Pythium Keratitis Leading to Fatal Cavernous Sinus Thrombophlebitis

Rathi, Anubha; Chakrabarti, Arunaloke; Agarwal, Tushar; Pushker, Neelam; Patil, Mukesh; Kamble, Hemant; Titiyal, Jeewan S; Mohan, Rishi; Kashyap, Seema; Sharma, Sanjay; Sen, Seema; Satpathy, Gita; Sharma, Namrata

doi:10.1097/ico.0000000000001504

Cited by 20 publications

(20 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 16 ] The important systemic associations include thalassemia/hemoglobinopathy syndrome, aplastic anaemia, paroxysmal nocturnal haemoglobinuria (PNH), chronic arterial insufficiency syndrome[ 14 ] and cavernous sinus thrombophlebitis. [ 18 ] Ocular Pythiosis has been in the recent upsurge in the past 4-5 years and numerous studies have been published on similar literature. [ 1 2 7 8 10 11 ] It is well known that the clinical features of Pythium keratitis closely mimic fungal keratitis and this is the probable reason why we were missing a major chunk of Pythium cases 4-5 years ago.…”

Section: Discussionmentioning

confidence: 99%

Retrospective multifactorial analysis of Pythium keratitis and review of literature

Gurnani

Christy

Narayana

et al. 2021

Indian Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose: The aim of this work was to study the demographic profile, clinical diagnostic features, challenges in management, treatment outcomes, and ocular morbidity of microbiological culture-proven Pythium keratitis in a tertiary eye care hospital in South India. Methods: Retrospective analysis of microbiologically proven Pythium keratitis patients was performed at a tertiary eye center from October 2017 to March 2020. Demographic details, risk factors, microbiological investigations, clinical course, and visual outcomes were analyzed. Results: Thirty patients were analyzed. The mean age was 43.1±17.2 years. Most common risk factors were history of injury in 80% and exposure to dirty water in 23.3%. Visual acuity at baseline was 20/30 to perception of light (PL). The most common clinical presentation was stromal infiltrate and hypopyon in 14 (46.6%) patients each. The microbiological confirmation was based on culture on blood agar and vesicles with zoospores formation with incubated leaf carnation method. Seven (23.3%) patients improved with topical 0.2% Linezolid and topical 1% Azithromycin, 19 (63.3%) patients underwent Therapeutic keratoplasty (TPK) and 4 were lost to follow-up. Seven (23.3%) patients had graft reinfection, and 3 (10%) developed endophthalmitis. The final visual acuity was 20/20- 20/200 in 6 (20%) patients, 20/240-20/1200 in 5 (16.6%) patients, hand movement to positive perception of light in 16 patients and no perception of light (Pthisis Bulbi) in 3 (10%) patients. Conclusion: P. insidiosum keratitis is a rapidly progressive infectious keratitis with prolonged and relapsing clinical course. It usually results in irreparable vision loss in majority of the patients. Prompt diagnosis, clinical awareness, and specific treatment options are needed for successfully managing this devastating corneal disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Retrospective multifactorial analysis of Pythium keratitis and review of literature

Gurnani

Christy

Narayana

et al. 2021

Indian Journal of Ophthalmology

View full text Add to dashboard Cite

show abstract

“…An extensive and aggressive infiltration of P . insidiosum could result in corneal perforation, anterior chamber, limbal and scleral invasions, or endophthalmitis in a few days or weeks (Lekhanont et al, 2009;Lelievre et al, 2015;Rathi et al, 2018;Agarwal et al, 2019;Badenoch et al, 2001;He et al, 2016;Maeno et al, 2019;Ros Castellar et al, 2017;Thanathanee et al, 2013;Sharma et al, 2015;Agarwal et al, 2018).…”

Section: Ocular Pythiosismentioning

confidence: 99%

“…Thus, whether thalassemia is a predisposing factor in ocular pythiosis is not known, warranting the need for additional studies to understand the relationship between ocular pythiosis and thalassemia hemoglobinopathies. Additionally, a fulminant form of Pythium keratitis can be observed in immunocompromised patients (such as those with diabetes or Crohn's disease treated with immunotherapy), which resulted in poor clinical outcomes (i.e., enucleation) (Rathi et al, 2018;Neufeld et al, 2018).…”

Section: Predisposing Factors Host (Intrinsic) Factorsmentioning

confidence: 99%

“…The CTA method has some advantages compared with angiogram for the determination of soft tissue and lymph node involvement. Magnetic resonance imaging with angiogram (MRI/MRA) is the preferred modality to assess cranial involvement, i.e., septic emboli, small abscesses, and cavernous sinus extensions (Rathi et al, 2018;Chitasombat et al, 2018b;Narkwiboonwong et al, 2011).…”

Section: Vascular Pythiosismentioning

confidence: 99%

“…If the warning signs are present, prompt re-grafting and adjunct therapies should be considered to avoid eye loss. Extensive infection involving the sclera and extraocular muscles could potentially lead to cavernous sinus thrombophlebitis (Rathi et al, 2018;Chitasombat et al, 2018b). Thus, imaging study of brain and orbit should be considered to determine disease extension and treatment planning.…”

Section: Follow-up and Monitoringmentioning

confidence: 99%

See 2 more Smart Citations

Recent update in diagnosis and treatment of human pythiosis

Chitasombat

Jongkhajornpong

Lekhanont

et al. 2020

PeerJ

View full text Add to dashboard Cite

Human pythiosis is an infectious condition with high morbidity and mortality. The causative agent is the oomycete microorganism Pythium insidiosum. The pathogen inhabits ubiquitously in a wet environment, and direct exposure to the pathogen initiates the infection. Most patients with pythiosis require surgical removal of the affected organ, and many patients die from the disease. Awareness of pythiosis among healthcare personnel is increasing. In this review, we summarized and updated information on the diagnosis and treatment of human pythiosis. Vascular and ocular pythiosis are common clinical manifestations. Recognition of the typical clinical features of pythiosis is essential for early diagnosis. The definitive diagnosis of the disease requires laboratory testing, such as microbiological, serological, molecular, and proteomic assays. In vascular pythiosis, surgical intervention to achieve the organism-free margin of the affected tissue, in combination with the use of antifungal drugs and P. insidiosum immunotherapy, remains the recommended treatment. Ocular pythiosis is a serious condition and earliest therapeutic penetrating keratoplasty with wide surgical margin is the mainstay treatment. Thorough clinical assessment is essential in all patients to evaluate the treatment response and detect an early sign of the disease recurrence. In conclusion, early diagnosis and proper management are the keys to an optimal outcome of the patients with pythiosis.

show abstract