<i>Cylindrocarpon lichenicola</i> keratomycosis in Nigeria: the challenge of limited access to effective antimicrobials

Abstract

IntroductionWe report a rare cause of keratitis, due to Cylindrocarpon lichenicola, in a farmer with keratomycosis. Despite the acknowledged virulence of this fungus, a suitable antifungal for its management was not accessible.Case presentationA 67-year-old farmer presented with a two-week history of pain, mucopurulent discharge, redness and a corneal ulcer with a visual acuity of hand movement in the right eye. With a working diagnosis of infective keratitis, corneal scrapings were taken under a slit lamp biomicroscope for microbiological testing. Direct lactophenol cotton blue mounts revealed septate fungal hyphae, while fungal culture on Sabouraud dextrose agar at room temperature grew woolly mould phenotypically consistent with C. lichenicola.Management and outcomeThe patient was started on hourly topical natamycin (5%), ciprofloxacin (0.3%), two-hourly instillation of tobramycin (0.3%) and atropine (1%) twice daily for three months following the isolation of the fungus. The eye healed with a corneal scar and no improvements in visual acuity.DiscussionThis infection was difficult to manage due to the inaccessibility of a suitable antifungal, namely, voriconazole in our setting. Hence, there is a need for prompt identification and early institution of suitable antifungals in any patient with suspected keratomycosis.

Clinical neglect of aspergillosis in pulmonary tuberculosis coinfection: a case report of avoidable mortality in a resourceconstrained setting

“…This duo has been greatly challenged in Africa and other resource-limited countries which do not only have high burden of infections by these opportunistic fungi but also basically deficient in advanced fungal diagnostics and mycologic experts (9,10). Missed clinical diagnoses of PA in patients with background PTB coupled with unavailability of rapid, sensitive and reliable laboratory capacity for fungal infections is a great challenge to early commencement of appropriate antifungal drug therapy, access to which is rather poor in Nigeria and most of other countries in sub-Saharan Africa, and all these have led to high mortality (11)(12)(13). We report a case of avoidable mortality resulting from late diagnosis of PA in a patient with TB co-infection.…”

Honing in on disease etiology

“…Our cover features a photomicrograph of Cylindrocarpon lichenicola from Irek and colleagues’ report of a rare but debilitating case of keratomycosis 1 . A skilled diagnostician can only confirm this infection with access to mycology laboratory resources, which are uncommon on the African continent.…”