Candida dubliniensis: A novel cause of fungal keratitis

Abstract

A 45-year-old female with history of contact lens wear presented with a persistent corneal ulcer that was unresponsive to topical moxifloxacin. The patient’s exam was concerning for fungal keratitis. Cultures were obtained, and the patient was started on fortified amphotericin B drops and oral voriconazole. The cultures identified Candida dubliniensis as the causative organism. The patient’s exam worsened despite treatment, and the decision was made for surgery. At the time of surgery, her cornea was found to have unexpectedly perforated. She underwent cryotherapy; tectonic penetrating keratoplasty; anterior chamber tap; intracameral voriconazole, amphotericin B, and cefuroxime; and a partial conjunctival flap. Pathology from the cornea showed GMS and PAS stains positive for fungal forms.C. dubliniensis is a yeast closely related to Candida albicans that was first described in 1995 as a cause of oral candidiasis in patients with AIDS. There are a few published cases of endophthalmitis due to C. dubliniensis in the ophthalmology literature, but to our knowledge, no cases of fungal keratitis due to this organism have been reported. C. dubliniensis is a novel cause of fungal keratitis that can be difficult to identify and treat but is felt to be less virulent than C. albicans and generally susceptible to available anti-fungal therapies.

Combined Candida dubliniensis and Candida albicans Keratitis following a Chemical Injury

“…To our knowledge, C. dubliniensis has been described only once previously in the literature as a cause of fungal keratitis and never in combination with C. albicans . In this previous case, the patient's condition worsened despite topical antifungal therapy and required cryotherapy, penetrating keratoplasty, and instillation of intracameral antimicrobial and antifungal agents, as well as partial conjunctival flap placement [3].…”

First Reported Case of Candida dubliniensis Endocarditis Related to Implantable Cardioverter-Defibrillator

“…Recommendations from the Infectious Disease Society of America recommend the use of echinocandin (such as micafungin), amphotericin B, or amphotericin B with 5-flucytosine for treatment of Candida endocarditis with or without an ICD device [32,33]. Regardless of the medication chosen, resolution of the fungemia [30] 59, M COPD, diabetes mellitus type 2, ulcerative colitis Pneumonia [31] 45, F None reported Keratitis 7 Case Reports in Cardiology usually occurs with ICD device removal, although one case report describes resolution of Candida endocarditis with medical management and no surgical intervention [34]. In our patient, treatment was continued for 4-6 weeks after ICD device removal.…”

Candida tropicalis Fungal Keratitis: A Case Report and Literature Review

“…It is regarded as a rare condition, although a slight increase in its prevalence has been reported [1]. Various agents responsible for fungal keratitis have been reported, with Candida albicans long recognized as a cause of fungal keratitis [2]. In recent years, new species of the Candida genus have also been identified as a cause of ocular infection, including Candida tropicalis as a causative agent of keratomycosis.…”