Orbital abscess caused by Exophiala dermatitidis following posterior subtenon injection of triamcinolone acetonide: a case report and a review of literature related to Exophiala eye infections

Iwahashi, Chiharu; Eguchi, Hiroshi; Hotta, Fumika; Uezumi, Mayu; Sawa, Miki; Kimura, Masatomo; Yaguchi, Takashi

doi:10.1186/s12879-020-05294-y

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Despite intravitreal injections for retinal disease becoming the most commonly performed intraocular procedure globally [ 155 ], and corticosteroid periocular injections being used routinely for the treatment of diabetic macular oedema [ 156 , 157 ], there have been no cases of fungal keratitis associated with this treatment reported in the scientific literature to date. However, other complicating local fungal infections have been reported, including fungal endophthalmitis, fungal orbital abscesses and conjunctival mycetoma [ 158 , 159 , 160 ].…”

Section: Epidemiology Of Fungal Keratitismentioning

confidence: 99%

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Hoffman

Burton

Leck

2021

JoF

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Mycotic or fungal keratitis (FK) is a sight-threatening disease, caused by infection of the cornea by filamentous fungi or yeasts. In tropical, low and middle-income countries, it accounts for the majority of cases of microbial keratitis (MK). Filamentous fungi, in particular Fusarium spp., the aspergilli and dematiaceous fungi, are responsible for the greatest burden of disease. The predominant risk factor for filamentous fungal keratitis is trauma, typically with organic, plant-based material. In developed countries, contact lens wear and related products are frequently implicated as risk factors, and have been linked to global outbreaks of Fusarium keratitis in the recent past. In 2020, the incidence of FK was estimated to be over 1 million cases per year, and there is significant geographical variation; accounting for less than 1% of cases of MK in some European countries to over 80% in parts of south and south-east Asia. The proportion of MK cases is inversely correlated to distance from the equator and there is emerging evidence that the incidence of FK may be increasing. Diagnosing FK is challenging; accurate diagnosis relies on reliable microscopy and culture, aided by adjunctive tools such as in vivo confocal microscopy or PCR. Unfortunately, these facilities are infrequently available in areas most in need. Current topical antifungals are not very effective; infections can progress despite prompt treatment. Antifungal drops are often unavailable. When available, natamycin is usually first-line treatment. However, infections may progress to perforation in ~25% of cases. Future work needs to be directed at addressing these challenges and unmet needs. This review discusses the epidemiology, clinical features, diagnosis, management and aetiology of FK.

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Section: Epidemiology Of Fungal Keratitismentioning

confidence: 99%

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Hoffman

Burton

Leck

2021

JoF

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“…and one case of orbital abscess due to Exophiala dermatitidis after subtenons steroid injection. 10 The authors’ review of cases of orbital abscess after posterior subtenons injections revealed bacterial abscess developed within 4–6 weeks, whereas fungal orbital abscess took 2–3 months to develop.…”

Section: Discussionmentioning

confidence: 99%

A Case of the Blues—Colored Pencil Orbitopathy in an 18-Month-Old Boy

Hwang

Maltry

Harrison

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Orbital penetrating injuries from pencils are rare. This report describes a case of penetrating orbital injury in a young child with a retained blue-colored pencil core foreign body, which led to rapid onset of orbital abscess requiring surgical drainage. Intraoperatively, orbital tissues were stained a bright-blue color. Histopathological study of specimen also highlighted bright blue aggregates of foreign material infiltrating the orbital tissues. Cultures grew Streptococcus mitis and Exophiala jeanselmei, which are rare causes of orbital abscess. Unique properties of retained colored pencil core as compared to graphite pencil core are herein discussed. Due to differences in composition, colored pencil core foreign bodies may require more timely surgical intervention compared to noncolored graphite pencil core.

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“…The most common manifestations of the infection are skin infections; in addition, less commonly, extracutaneous diseases from traumatic implantation have been reported, including the eyes, heart, gastrointestinal tract, lungs, and bones[ 3 , 4 , 14 , 22 , 25 , 26 ]. The fungus can actively grow and penetrate the skin; consequently, it is more frequently isolated from superficial, cutaneous, subcutaneous, and deep seated infections, including visceral infections, with central line associated bloodstream infection (CLABSI) or endocarditis seen on rare occasions[ 11 , 25 , 27 - 29 ].…”

Section: Symptomsmentioning

confidence: 99%

Exophiala dermatitidis

Usuda¹,

Higashikawa²,

Hotchi³

et al. 2021

WJCC

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Exophiala is a genus comprising several species of opportunistic black yeasts, which belongs to Ascomycotina. It is a rare cause of fungal infections. However, infections are often chronic and recalcitrant, and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people, detailed knowledge remains scarce regarding infection mechanisms, virulence factors, specific predisposing factors, risk factors, and host response. The most common manifestations of Exophiala infection are skin infections, and the most frequent type of deep infection is pulmonary infection due to inhalation. The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs. The final identification of the causative organism should be achieved through a combination of several methods, including the newly introduced diagnostic analysis, matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry, together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi, and histological and culture findings. Regarding treatment, because anti-infective agents and natural compounds exhibited poor antibiofilm activity, few treatments have ultimately been found to be effective for specific antifungal therapy, so the optimal antifungal therapy and duration of therapy for these infections remain unknown. Therefore, most forms of disease caused by Exophiala dermatitidis require aggressive combination therapies: Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.

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Orbital abscess caused by Exophiala dermatitidis following posterior subtenon injection of triamcinolone acetonide: a case report and a review of literature related to Exophiala eye infections

Cited by 12 publications

References 38 publications

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

A Case of the Blues—Colored Pencil Orbitopathy in an 18-Month-Old Boy

Exophiala dermatitidis

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