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Polymicrobial Keratitis With Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia After Penetrating Keratoplasty: A Rare Case Report With Literature Review.
Eye Contact Lens. 2019 Mar; 45(2):e5-e10.EC

Abstract

OBJECTIVES

To report the first case of fungal keratitis caused by Cryptococcus curvatus after penetrating keratoplasty (PK) in an immunocompetent patient and to describe its therapeutic challenge and long-term outcome.

METHODS

An interventional case report.

RESULTS

A 54-year-old female patient underwent right PK for lattice dystrophy. At 5-year post-PK, she developed a polymicrobial keratitis caused by Candida parapsilosis, and Stenotrophomonas maltophilia at the peripheral graft, which was successfully treated with topical antibiotic and antifungal drops. One year later, another fungal keratitis occurred which apparently resolved with antifungal treatment but recurred in an unusual fashion and required a repeat PK revealing the diagnosis of C. curvatus keratitis. This was confirmed by microbiological culture on Sabouraud dextrose agar, nuclear ribosomal repeat regional sequencing of the D1-D2 and internal transcribed spacer regions, and histopathological examination. Various topical, intracorneal, and systemic antifungal treatments had been attempted but failed to resolve the infection completely, necessitating a subsequent third PK. A further recurrence was noted 16-month post-third PK, which was eradicated with multiple topical and intracorneal antifungal treatment, and direct cryotherapy to the corneal abscess. No further recurrence of C. curvatus was noted at 4-year follow-up.

CONCLUSIONS

Cryptococcus curvatus should be added to the known list of organisms capable of causing fungal keratitis. Our experience suggests that this type of organism could cause low-grade, grumbling infection, which may however be exceptionally difficult to treat. Long-term eradication of this rare fungal keratitis could be potentially achieved by intensive ocular and systemic antifungal treatment, repeat therapeutic keratoplasties, and focal cryotherapy.

Authors+Show Affiliations

Sunderland Eye Infirmary (D.S.J.T., S.J.M., and S.G.), Sunderland, United Kingdom; Department of Microbiology (G.B. and R.K.), Sunderland Royal Hospital, Sunderland, United Kingdom; Histopathology Department (L.D.I.), Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; and Mycology Reference Laboratory (E.J.), Public Health England South West Laboratory, Bristol, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

29944507

Citation

Ting, Darren Shu Jeng, et al. "Polymicrobial Keratitis With Cryptococcus Curvatus, Candida Parapsilosis, and Stenotrophomonas Maltophilia After Penetrating Keratoplasty: a Rare Case Report With Literature Review." Eye & Contact Lens, vol. 45, no. 2, 2019, pp. e5-e10.
Ting DSJ, Bignardi G, Koerner R, et al. Polymicrobial Keratitis With Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia After Penetrating Keratoplasty: A Rare Case Report With Literature Review. Eye Contact Lens. 2019;45(2):e5-e10.
Ting, D. S. J., Bignardi, G., Koerner, R., Irion, L. D., Johnson, E., Morgan, S. J., & Ghosh, S. (2019). Polymicrobial Keratitis With Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia After Penetrating Keratoplasty: A Rare Case Report With Literature Review. Eye & Contact Lens, 45(2), e5-e10. https://doi.org/10.1097/ICL.0000000000000517
Ting DSJ, et al. Polymicrobial Keratitis With Cryptococcus Curvatus, Candida Parapsilosis, and Stenotrophomonas Maltophilia After Penetrating Keratoplasty: a Rare Case Report With Literature Review. Eye Contact Lens. 2019;45(2):e5-e10. PubMed PMID: 29944507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polymicrobial Keratitis With Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia After Penetrating Keratoplasty: A Rare Case Report With Literature Review. AU - Ting,Darren Shu Jeng, AU - Bignardi,Giuseppe, AU - Koerner,Roland, AU - Irion,Luciane D, AU - Johnson,Elizabeth, AU - Morgan,Stephen J, AU - Ghosh,Saurabh, PY - 2018/6/27/pubmed PY - 2019/5/18/medline PY - 2018/6/27/entrez SP - e5 EP - e10 JF - Eye & contact lens JO - Eye Contact Lens VL - 45 IS - 2 N2 - OBJECTIVES: To report the first case of fungal keratitis caused by Cryptococcus curvatus after penetrating keratoplasty (PK) in an immunocompetent patient and to describe its therapeutic challenge and long-term outcome. METHODS: An interventional case report. RESULTS: A 54-year-old female patient underwent right PK for lattice dystrophy. At 5-year post-PK, she developed a polymicrobial keratitis caused by Candida parapsilosis, and Stenotrophomonas maltophilia at the peripheral graft, which was successfully treated with topical antibiotic and antifungal drops. One year later, another fungal keratitis occurred which apparently resolved with antifungal treatment but recurred in an unusual fashion and required a repeat PK revealing the diagnosis of C. curvatus keratitis. This was confirmed by microbiological culture on Sabouraud dextrose agar, nuclear ribosomal repeat regional sequencing of the D1-D2 and internal transcribed spacer regions, and histopathological examination. Various topical, intracorneal, and systemic antifungal treatments had been attempted but failed to resolve the infection completely, necessitating a subsequent third PK. A further recurrence was noted 16-month post-third PK, which was eradicated with multiple topical and intracorneal antifungal treatment, and direct cryotherapy to the corneal abscess. No further recurrence of C. curvatus was noted at 4-year follow-up. CONCLUSIONS: Cryptococcus curvatus should be added to the known list of organisms capable of causing fungal keratitis. Our experience suggests that this type of organism could cause low-grade, grumbling infection, which may however be exceptionally difficult to treat. Long-term eradication of this rare fungal keratitis could be potentially achieved by intensive ocular and systemic antifungal treatment, repeat therapeutic keratoplasties, and focal cryotherapy. SN - 1542-233X UR - https://www.unboundmedicine.com/medline/citation/29944507/Polymicrobial_Keratitis_With_Cryptococcus_curvatus_Candida_parapsilosis_and_Stenotrophomonas_maltophilia_After_Penetrating_Keratoplasty:_A_Rare_Case_Report_With_Literature_Review_ L2 - https://doi.org/10.1097/ICL.0000000000000517 DB - PRIME DP - Unbound Medicine ER -