We report a case of Aspergillus tamarii keratitis. Ocular injury was known to be a predisposing factor. Topical natamycin and econazole treatment and subsequent systemic ketoconazole treatment proved effective. The isolate was identified by morphological characteristics and sequence analysis as A. tamarii, a member of Aspergillus section Flavi not hitherto reported from keratomycosis.
CASE REPORTA 32-year-old female from Coimbatore was presented to the Aravind Eye Hospital, Coimbatore, South India, on December 27, 2005, with complaints of pain, redness, and defective vision of a 4-day duration in the left eye. She indicated that she had suffered an ocular injury caused by an iron piece while hammering 4 days earlier. On examination, her uncorrected visual acuities in the right and left eyes were 6/9 (partial) and 1/2/60, respectively. An anterior segment examination of the left eye showed lid edema and conjunctival congestion. The cornea showed a central 3-by-3-mm ulcer with an anterior midstromal infiltrate with feathery edges and surrounding edema. The anterior chamber showed a moderate number of cells (2ϩ grade). The lens was clear. The anterior segment of the right eye and the posterior segments of both eyes were within normal limits.With due aseptic precautions, the ulcer was scraped and two smears were made on glass slides for a 10% KOH wet mount and Gram staining. The microscopic examination of the KOH wet mount and Gram staining showed fungal filaments. Material from scraping was also directly inoculated onto potato dextrose agar and incubated at 25°C. Based on the colony appearance, the fungus was identified as an Aspergillus sp. Topical antifungal therapy was started with 5% natamycin suspension and 2% econazole drops every half hour, along with 1% homatropine three times a day.When reviewed after 3 days, the patient's uncorrected visual acuity in the left eye had improved to 6/36, but the corneal midstromal infiltrate was still active. The anterior chamber showed a hypopyon of 0.5 mm. The patient was admitted as an inpatient and advised to continue the same medications along with 200 mg oral ketoconazole and 0.2% subconjunctival fluconazole based on the results of our previous study (6). The patient showed improvement during the next 3 weeks; the infiltrate reduced gradually, and the anterior segment inflammations subsided. On the last review, the anterior segment of the left eye showed a central nebular scar, with the best corrected visual acuity having improved to 6/12. The patient was advised to use glasses and to report for review after 6 months.The clinical isolate was further examined at the CBS Fungal Biodiversity Centre and at the University of Szeged for species assignment and antifungal susceptibility tests.Mycological study and diagnosis. The fungus was subcultured on malt extract agar plates and identified as Aspergillus tamarii Kita based on the colony morphology and microscopic features of the isolate ( Fig. 1 and 2). Colonies on malt extract agar at room temperature attained diameters o...