Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2022 Oct;70(10):3522-3527. doi: 10.4103/ijo.IJO_659_22.
To study the risk factors, clinical presentation, management options, and outcomes in cases of culture-proven Acremonium keratitis.
Medical and microbiology records of culture-proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients.
During the 13-year study period, 65 cases of culture-proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60).
When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection.
研究培养证实的棘孢木霉角膜炎的危险因素、临床表现、治疗选择和结局。
回顾 2007 年 1 月至 2019 年 12 月在一家三级眼科中心培养证实的棘孢木霉角膜炎的医学和微生物学记录。从病历中查看每次就诊的临床发现细节和手术记录。所有病例在首次就诊时均进行角膜刮片进行微生物学检查，包括直接涂片检查和培养。局部使用 5%那他霉素是主要的药物治疗方法。对无反应的患者考虑手术治疗。
在 13 年的研究期间，在 1605 例真菌性角膜炎中发现 65 例培养证实的棘孢木霉角膜炎。创伤是 32 例（49.2%）患者最常见的诱发因素。初次就诊时角膜基质浸润的平均面积为 24.8mm。28 例（43.1%）患者就诊时出现前房积脓。金黄色葡萄球菌是最常见的（n=22，33.8%）与棘孢木霉共存的病原体。65 例（87.6%）中有 57 例角膜刮片的直接显微镜检查显示真菌丝阳性。单独给予药物治疗的有 44 例（67.6%）。年龄（>50 岁）和治疗延迟（>15 天）是视力最终结局不良（VA<20/60）的独立危险因素。
早期治疗时，棘孢木霉角膜炎对目前可用的局部抗真菌药物治疗反应良好。然而，晚期和无反应的病例需要手术干预以清除感染。
