Hotta Fumika, Eguchi Hiroshi, Nishimura Keiko, Kogiso Masahiro, Ishimaru Mayumi, Kusaka Shunji, Shimomura Yoshikazu, Yaguchi Takashi
Department of Ophthalmology, Sakai Hospital Kindai University, 2-7-1 Harayamadai, Minami-ku, Sakai, Osaka, 590-0132, Japan.
Department of Ophthalmology, Shikoku Medical Center for Children and Adults, 2-1-1 Senyu-cho, Zentsuji, Kagawa, 765-8507, Japan.
Ann Clin Microbiol Antimicrob. 2017 Mar 9;16(1):11. doi: 10.1186/s12941-017-0187-z.
Polymicrobial keratitis with fungus and bacteria can lead to blindness and is challenging to treat. Here, we introduce a case of fungal keratitis caused by two different strains in addition to definite bacterial super-infection caused by an α-Streptococcus sp., and describe the importance of microscopic examination.
A 74-year-old woman, who had a past history of infection with leprosy, presented with conjunctival hyperaemia, pain, and corneal opacity in her right eye. Under the presumptive diagnosis of infectious keratitis, corneal scrapings were stained by various reagents and inoculated on several agar plates. Microscopic findings of the scrapings revealed fungi and a small number of Gram-positive cocci. Multiple anti-fungal therapies with levofloxacin ophthalmic solution were administered. Although empiric treatment was initially effective, keratitis recurred 10 days after its initiation. Repeated corneal scraping revealed an abundance of Gram-positive chain cocci and a small amount of fungi, resulting in the switching of an antibiotic medication from levofloxacin to moxifloxacin and cefmenoxime. Keratitis resolved gradually after the conversion. Stemphylium sp., Acremonium sp., and α-Streptococcus sp. were simultaneously isolated from the corneal scrapings.
To the best of our knowledge, this is the first case of fungal keratitis caused by Stemphylium sp., and also the first case of super-infection in the cornea caused by two different fungi and one bacterium. Microscopic examination of the corneal scrapings was beneficial in rapid decision of changing to appropriate drug according to the dominancy of pathogenicity.
真菌和细菌混合感染引起的角膜溃疡可导致失明，治疗颇具挑战性。在此，我们介绍一例除由α-链球菌引起明确的细菌二重感染外，还由两种不同菌株引起的真菌性角膜炎病例，并描述显微镜检查的重要性。
一名74岁女性，有麻风感染病史，右眼出现结膜充血、疼痛和角膜混浊。在初步诊断为感染性角膜炎后，角膜刮片用各种试剂染色并接种在多个琼脂平板上。刮片的显微镜检查发现真菌和少量革兰氏阳性球菌。给予左氧氟沙星滴眼液进行多种抗真菌治疗。虽然经验性治疗最初有效，但治疗开始10天后角膜炎复发。重复角膜刮片显示大量革兰氏阳性链状球菌和少量真菌，导致抗生素药物从左氧氟沙星换成莫西沙星和头孢甲肟。换药后角膜炎逐渐消退。同时从角膜刮片中分离出匍柄霉属、枝顶孢属和α-链球菌。
据我们所知，这是首例由匍柄霉属引起的真菌性角膜炎病例，也是首例由两种不同真菌和一种细菌引起的角膜二重感染病例。角膜刮片的显微镜检查有助于根据致病性优势快速决定更换合适的药物。
