Pythium insidiosum Keratitis

Sharma, Savitri; Balne, Praveen Kumar; Motukupally, Swapna Reddy; Das, Sujata; Garg, Prashant; Sahu, Srikant K; Arunasri, Kotakonda; Manjulatha, Kodiganti; Mishra, Dilip Kumar; Shivaji, Sisinthy

doi:10.1097/ico.0000000000000349

Cited by 69 publications

(56 citation statements)

References 17 publications

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“…The first case of human subcutaneous pythiosis was reported in Thailand in 1985, and Thailand has the highest incidence of this disease (1). Currently, the increased trend of human pythiosis cases has been revealed not only in Thailand but also in other countries in Asia (2)(3)(4)(5)(6), Australia (7)(8)(9), North America (10), and South America (11). Vascular pythiosis is the most common manifestation of human pythiosis, which almost always occurs in patients with underlying hemoglobinopathy complicated by hemochromatosis (1,(12)(13)(14).…”

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confidence: 99%

Monitoring Anti-Pythium insidiosum IgG Antibodies and (1→3)-β-d-Glucan in Vascular Pythiosis

et al. 2018

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Despite aggressive treatment, vascular pythiosis has a mortality rate of 40%. This is due to delays in diagnosis and a lack of effective monitoring tools. To overcome this drawback, serum beta-d-glucan (BG) and -specific antibody (-Ab) were examined as potential monitoring markers in vascular pythiosis. A prospective cohort study of vascular pythiosis patients was carried out from January 2010 to July 2016. Clinical information and blood samples were collected and evaluated by the BG and -Ab assays. Linear mixed-effect models were used to compare BG and-Ab levels. The susceptibility test was performed with all isolates from culture-positive cases. A total of 50 patients were enrolled: 45 survived and 5 died during follow-up. The survivors had a significantly shorter time to medical care ( < 0.0001) and a significantly shorter waiting time to the first surgery ( < 0.0001). There were no differences in BG levels among the groups at diagnosis ( = 0.33); however, BG levels among survivors were significantly lower than those of the deceased group at 0.5 months ( < 0.0001) and became undetectable after 3 months. Survivors were able to maintain an enzyme-linked immunosorbent assay (ELISA) value (EV) of -Ab above 8, whereas the EV among deceased patients was less than 4. susceptibility results revealed no synergistic effects between itraconazole and terbinafine. This study showed that BG and -Ab are potentially valuable markers to monitor the disease after treatment initiation. An unchanged BG level at 2 weeks after surgery should prompt an evaluation for residual disease.

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confidence: 99%

Monitoring Anti-Pythium insidiosum IgG Antibodies and (1→3)-β-d-Glucan in Vascular Pythiosis

et al. 2018

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“…It appeared at the intermediate stage, along with the presence of dot-like and tentacle-like corneal infiltrates described in Savitri Sharma’s report [18]. The flocculent-like sphacelus covered the ulcer surface and became easier to be observed after application of Natamycin.…”

Section: Discussionmentioning

confidence: 89%

“…Recently, India has been highlighted due to the 9 cases reported in 2015. The researchers from Thailand and India demonstrated that ocular pythiosis may be not as rare as was previously considered, but simply goes unrecognized [2,18]. Briefly, the main reasons for the misdiagnosis of pythiosis include lack of characteristic clinical features, unawareness among clinicians, and a lack of early diagnosis in some regions.…”

Section: Discussionmentioning

confidence: 99%

“…Aside from enucleation/evisceration, penetrating keratoplasty (PK) is the most effective means for removing infected tissue while protecting the globe and vision. Although cases of P. insidiosum keratitis have been discovered in several countries, including Thailand [1,17], India [18], Australia [19], Haidi [3], New Zealand [13], Israel [20,21], Malaysia [22], and Canada [23], there has been no previous case reported originally from China. Here, we present a case of P. insidiosum keratitis in a Chinese child.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Treatment of Pythium Insidiosum Corneal Ulcer in a Chinese Child: A Case Report and Literature Review

Liu

Chen

et al. 2016

Am J Case Rep

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Patient: Male, 7Final Diagnosis: Pythium insidiosumSymptoms: Painful vision loss • red eyeMedication:—Clinical Procedure: Application of multiple antifungal medicines followed by the penetrating keratoplastySpecialty: OphthalmologyObjective:Rare diseaseBackground:Pythium insidiosum keratitis is a rare but sight-threatening disease with a high morbidity rate. It can be mis-diagnosed as fungal keratitis in clinic settings. We report a case of severe Pythium insidiosum keratitis in a Chinese child, treated with combined approaches.Case Report:A 7-year-old boy from Hainan province in the south of China developed a suppurative corneal ulcer after being in a forest. A mass of hyphae was detected by confocal imaging in vivo, fungal smear test, and histochemical examination. Treatment with Natamycin, fluconazole, and Voriconazole for 1 month was unsuccessful, and a penetrating keratoplasty with anterior vitrectomy was performed. The infection reappeared 1 day after surgery, immediately after which anterior chamber irrigation with 0.02% Fluconazole and amphotericin B solution was performed. Finally, the globe was saved and there was no further recurrent infection. A cultured mycelial organism, which was hard to identify by biomorphology, was confirmed by PCR to be Pythium insidiosum. The zoospores were observed in water environments. The imaging characteristics of P. insidiosum in confocal microscopy are described herein.Conclusions:This is the first case of Pythium insidiosum keratitis reported in China. It can be misdiagnosed as fungal keratitis in the clinic. Improving the awareness of clinicians, promoting early diagnosis, and a multidisciplinary approach, especially early surgery, improve the prognosis.

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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%

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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Pythium insidiosum Keratitis

Cited by 69 publications

References 17 publications

Monitoring Anti-Pythium insidiosum IgG Antibodies and (1→3)-β-d-Glucan in Vascular Pythiosis

Monitoring Anti-Pythium insidiosum IgG Antibodies and (1→3)-β-d-Glucan in Vascular Pythiosis

Diagnosis and Treatment of Pythium Insidiosum Corneal Ulcer in a Chinese Child: A Case Report and Literature Review

Recent update in diagnosis and treatment of human pythiosis

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