21 ] and has been described in Pythium along with other non-sporulating molds. [ 22 23 24 25 26 27 28 29 30 31 32 33 ]…”
Section: Diagnosismentioning
confidence: 99%
“…Several new pathogenic fungi causing keratitis, with varying or suboptimal susceptibility to antifungal therapy, are emerging [ Table 2 ]. [ 23 24 25 26 27 28 29 30 31 32 33 34 35 45 46 47 48 49 50 51 52 ] Knowledge of the sensitivity profile of antifungals by antifungal susceptibility test (AFST) against various species helps in initiating appropriate treatment and improving the outcome. A recent study from South America reported A. fumigatus isolate from post-traumatic keratitis in a 27-year-old male worker carrying the substitution G54E at Cyp51Ap associated with itraconazole resistance, highlighting the possibility of mutation-induced resistance to common antifungal therapy.…”
Section: Emerging New Pathogenic Microbesmentioning
Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.
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