Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.
Key Laboratory of Precision Medicine for Head and Neck Cancers of Zhejiang Province, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China.
Ann Clin Microbiol Antimicrob. 2024 Jul 18;23(1):64. doi: 10.1186/s12941-024-00723-1.
Infectious keratitis, a significant contributor to blindness, with fungal keratitis accounting for nearly half of cases, poses a formidable diagnostic and therapeutic challenge due to its delayed clinical presentation, prolonged culture times, and the limited availability of effective antifungal medications. Furthermore, infections caused by rare fungal strains warrant equal attention in the management of this condition.
A case of fungal keratitis was presented, where corneal scraping material culture yielded pink colonies. Lactophenol cotton blue staining revealed distinctive spore formation consistent with the Fusarium species. Further analysis using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) identified the causative agent as Fusarium proliferatum. However, definitive diagnosis of Pseudonectria foliicola infection was confirmed through ITS sequencing. The patient's recovery was achieved with a combination therapy of voriconazole eye drops and itraconazole systemic treatment.
Pseudonectria foliicola is a plant pathogenic bacterium that has never been reported in human infections before. Therefore, ophthalmologists should consider Pseudonectria foliicola as a possible cause of fungal keratitis, as early identification and timely treatment can help improve vision in most eyes.
感染性角膜炎是导致失明的主要原因之一，其中真菌性角膜炎占近一半病例。由于其临床表现延迟、培养时间延长以及有效抗真菌药物的有限可用性，真菌性角膜炎的诊断和治疗极具挑战性。此外，对于罕见真菌菌株引起的感染，在这种情况下的管理中也需要给予同等重视。
介绍了一例真菌性角膜炎病例，角膜刮片培养物产生粉红色菌落。乳酚棉蓝染色显示出独特的孢子形成，符合镰刀菌属。进一步使用基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF MS）分析鉴定病原体为多育镰刀菌。然而，通过 ITS 测序确认了拟茎点霉感染的明确诊断。患者通过伏立康唑滴眼液联合伊曲康唑全身治疗得以康复。
拟茎点霉是一种植物病原菌，以前从未在人类感染中报道过。因此，眼科医生应将拟茎点霉视为真菌性角膜炎的可能病因，因为早期识别和及时治疗有助于改善大多数眼睛的视力。
