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[用聚维酮碘滴眼液联合口服氟康唑治疗尖孢镰刀菌所致角膜真菌病]

[Keratomycosis due to Fusarium oxysporum treated with the combination povidone iodine eye drops and oral fluconazole].

作者信息

Diongue K, Sow A S, Nguer M, Seck M C, Ndiaye M, Badiane A S, Ndiaye J M, Ndoye N W, Diallo M A, Diop A, Ndiaye Y D, Dieye B, Déme A, Ndiaye I M, Ndir O, Ndiaye D

机构信息

Laboratoire de parasitologie-mycologie, CHU Aristide Le Dantec, Dakar, Sénégal.

Clinique d'ophtalmologie, CHU Aristide Le Dantec, BP 5005, Dakar, Sénégal.

出版信息

J Mycol Med. 2015 Dec;25(4):e134-7. doi: 10.1016/j.mycmed.2015.10.006. Epub 2015 Nov 17.

Abstract

In developing countries where systemic antifungal are often unavailable, treatment of filamentous fungi infection as Fusarium is sometimes very difficult to treat. We report the case of a keratomycosis due to Fusarium oxysporum treated by povidone iodine eye drops and oral fluconazole. The diagnosis of abscess in the cornea was retained after ophthalmological examination for a 28-year-old man with no previous ophthalmological disease, addressed to the Ophthalmological clinic at the University Hospital Le Dantec in Dakar for a left painful red eye with decreased visual acuity lasting for 15 days. The patient did not receive any foreign body into the eye. Samples by corneal scraping were made for microbiological analysis and the patient was hospitalized and treated with a reinforced eye drops based treatment (ceftriaxone+gentamicin). The mycological diagnosis revealed the presence of a mold: F. oxysporum, which motivated the replacement of the initial treatment by eye drops containing iodized povidone solution at 1% because of the amphotericin B unavailability. Due to the threat of visual loss, oral fluconazole was added to the local treatment with eye drops povidone iodine. The outcome was favorable with a healing abscess and visual acuity amounted to 1/200th. Furthermore, we noted sequels such as pannus and pillowcase. The vulgarization of efficient topical antifungal in developing countries would be necessary to optimize fungal infection treatment.

摘要

在系统性抗真菌药物常常难以获得的发展中国家,治疗像镰刀菌这样的丝状真菌感染有时非常困难。我们报告了一例由尖孢镰刀菌引起的角膜真菌病,用聚维酮碘滴眼液和口服氟康唑进行治疗的病例。一名28岁、既往无眼科疾病的男性因左眼疼痛、眼红且视力下降持续15天,前往达喀尔勒丹泰克大学医院眼科诊所就诊。眼科检查后确诊为角膜脓肿。患者眼部未进入任何异物。取角膜刮片样本进行微生物分析,患者住院并接受强化滴眼液治疗(头孢曲松+庆大霉素)。真菌学诊断显示存在一种霉菌:尖孢镰刀菌,由于无法获得两性霉素B,因此改用1%含碘聚维酮溶液滴眼液替代初始治疗。由于存在视力丧失的风险,在局部使用聚维酮碘滴眼液治疗的基础上加用了口服氟康唑。结果良好,脓肿愈合,视力达到1/200。此外,我们还注意到了诸如血管翳和瘢痕等后遗症。在发展中国家普及有效的局部抗真菌药物对于优化真菌感染治疗很有必要。

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