Long-term follow-up after successful treatment of Pythium insidiosum keratitis in Israel.

Abstract

The purpose of this project is to report a case of severe Pythium insidiosum keratitis confirmed by polymerase chain reaction (PCR), and its long-term cure after therapeutic penetrating keratoplasty. A 24-year-old woman with a history of contact lens wear and exposure to swimming pool water presented with a severe corneal abscess. She was treated with intensive fortified topical antibiotics and natamycin with limited response. Initial cultures suggested the presence of a septate mold, unclearly identified; therefore, both topical and intravenous voriconazole were administered. Despite the above treatment, there was worsening of the clinical picture. PCR assay revealed homology to Pythium insidiosum. Promptly, the patient underwent a large therapeutic penetrating keratoplasty. After five years of follow-up, the graft exhibits neither signs of rejection nor any recurrence of infection. We conclude that prompt identification of Pythium insidiosum keratitis and aggressive treatment by therapeutic penetrating keratoplasty may offer a cure to this disease.

• Authors: Irina S Barequet, Fabio Lavinsky, Mordechai Rosner
• Journal: Seminars in ophthalmology (Semin Ophthalmol) Vol. 28 Issue 4 Pg. 247-50 (Jul 2013) ISSN: 1744-5205 [Electronic] England
• PMID: 23627654 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• DNA, Fungal

Topics

• Abscess (microbiology, surgery)
• Anti-Bacterial Agents (therapeutic use)
• Contact Lenses, Hydrophilic (microbiology)
• Corneal Ulcer (diagnosis, microbiology, surgery)
• DNA, Fungal (analysis)
• Eye Infections, Fungal (diagnosis, microbiology, surgery)
• Female
• Follow-Up Studies
• Humans
• Israel
• Keratoplasty, Penetrating
• Polymerase Chain Reaction
• Pythiosis (diagnosis, microbiology, surgery)
• Pythium (genetics, isolation & purification)
• Young Adult