Pulliam Sarah L, Nkangabwa Martha S, Lantz Rebekah, Khan Asif
General Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA.
Clinical Research, Wright State University Boonshoft School of Medicine, Dayton, USA.
Cureus. 2023 Aug 1;15(8):e42822. doi: 10.7759/cureus.42822. eCollection 2023 Aug.
Keratitis is the leading cause of corneal blindness in the world. Nearly half the cases are due to a fungal infection known as fungal keratitis (FK). There is much variability in the clinical presentation of FK, so diagnosis can be difficult. With the risks of blindness in disease progression being so high, it is vital to diagnose and treat FK quickly. We present a case of FK due to and after a motor vehicle accident, its treatment, and the general outcome. A 71-year-old man with a history of hypertension, hyperlipidemia, arthritis, and previous tobacco use presented after a helmeted motorcycle accident with back pain and bilateral lower extremity sensory and motor function loss. He suffered many fractures and was in neurogenic shock. He had nearly daily reduction and fixation of multiple axial spinal fractures while in the surgical intensive care unit and was ultimately unable to be successfully extubated. Between two intubations, he complained to his family of blurry vision, and there was notable purulence and corneal haziness in bilateral eyes. The healthcare team initially suspected the eye infection was due to a bacterial etiology, and he was subsequently diagnosed with on respiratory cultures. However, several days of antibiotics did not improve the ocular exam. A corneal culture was positive for and and anti-fungal treatment was initiated with ocular improvement. Unfortunately, the patient succumbed to his injuries and further sepsis at another site. With a progressively poor prognosis and machine dependence, he was made do-not-resuscitate per family wishes and died within two hours after cessation of hemodialysis. One of the greatest barriers to diagnosing FK in the United States is the absence of information regarding the disease. Though novel diagnoses and treatment strategies are in development, the fungal etiology of keratitis should be included in the curricula for not just medical students but also for providers and specialists, as the incidence of FK continues to grow with globalization. We also aim to emphasize the importance of a multidisciplinary team in these cases, as ophthalmology and infectious disease specialists should be involved immediately in order to improve patient outcomes.
角膜炎是全球角膜盲的主要原因。近一半的病例是由一种称为真菌性角膜炎（FK）的真菌感染引起的。FK的临床表现差异很大，因此诊断可能很困难。由于疾病进展导致失明的风险如此之高，快速诊断和治疗FK至关重要。我们报告一例因机动车事故后发生的FK病例、其治疗过程及总体结果。一名71岁男性，有高血压、高脂血症、关节炎病史且既往吸烟，在骑摩托车戴头盔发生事故后出现背痛以及双侧下肢感觉和运动功能丧失。他多处骨折，处于神经源性休克状态。在外科重症监护病房期间，他几乎每天都要对多节轴向脊柱骨折进行复位和固定，最终未能成功拔管。在两次插管期间，他向家人抱怨视力模糊，双眼有明显的脓性分泌物和角膜混浊。医疗团队最初怀疑眼部感染是由细菌引起的，随后在呼吸道培养中诊断出[此处原文缺失具体病菌名称]。然而，使用几天抗生素后眼部检查并无改善。角膜培养显示[此处原文缺失具体病菌名称]呈阳性，遂开始抗真菌治疗，眼部情况有所改善。不幸的是，患者因伤势过重及另一部位的败血症而死亡。在美国，诊断FK的最大障碍之一是缺乏关于该疾病的信息。尽管新的诊断和治疗策略正在研发中，但角膜炎的真菌病因不仅应纳入医学生的课程，也应纳入医疗服务提供者和专家的课程，因为随着全球化进程，FK的发病率持续上升。我们还旨在强调在这些病例中多学科团队的重要性，因为眼科和传染病专家应立即参与，以改善患者的治疗效果。
