Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and.
Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
Cornea. 2024 Jan 1;43(1):129-132. doi: 10.1097/ICO.0000000000003393. Epub 2023 Sep 21.
The aim of this study was to report the first case of mycotic keratitis caused by Botryosphaeria dothidea .
A 29-year-old man developed a fungal infection after being hit with chestnut thorns in the left eye. In vivo confocal microscopy, microbial culture, and next-generation sequencing (NGS) were used in the diagnosis of mycotic keratitis.
The patient was provisionally diagnosed with mycotic keratitis based on IVCM and promptly received local and systemic antifungal treatment with voriconazole and amphotericin B. Although microbial culture failed to identify the pathogen, NGS revealed B. dothidea as the causative agent. Although the infection was quickly contained, corneal perforation still occurred. Owing to the lack of fresh donor corneas, the patient underwent multilayer amniotic membrane and conjunctival pedicle graft surgery. The infection was successfully controlled, and during the 6-month follow-up, the cornea remained clear in the inferotemporal optical zone.
We report a novel phytopathogen- B. dothidea -causing mycotic keratitis . Our case indicates that B. dothidea responds well to voriconazole and amphotericin therapy. This case broadens the spectrum of fungal keratitis and highlights the application of NGS in identifying molds.
本研究旨在报告首例由地丝孢菌引起的真菌性角膜炎病例。
1 名 29 岁男性左眼被栗刺刺伤后发生真菌感染。采用活体共聚焦显微镜、微生物培养和下一代测序（NGS）对真菌性角膜炎进行诊断。
根据 IVCM，患者被初步诊断为真菌性角膜炎，并立即接受伏立康唑和两性霉素 B 的局部和全身抗真菌治疗。虽然微生物培养未能鉴定病原体，但 NGS 显示地丝孢菌为致病因子。尽管感染迅速得到控制，但仍发生了角膜穿孔。由于缺乏新鲜供体角膜，患者接受了多层羊膜和结膜蒂瓣移植手术。感染得到了成功控制，在 6 个月的随访中，下颞侧光学区的角膜保持透明。
我们报告了一种新型植物病原菌-地丝孢菌引起的真菌性角膜炎。我们的病例表明，地丝孢菌对伏立康唑和两性霉素治疗反应良好。该病例拓宽了真菌性角膜炎的谱，并强调了 NGS 在鉴定霉菌中的应用。
