RareKodamaea ohmerikeratitis following a trivial vegetative trauma

Abstract

Kodamaea ohmeri keratitis is an opportunistic pathogen seen in patients who have undergone invasive procedures and immunocompromised state. It has been identified in septicemia patients, resulting in mortality. To the best of our knowledge, we identified the first case of K. ohmeri keratitis following an injury with vegetative material. A 57-year-old woman with underlying, poorly controlled diabetes mellitus was gardening when a tree leaf accidentally poked her in the eye. Two weeks later, the patient presented with right eye pain, redness and progressive blurring of vision due to a traumatised right cornea. Slit-lamp examination showed a small inferior paracentral corneal stromal infiltrate with overlying epithelial defect. A corneal scraping sample yielded K. ohmeri from Analytical Profile Index (API) 20C yeast identification system. She was treated with intensive topical amphotericin B and fluconazole. After 6 weeks of treatment, the keratitis resolved with faint scar tissue, and her visual acuity improved.

A Repertoire of the Less Common Clinical Yeasts

“…Endogenous endophthalmitis was frequently encountered secondary to a bloodstream infection [69,70]. Fungal keratitis mainly developed secondary to keratoplasty [71][72][73][74], trauma [75][76][77], or immunosuppressive therapy [78]. As species level, Malassezia furfur was predominant with Candida dubliniensis, Wickerhamomyces anomalus, and Candida auris (Table S1).…”

Kodamea ohmeri keratitis

“…1 In the only other case of keratitis owing to K. ohmeri found in the literature, there was preceding trauma by vegetative material in a patient with uncontrolled diabetes mellitus. 2 There are limited data on the risk factors, laboratory analysis, treatment, and prevention of K. ohmeri infection. However, ocular trauma with vegetative material is a major risk factor for any fungal keratitis.…”

“…In the previously documented case of K. ohmeri keratitis, there was also no growth on Sabouraud dextrose agar, and K. ohmeri was isolated using the commercial yeast detection kit API 20c (bioM erieux Inc, Durham, NC). 2 Noninvasive imaging modalities such as confocal microscopy and anterior segment optical coherence tomography have emerged as useful tools in the identification and monitoring of fungal keratitis but are not yet widely available. 3 The treatment of fungal keratitis remains challenging because it often leads to deep stromal infections that are difficult to eradicate.…”

“…4 In the previously reported case of K. ohmeri keratitis, a combination of fluconazole and amphoterecin B was also used with good response. 2 In systemic infections, K. ohmeri is generally susceptible to amphoterecin B but commonly resistant to fluconazole. 1 Despite prolonged courses of antifungal agents, treatment success may be limited in fungal keratitis because of the fungistatic nature of the antifungal medications.…”