Kalkan Akçay Emine, Açıkgöz Ziya Cibali, Can Mehmet Erol, Celikbilek Nevreste, Dereli Can Gamze, Cağıl Nurullah
Ankara Ataturk Training and Research Hospital, Ophtalmology Clinic, Ankara, Turkey.
Mikrobiyol Bul. 2013 Oct;47(4):727-33. doi: 10.5578/mb.5262.
Fungal keratitis, an eye infection with poor prognosis, is difficult to treat and can lead to loss of vision. Among filamentous fungi Scedosporium spp. rarely lead to fungal keratitis. Here we present a case of keratitis caused by Scedosporium apiospermum. A 61-year-old female patient was admitted to our hospital with the complaints of right eye pain and decreased vision after a foreign body trauma to the right eye. The patient was diagnosed as keratitis by biomicroscopic examination. Conjunctival swabs collected from both eyes were inoculated onto sheep blood agar, chocolate agar, eosin methylene blue agar and Sabouraud dextrose agar. Corneal scrapings from the right eye were inoculated onto the same solid media by "C-streak" method, and in brain-heart-infusion broth by immersion. While gram-stained smears of conjunctival swabs showed no significant finding, smears of corneal scrapings revealed abundant neutrophils and profuse septate hyphae. Fungal keratitis was diagnosed and topical enhanced amphotericin B (0.5 mg/ml) therapy was initiated with netilmicin sulfate and oxytetracycline HCl plus polymyxin B sulfate. At the 10th day of therapy a mold growth was detected in corneal scraping cultures and was identified microscopically as S.apiospermum. Based on the relevant literature, therapy was changed to enhanced topical voriconazole (2 mg/ml) applied hourly, plus systemic voriconazole administration. At the third day of treatment, reduction of epithelial defect and decline in the focus of keratitis were observed. In the following days, however, a progression occurred in the focus of keratitis and 5% natamycin ophthalmic suspension was added to the therapy. Since the patient did not respond to any of the medical treatments, therapeutic penetrating keratoplasty was planned; yet, the patient refused the operation and was discharged with her own request. As far as the local literature was concerned, this is the first report of keratitis caused by S.apiospermum in Turkey. Though a very rare causative agent of keratitis, S.apiospermum is generally resistant to antifungal therapy and often require surgical treatment. Especially in patients with predisposing factors, this organism should be kept in mind as a potential causative agent and relevant microbiological examinations should be performed.
真菌性角膜炎是一种预后较差的眼部感染，难以治疗且可导致视力丧失。在丝状真菌中，波氏假阿利什霉属很少引起真菌性角膜炎。在此，我们报告一例由尖端赛多孢子菌引起的角膜炎病例。一名61岁女性患者因右眼异物外伤后出现右眼疼痛和视力下降而入院。经生物显微镜检查，该患者被诊断为角膜炎。从双眼采集的结膜拭子接种于羊血琼脂、巧克力琼脂、伊红美蓝琼脂和沙氏葡萄糖琼脂上。右眼的角膜刮片通过“C形划线”法接种于相同的固体培养基上，并通过浸泡法接种于脑心浸液肉汤中。虽然结膜拭子的革兰氏染色涂片未发现明显异常，但角膜刮片涂片显示有大量中性粒细胞和丰富的分隔菌丝。诊断为真菌性角膜炎，并开始使用硫酸奈替米星、盐酸土霉素加硫酸多粘菌素B进行局部强化两性霉素B（0.5mg/ml）治疗。在治疗的第10天，在角膜刮片培养物中检测到霉菌生长，经显微镜鉴定为尖端赛多孢子菌。根据相关文献，治疗改为每小时局部应用强化伏立康唑（2mg/ml），并加用全身伏立康唑给药。在治疗的第三天，观察到上皮缺损减少，角膜炎病灶缩小。然而，在接下来的几天里，角膜炎病灶出现进展，遂在治疗中加用5%那他霉素眼膏。由于患者对任何药物治疗均无反应，计划进行治疗性穿透性角膜移植术；然而，患者拒绝手术并按其自身要求出院。就当地文献而言，这是土耳其首例由尖端赛多孢子菌引起的角膜炎报告。尽管尖端赛多孢子菌是一种非常罕见的角膜炎病原体，但它通常对抗真菌治疗耐药，且常需手术治疗。特别是对于有易感因素的患者，应将该病原体视为潜在病原体并进行相关微生物学检查。
