Indian Journal of Medical Microbiology IAMM  | About us |  Subscription |  e-Alerts  | Feedback |  Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Ahead of Print | Current Issue | Archives | Search | Instructions  
Users Online: 1225 Official Publication of Indian Association of Medical Microbiologists 
  Search
 
 ~ Next article
 ~ Previous article 
 ~ Table of Contents
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (1,484 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
 ~  Acknowledgement
 ~  References
 ~  Article Figures

 Article Access Statistics
    Viewed4074    
    Printed73    
    Emailed0    
    PDF Downloaded103    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 


 
CORRESPONDENCE
Year : 2010  |  Volume : 28  |  Issue : 4  |  Page : 414-415
 

Keratomycosis due to Scedosporium apiospermum


1 Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, India
2 Department of Ophthalmology, Assam Medical College and Hospital, Dibrugarh, India

Date of Submission25-Jan-2010
Date of Acceptance08-Jul-2010
Date of Web Publication20-Oct-2010

Correspondence Address:
R Nath
Department of Microbiology, Assam Medical College and Hospital, Dibrugarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.71811

Rights and Permissions



How to cite this article:
Nath R, Gogoi R N, Saikia L. Keratomycosis due to Scedosporium apiospermum. Indian J Med Microbiol 2010;28:414-5

How to cite this URL:
Nath R, Gogoi R N, Saikia L. Keratomycosis due to Scedosporium apiospermum. Indian J Med Microbiol [serial online] 2010 [cited 2019 Oct 18];28:414-5. Available from: http://www.ijmm.org/text.asp?2010/28/4/414/71811


Dear Editor,

Mycotic keratitis is an important ophthalmic problem in the developing world. Besides the common fungi Aspergillus and Fusarium,[1] many more fungi are also being recognized as causes of keratomycosis, Scedosporium apiospermum is one of them. [2],[3],[4] Treatment of these keratomycosis cases is difficult due to resistance of this fungus to various antifungal agents. [2],[3],[4],[5] In this letter, we report two cases of keratomycosis by Scedosporium apiospermum.

A 48-year-old housewife came with an ulcer in the left cornea following a paddy leaf injury three months back. [Figure 1].Visual acuity was perception of light positive in the affected eye. Slit-lamp biomicroscopic examination revealed a perforated paracentral circular corneal ulcer of 4 mm in diameter with anterior synechiae of the iris and a hypopyon (2 mm). Five percent natamycin at hourly interval for 7 days and at two-hourly interval thereafter for 15 days were already given without any response. Another 47-year-old patient, farmer, presented with an ulcer in the right central cornea following an injury by a paddy leaf 20 days back. The visual acuity of the right eye was finger counting positive at a distance of three metres. There was an irregular shaped superficial corneal ulcer with a 2 mm hypopyon. Corneal scrapings were inoculated into blood agar; Sabouraud's dextrose agar with chloramphenicol in a row of C-shaped streaks, directly examined with 10% potassium hydroxide (KOH), which revealed abundant septate hyaline hyphae with the characteristic ovoid conidia in the first case and abundant septate hyaline hyphae in the second case. Culture yielded growth of the same fungus in Sabouraud's dextrose agar as well as in blood agar in all the C-streaks [Figure 2]a and b. In blood agar medium at 37°C, it showed good growth in 48 hours. No bacterial growth was detected. Identification was made from typical colonies growing after two days as well as slide culture in potato dextrose agar, which showed septate hyaline hyphae with numerous single-celled, pale-brown, broadly clavate to ovoid conidia [Figure 3]. The culture was identified as Scedosporium apiospermum. The patients were put on itraconazole (1%) eye drops at hourly interval to start with for seven days and thereafter at two-hourly interval. Oral fluconazole 200 mg was given daily for two weeks and thereafter 150 mg daily for two weeks. Both the patients gradually responded. In the first patient, the ulcer healed with an opacity in six weeks but the visual acuity did not improve. The second patient responded with decrease of congestion and hypopyon decreased in size after 10 days of therapy. Visual acuity improved to 6/24 after eight weeks.
Figure 1: Dry, paracentral corneal ulcer with irregular hyphate border caused by S. apiospermum

Click here to view
Figure 2: a: Blood agar showing growth in C-streaks. Colonies grow fast, grey to white in colour, suede like
b: Sabouraud's dextrose agar showing white suede-like colonies in C-streaks


Click here to view
Figure 3: Hyaline septate hyphae with numerous single-celled, broadly clavate to ovoid conidia in potato dextrose agar (Lactophenol cotton blue stain, ×40)

Click here to view


Azoles are often cited as agents of choice for this fungus. [5] Both our cases responded with decreased inflammation within 10 days with topical itraconazole and oral fluconazole. The treatment strategy varies in different case reports. Topical (1%) and oral voriconazole (200 mg/day) therapy proved to be efficacious in several reports with or without surgical intervention like debridement, keratectomy and penetrating keratoplasty. [4] Good response is also reported with debridement and amphotericin B therapy, in spite of in vitro resistance to amphotericin B, itraconazole, and ketoconazole. [4] Early identification of the species and cautious antifungal therapy depending on clinical response can be helpful in the treatment of unusual fungal keratitis cases like Scedosporium keratitis.


 ~ Acknowledgement Top


Authors acknowledge the financial grant by Indian Council of Medical Research for a study on microbial agents of corneal ulcers.

 
 ~ References Top

1.Chander J, Sharma A. Prevalence of fungal corneal ulcers in North India. Infection 1994;22:207-9.  Back to cited text no. 1  [PUBMED]    
2.Leck A, Matheson M, Tuft S, Waheed K, Lagonowski H. Scedosporium apiospermum keratomycosis with secondary endophthalmitis. Eye (Lond) 2003;17:841-3.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Nulens E, Eggink C, Rijs AJ, Wesseling P, Verweij PE. Keratitis by Scedosporium apiospermum successfully treated with a cornea transplant and Voriconazole. J Clin Microbiol 2003,41:2261-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.D'Hondt K, Parys-Van Ginderdeuren R, Foets B. Fungal keratitis caused by Pseudallescheria boydii (Scedosporium apiospermum). Bull Soc Belge Ophtalmol 2000;277:53-6.  Back to cited text no. 4  [PUBMED]    
5.Dignani MC, Kiwan EN, Anaissie EJ. Hyalohyphommycosis, Chapter 13. In: Anaissie EJ, McGinnis MR, Pfaller MA, editors. Clinical Mycology. 1 st ed. Philadelphia: Churchill Livingstone; 2003. p. 319.  Back to cited text no. 5      


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole
Mohd-Tahir Fadzillah,Siti-Raihan Ishak,Mohtar Ibrahim
Case Reports in Ophthalmological Medicine. 2013; 2013: 1
[Pubmed] | [DOI]
2 The emerging epidemiology of mould infections in developing countries
Arunaloke Chakrabarti,Rachna Singh
Current Opinion in Infectious Diseases. 2011; 24(6): 521
[Pubmed] | [DOI]
3 The emerging epidemiology of mould infections in developing countries
Chakrabarti, A., Singh, R.
Current Opinion in Infectious Diseases. 2011; 24(6): 521-526
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04