Successful Medical Management of Presumptive Pythium insidiosum Keratitis

Ramappa, Muralidhar; Nagpal, Ritu; Sharma, Savitri; Chaurasia, Sunita

doi:10.1097/ico.0000000000001162

Cited by 46 publications

(51 citation statements)

References 12 publications

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“…One of our recent publications records the success with treatment of one case with linezolid and azithromycin9 and this report gives an overview of the laboratory and clinical scenario of P insidiosum keratitis in largest number of cohort reported so far. Rate of TPK and healed ulcers saw a definite reversal in 18 patients treated with linezolid and azithromycin compared with 14 patients treated with natamycin in 2016.…”

Section: Discussionmentioning

confidence: 97%

Leap forward in the treatment of Pythium insidiosum keratitis

et al. 2018

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Section: Discussionmentioning

confidence: 97%

Leap forward in the treatment of Pythium insidiosum keratitis

et al. 2018

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“…More recently, antibacterial drugs such as azithromycin, minocycline, linezolid and tigecycline have been described as promising candidate therapies, since these compounds have demonstrated in vitro inhibition of the growth of P . insidiosum isolates [12], in vivo curative efficacy against subcutaneous pythiosis in experimental pythiosis [13] and a successful resolution of a presumptive human Pythium keratitis [14]. …”

Section: Introductionmentioning

confidence: 99%

Chemically induced disseminated pythiosis in BALB/c mice: A new experimental model for Pythium insidiosum infection

et al. 2017

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Pythiosis is a severe and life-threatening disease that affects humans and various animal species. We report a model of vascular/disseminated pythiosis occurring after subcutaneous inoculation of 2 x 104 Pythium insidiosum zoospores/mL in immunocompromised BALB/c mice. For this model, we carried out two rounds of experiments. First, we evaluated two protocols of immunosuppression before inoculation: cyclophosphamide at 150 mg/kg (CYP group) and cyclophosphamide 200 mg/kg plus hydrocortisone acetate at 250 mg/kg (CYP+HCA group). It was not possible to obtain mortality in the CYP group; however, the combination of CYP+HCA altered disease outcomes, with mortality rates reaching 60%. Second, we used the CYP+HCA immunosuppression protocol to analyze the histological and immunological statuses triggered by disease. When we inoculated immunocompetent mice with P. insidiosum zoospores, self-healing occurred via increased levels of IL-2, IFN-γ and IL-17A, which are characteristic of the Th1/Th17 cytokine response. For infected and immunosuppressed mice, the cytokine profiles showed high levels of IL-10, IL-6 and TNF-α. Increased IL-10 values are related to fungal infection susceptibility and led us to speculate that infection may be established through suppression of the host immune response. In addition, histopathological evaluation of the kidneys and liver demonstrated the presence of hyphae and the cellular findings suggested an acute vascular inflammation that mimics vascular/disseminated pythiosis in humans. This is the first murine model for pythiosis that is useful both for understanding the pathogenesis of this disease and for evaluating new treatment approaches.

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“…A large ocular series showed in vitro activity of tigecycline, mupirocin, and minocycline against Indian P. insidiosum strains (Bagga et al, 2018). The first patient with presumptive Pythium keratitis was successfully managed non-surgically with a triple regimen, consisting of topical 0.2% linezolid every hour, topical 1% azithromycin every 2 h, and oral azithromycin 500 mg once daily for 3 days a week (Ramappa et al, 2017). One presumptive case and two confirmed cases of Pythium keratitis were successfully treated with similar regimens, including a combination of topical and oral azithromycin and topical voriconazole, a combination of topical minocycline and chloramphenicol and oral linezolid, and a combination of oral doxycycline and clindamycin and topical azithromycin, respectively (Chatterjee & Agrawal, 2018;Maeno et al, 2019;Bernheim et al, 2019).…”

Section: Antimicrobial Agentsmentioning

confidence: 99%

Recent update in diagnosis and treatment of human pythiosis

Chitasombat

Jongkhajornpong

Lekhanont

et al. 2020

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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.

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Successful Medical Management of Presumptive Pythium insidiosum Keratitis

Abstract: Presumptive Pythium keratitis of the patient completely resolved with antibacterial treatment alone. It is pertinent for ophthalmologists to be aware of this new treatment regimen.

Cited by 46 publications

References 12 publications

Leap forward in the treatment of Pythium insidiosum keratitis

Leap forward in the treatment of Pythium insidiosum keratitis

Chemically induced disseminated pythiosis in BALB/c mice: A new experimental model for Pythium insidiosum infection

Recent update in diagnosis and treatment of human pythiosis

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