Penetrating Keratoplasty for Exogenous Paecilomyces Keratitis Followed by Postoperative Endophthalmitis

Kozarsky, Alan M.; Stulting, R. Doyle; Waring, George O.; Cornell, F. Michael; Wilson, Louis A.; Cavanagh, Harrison D

doi:10.1016/0002-9394(84)90239-3

Cited by 39 publications

(16 citation statements)

References 5 publications

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“…Keratitis (121,197,334,365), endophthalmitis (280), and intralenticular infection (80a) (120,334) or other ophthalmic infection (313), many of which were based on retrospective analysis of patient records, were assessed differently since such publications rarely provided detailed descriptions of the fungi isolated from individual patients or of the appearance of the fungi in the specimens or tissues. The observations made in these papers were considered valid if definite criteria had been used to assess the significance of the fungi isolated; for example, the presence of clinical features suggesting a fungal infection, growth of the same fungus from repeated samples, growth of the same fungus on two or more solid media, or confluent growth at the site of inoculation in one solid medium with direct microscopic demonstration of fungal hyphae or yeast cells in the sample (85,120,208,216,364,377).…”

Section: Paecilomyces (P Lilacinus P Variotii)mentioning

confidence: 99%

“…Many documented ocular infections by Paecilomyces spp. have followed surgical procedures (121,197,280).…”

Section: Etiological Agents and Laboratory Diagnosis Of Ophthalmic Mymentioning

confidence: 99%

“…In Philadelphia, penetrating keratoplasty was performed for 2 of 11 patients with C. albicans keratitis, 2 of 6 patients with keratitis due to Fusarium spp., and the only patient who had Aspergillus keratitis (377). Other fungi that may cause a severe keratitis that does not respond to medical therapy and necessitates penetrating keratoplasty include L. theobromae (37,389), P. insidiosum (155), and P. lilacinus (121,197,280).…”

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confidence: 99%

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Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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Section: Paecilomyces (P Lilacinus P Variotii)mentioning

confidence: 99%

“…Many documented ocular infections by Paecilomyces spp. have followed surgical procedures (121,197,280).…”

Section: Etiological Agents and Laboratory Diagnosis Of Ophthalmic Mymentioning

confidence: 99%

mentioning

confidence: 99%

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Current Perspectives on Ophthalmic Mycoses

2003

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“…In a case of keratitis due to Scopulariopsis brevicaulis, the infection was controlled by topical and systemic administration after scraping the superficial corneal stro ma [36]. The substance seems to be the only potent drug against Paecilomyces lilacinus [37,38], The drug together with itraconazole failed to control a keratitis caused by P. boydii [39].…”

Section: Azolesmentioning

confidence: 99%

Topical Antimycotics in Ophthalmology

Behrens–Baumann¹

1997

Ophthalmologica

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This article surveys the current treatment of fungal eye diseases with topical antimycotics. Their various pharmacokinetic characteristics and antimycotic activities are presented and, in addition, the clinical symptoms of fungal eye diseases which can be topically treated are described, so that a correct diagnosis can be achieved rapidly to avoid delaying proper therapy. Finally, guidelines for treatment of keratomycosis are recommended.

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“…Microsporidia are obligate, intracellular and spore-forming. Recent phylogenetic analysis suggests that microsporidia are related to fungi (3)(4)(5). The size of microsporidial spores varies between 1 and 40 mm (6).…”

Section: Introductionmentioning

confidence: 99%