Mena Rodrigo, Carrasco Eduardo, Godoy-Martínez Patricio, Stchigel Alberto M, Cano-Lira José F, Zaror Luis
Servicio de Oftalmología, Hospital Base de Valdivia, Valdivia, Chile.
Instituto de Microbiología Clínica, Universidad Austral de Chile, Valdivia, Chile.
Rev Iberoam Micol. 2015 Apr-Jun;32(2):106-10. doi: 10.1016/j.riam.2013.12.001. Epub 2014 May 2.
Keratomycosis is one of the most prevalent ophthalmic infections, which needs a specific treatment depending on the nature of the infecting fungus. The prognosis is usually severe and depends on an early diagnosis and suitable therapy.
We describe a case of keratitis due to Fusarium solani in a patient from a rural area, who, between May and October 2011, suffered a corneal trauma caused by dust particles in Valdivia, Chile. On two occasions, direct examination of eye scrapes revealed abundant septate hyphae. All cultures were positive for the same fungus, which was identified as Fusarium solani by phenotypic characterization and sequencing of ribosomal nuclear genes. The patient was initially treated with amphotericin B and afterwards successfully responded to a treatment with oral and intravenous voriconazole, although corneal opacity persisted.
Although keratomycosis in Chile is rare, its diagnostic particularities must be taken into consideration to establish the most effective treatment. Thus, a rapid visualization of the fungus in the lesion, an efficient isolation of the etiologic agent in pure culture is essential, as well as its rapid identification, which requires the use of molecular sequencing techniques in the case of Fusarium species.
角膜真菌病是最常见的眼部感染之一,需要根据感染真菌的性质进行特定治疗。预后通常很严重,取决于早期诊断和适当的治疗。
我们描述了一名来自农村地区患者的茄病镰刀菌角膜炎病例,该患者于2011年5月至10月间在智利瓦尔迪维亚因灰尘颗粒导致角膜外伤。两次眼部刮片直接检查均发现大量有隔菌丝。所有培养物对同一真菌均呈阳性,通过表型鉴定和核糖体核基因测序确定为茄病镰刀菌。患者最初接受两性霉素B治疗,随后口服和静脉注射伏立康唑治疗成功,尽管角膜混浊仍然存在。
尽管角膜真菌病在智利罕见,但为了确定最有效的治疗方法,必须考虑其诊断特殊性。因此,在病变中快速观察到真菌、在纯培养物中有效分离病原体及其快速鉴定至关重要,对于镰刀菌属而言,这需要使用分子测序技术。