| Title | Pathogenesis and outcome of Paecilomyces keratitis. | | Author(s) | Yuan X, Wilhelmus KR, Matoba AY, Alexandrakis G, Miller D, Huang AJ | | Institution | Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. | | Source | Am J Ophthalmol 2009 Apr; 147(4):691-696.e3. | | MeSH | Adolescent
Adult
Aged
Aged, 80 and over
Amphotericin B
Animals
Anti-Bacterial Agents
Combined Modality Therapy
Cornea
Corneal Ulcer
Disease Models, Animal
Eye Infections, Fungal
Female
Humans
Keratoplasty, Penetrating
Male
Mice
Mice, Inbred BALB C
Microbial Sensitivity Tests
Middle Aged
Mycoses
Natamycin
Paecilomyces
Tissue Donors
Treatment Outcome
| | Abstract | PURPOSE: To examine the clinical pathology and management of Paecilomyces lilacinus keratitis.
DESIGN: Observational case series, literature review, and laboratory study.
METHODS: Characteristics and outcome of 17 patients with laboratory-confirmed Paecilomyces keratitis treated at 2 referral centers were combined with 25 previously reported cases. Experimental models were developed by topically inoculating a human corneal isolate of P. lilacinus onto murine eyes and onto human donor corneas.
RESULTS: Of 42 reported eyes with Paecilomyces keratitis, 13 (31%) were associated with chronic keratopathy or previous ocular surgery, 11 (26%) followed corneal trauma, and 10 (24%) occurred in soft contact lens wearers. Medical cure occurred in 13 (31%), including 9 of 31 eyes (29%) treated with natamycin or amphotericin B. Penetrating keratoplasty or other surgery was performed in 29 (69%). In vitro testing of P. lilacinus indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole. Experimental inoculation after superficial scarification established moderately severe corneal paecilomycosis by hyphae and conidia in immunosuppressed mice and in explanted donor corneas.
CONCLUSIONS: P. lilacinus is an emerging fungal pathogen that infects corneal tissue by filamentous invasion with occasional intrastromal sporulation. P. lilacinus keratitis does not reliably respond to natamycin or amphotericin B and has often required therapeutic keratoplasty, but topical azole antifungal agents such as voriconazole appear promising. | | Language | eng | | Pub Type(s) | Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
| | PubMed ID | 19195638 |
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