Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Serviço de Oftalmologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Mycopathologia. 2018 Jun;183(3):565-571. doi: 10.1007/s11046-017-0234-5. Epub 2018 Jan 30.
Lasiodiplodia theobromae is a rare ocular pathogen. We report a patient with fungal keratitis caused by L. theobromae. The patient was a 75-year-old male, a farmer with diabetes type II, and no previous history of ocular trauma. Histopathology analysis revealed the presence fungi invading Descemet's membrane of the cornea. The fungus was characterized by septate, highly bulged fungal filaments involving full corneal thickness in the corresponding histopathology specimens. A dematiaceous mold was isolated and initally identified as L. theobromae by microscopic and macroscopic morphology, and further confirmed by PCR-based determination of internal transcribed spacer (ITS) regions of ribosomal DNA. Antifungal susceptibility tests showed sensitivity to amphotericin B (AMB) and voriconazole ( VRC), and resistance to other azoles, including itraconazole (ITC) and fluconazole (FLC). Corneal transplant was performed. Despite in vitro itraconazole resistance, the patient was successfully treated with oral itraconazole, topical voriconazole and natamycin, combined with ocular injections of amphotericin B and voriconazole.
热带假丝酵母是一种罕见的眼部病原体。我们报告了一例由热带假丝酵母引起的真菌性角膜炎患者。该患者为 75 岁男性，农民，患有 2 型糖尿病，无眼部外伤史。组织病理学分析显示有真菌侵犯角膜的后弹力层。真菌的特征是分隔、高度肿胀的真菌丝，在相应的组织病理学标本中累及整个角膜厚度。分离出一种暗色霉菌，最初通过显微镜和宏观形态学鉴定为热带假丝酵母，进一步通过聚合酶链反应（PCR）确定核糖体 DNA 的内部转录间隔区（ITS）区域得到确认。抗真菌药敏试验显示对两性霉素 B（AMB）和伏立康唑（VRC）敏感，对其他唑类药物（包括伊曲康唑（ITC）和氟康唑（FLC））耐药。进行了角膜移植。尽管体外伊曲康唑耐药，但该患者成功接受了口服伊曲康唑、局部伏立康唑和那他霉素联合眼内注射两性霉素 B 和伏立康唑治疗。
