[拟青霉属菌种引起的眼部感染的临床表现、治疗及转归]

[Clinical manifestations, treatment and outcome of ocular infections caused by Paecilomyces species].

作者信息

Kawakami Hideaki, Inuzuka Hiroko, Mochizuki Kiyofumi, Takahashi Nobumichi, Muto Toshihiro, Ohkusu Kiyofumi, Yaguchi Takashi, Nishimura Kazuko

机构信息

Department of Ophthalmology, Gifu Municipal Hospital, Japan.

出版信息

Nippon Ganka Gakkai Zasshi. 2012 Jul;116(7):613-22.

PMID:22844780

Abstract

PURPOSE

To report the predisposing factors, patient background, treatment and outcomes of ocular infections caused by Paecilomyces spp. in Japan.

METHODS

We reviewed the medical records and the published literature in Japan on ocular infections caused by microbiologically-proven Paecilomyces spp. Nineteen eyes of 18 patients; 4 eyes of 4 of our patients and 15 eyes of 14 published Japanese patients were studied.

RESULTS

Ten men and 8 women (9 OD, 8 OS, 1 OU) were diagnosed with ocular infections caused by Paecilomyces spp. The mean age was 69 years (range 33 to 90 years). The initial diagnosis of ocular infection caused by Paecilomyces spp. was keratitis in 14 eyes and endophthalmitis in 5 eyes. The final diagnosis was keratitis in 2 eyes, keratitis with involvement of the anterior segment of the eye, i.e., hypopyon or corneal rupture, in 12 eyes, and endophthalmitis in 5 eyes. The predisposing factors had a history of ocular surgery, corneal trauma and soft contact lens use. Other factors were diabetes and old age. The infections developed more often in the fall and winter. The identified Paecilomyces spp. had a high sensitivity to micafungin and voriconazole, but low sensitivity to amphotericin B, flucytosine and fluconazole. The prognosis of Paecilomyces spp. ocular infections was very poor, viz., final vision was counting fingers or worse in 60%, ocular perforation in 42%, and eye enucleation in 11%. The percentage of eyes with a final visual acuity worse than counting fingers was 0% in those with keratitis, 50% in those with involvement of the anterior segment, and 100% in those with endophtalmitis (p = 0.0446). Among the antifungal agents, the percentage of cases with final vision of counting fingers or worse was 90% with fluconazole, 80% with itraconazole, 100% with miconazole, and 71% with voriconazole.

CONCLUSION

The results show that if the Paecilomyces spp. infection spreads intraocularly, it is difficult to mitigate the clinical damage even with antifungal agents with high sensitivity.

摘要

目的

报告日本由拟青霉属引起的眼部感染的诱发因素、患者背景、治疗及预后情况。

方法

我们回顾了日本微生物学证实的拟青霉属引起的眼部感染的病历及已发表文献。研究了18例患者的19只眼；其中包括我们4例患者的4只眼以及14例已发表的日本患者的15只眼。

结果

10名男性和8名女性（9只右眼、8只左眼、1只双眼）被诊断为拟青霉属引起的眼部感染。平均年龄为69岁（范围33至90岁）。拟青霉属引起的眼部感染最初诊断为角膜炎14只眼，眼内炎5只眼。最终诊断为角膜炎2只眼，累及眼前段（即前房积脓或角膜破裂）的角膜炎12只眼，眼内炎5只眼。诱发因素有眼部手术史、角膜外伤和软性接触镜使用史。其他因素为糖尿病和老年。感染在秋冬季节更易发生。鉴定出的拟青霉属对米卡芬净和伏立康唑敏感性高，但对两性霉素B、氟胞嘧啶和氟康唑敏感性低。拟青霉属眼部感染的预后很差，即最终视力为眼前指数或更差的占60%，眼部穿孔的占42%，眼球摘除的占11%。角膜炎患者最终视力差于眼前指数的比例为0%，累及眼前段的患者为50%，眼内炎患者为100%（p = 0.0446）。在抗真菌药物中，最终视力为眼前指数或更差的病例比例，氟康唑为90%，伊曲康唑为80%，咪康唑为100%，伏立康唑为71%。