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 ~  Abstract
 ~ Introduction
 ~ Discussion
 ~ Acknowledgement
 ~ Case Report
 ~  References
 ~  Article Figures

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  Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 33  |  Issue : 2  |  Page : 303-304
 

Mycotic keratitis due to Engyodontium album: First case report from India


1 Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
2 Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India

Date of Submission13-Feb-2014
Date of Acceptance21-Mar-2014
Date of Web Publication10-Apr-2015

Correspondence Address:
D C Thamke
Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.154890

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 ~ Abstract 

Engyodontium album is a rare and an unusual human pathogen. It is a common inhabitant of waste and moist material and frequently isolated from substrates such as paper, jute, linen and painted walls. This fungus grew within 3 days on SDA with chloramphenicol from corneal scrapping of a 70-year-old male farmer with a history of trauma by unknown vegetative matter. The fungus can be confused with Tritirachium sp and Beauveria sp.


Keywords: Engyodontium album, mycotic keratitis, rare fungus


How to cite this article:
Thamke D C, Mendiratta D K, Dhabarde A, Shukla A K. Mycotic keratitis due to Engyodontium album: First case report from India. Indian J Med Microbiol 2015;33:303-4

How to cite this URL:
Thamke D C, Mendiratta D K, Dhabarde A, Shukla A K. Mycotic keratitis due to Engyodontium album: First case report from India. Indian J Med Microbiol [serial online] 2015 [cited 2019 Dec 9];33:303-4. Available from: http://www.ijmm.org/text.asp?2015/33/2/303/154890



 ~ Introduction Top


Mycotic keratitis presents as a suppurative, usually ulcerative corneal infection. The fungi implicated appear to vary depending on the geographical location. [1] Aspergillus and Fusarium sp. are the most common causes of mycotic keratitis in the Indian subcontinent. However, various rare fungi causing mycotic keratitis have been reported from different parts of India. Earlier, we reported rare fungi, Colletotrichum dematium[2] and Acrophialophora fusispora[3]in corneal scrapings from our region. Engyodontium album has not been reported from India. This is the second report in literature and the first in India, where in Engyodontium album has been isolated and confirmed in corneal scrapping. The first case of mycotic keratitis caused by same fungus following phacoemulsification and intraocular lens implantation was reported by McDonell et al. (1984) [4] as Beaveria alba.


 ~ Case Report Top


A 70-year-old male agricultural worker was admitted to the ophthalmology ward with complaints of redness, pain, watering and photophobia with foreign body sensation and diminution of vision of right eye since 8 days. He gave history of trauma with vegetative matter 15 days back. Patient was treated by a private practitioner and referred to our hospital for further management. Details of the treatment are not known.

On ocular examination of right eye: For visual acuity, perception of light was present and projection of rays was inaccurate. Upper and lower lids showed oedema. Lashes were matted. Conjunctival and circumciliary congestion was seen. On slit-lamp examination, cornea was normal in shape and size. The surface of cornea was irregular at the centre of the pupillary area of size 7 mm × 8 mm and fluorescent stain was positive. No superficial or deep vascularisation was seen. Corneal sensations were decreased at the centre of the papillary area. On anterior chamber examination, depth was normal and hypopyon was present. On direct ophthalmoscopy, the media was hazy and fundus details were not seen. Based on these findings, the diagnosis of hypopyon fungal corneal ulcer with endophthalmitis was made. Corneal scrapping was obtained by using Bard Parker knife no. 15 for direct microscopic examination and culture.

Mycology work-up: A 10%-KOH mount showed hyaline septate hyphae [Figure 1]a. Gram stain was negative for bacteria, and wet mount was negative for cysts of acanthamoeba. In Calcoflour white stain, apple green septate hyphae were seen. Corneal scrapings were inoculated on a plate of SDA with chloramphenicol and incubated at 25°C in BOD and on sheep blood agar at 37°C. On SDA plate, white floccose colonies were seen with colourless reverse within 3 days [Figure 1]b and c.
Figure 1: (a) 10% KOH mount-hyaline septate hyphae (b) white floccose colonies on SDA with chloramphenicol, (c) Reverse of colony-colorless, (d) 1: Conidiogeneous cells in whorls (1-3), 2: Zig zag rachis (× 400)

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Microscopic examination of slide culture of the white floccose colonies showed thin hyaline septate hyphae. Conidiophores were ascending bearing conidiogenous cells in whorls (1-3) arising in right angles. Conidiogenous cells which were geniculate and denticulate, cylindrical, tapering at base and forming a zigzag rachis [Figure 1]d were about 35 u long and 1 u wide. Conidia were hyaline, subspherical or globose. The fungus was identified as E. album according to the criteria described by Hoog GS and Guarro [5] and was confirmed at WHO Collaboration Centre, Centre of Advanced Research in Medical Mycology, Dept of Medical Microbiology, PGIMER, Chandigarh as E. album. The patient was treated with oral Novaclox (500 mg TDS), Fluconazole (150 mg BD) and Diamox (75 mg OD) and locally with eye drops Natamycin, Gataquin six hourly, and Iotim 0.5%, ointments Nystin C and Chlorocol BD for seven days. After treatment, the patient did not show improvement. Therefore, therapeutic penetrating keratoplasty was performed. Post-operatively, the patient was treated with Ciplox (500 mg BD), Prednisolone (30 mg OD) orally and locally by eye drops Gatiquin and Natamet six hourly and ointment Chlorocol BD for seven days and discharged. The patient did not return for further follow up.


 ~ Discussion Top


The taxonomic status of E. album has gone through many changes. Originally, it was included in genus Beauveria by Vuillemin, in Tritarachium by Limer. In 1972, the genus Engyodontium was created. The fungus can be confused with Tritarachium sp. and Beauveria sp. Unlike E. album, Tritarachium sp. produces a pigment and in Beauveria sp., conidiogeneous cells are not present in whorls but rather borne singly in pairs or in clusters. E. album secretes extracellular enzymes such as proteinase and keratinolase [6] and can cause fungemia, endocarditis, brain abscess and eczema vesiculosum. [7],[8] This proves the pathogenic nature of the fungus. It is an unusual pathogen but is a rather common inhabitant of waste and moist material, relatively frequently being isolated from substrates such as paper, jute, linen, and painted walls. Its dispersal is by dry, hydrophobic conidia. [6] Given the invasive nature of the fungus, diagnosis of E. album become more important for prompt treatment. Antifungal susceptibility testing results are not available for E. album but Amphotericin B and Fluconazole were used to treat the patients. [6] The present case is reported to create awareness. Careful examination of the culture can help in identifying the fungus.


 ~ Acknowledgement Top


The authors are grateful to Dr. A. K. Chakrabarty PGIMER, Chandigarh for confirming the fungus.

 
 ~ References Top

1.
Thomas PA. Current perspectives on ophthalmic mycoses. Clin Microbiol Rev 2003;16:730-97.  Back to cited text no. 1
    
2.
Mendiratta DK, Thamke D, Shukla AK, Narang P. Keratitis due to Colletotrichum dematium: A case report. Indian J Med Microbiol 2005;23:56-8.  Back to cited text no. 2
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3.
Guarro J, Mendiratta DK, De Sequeira H, Rodríguez V, Thamke D, Gomes AM, et al. Acrophialophora fusispora: An emerging agent of human mycoses. A report of 3 new clinical cases. Diagn Microbiol Infect Dis 2007;59:85-8.  Back to cited text no. 3
    
4.
McDonnell PJ, Werblin TP, Sigler L, Green WR. Mycotic keratitis due to Beauveria alba. Cornea 1984-1985;3:213-6.  Back to cited text no. 4
    
5.
De Hoog GS, Guarro J, Gene J, Figueras MJ. Atlas of Clinical Fungi. CD- ROM (Electronic version 3.1). Netherlands: CBS Publishers; 2011.  Back to cited text no. 5
    
6.
Simonovicova A, Godyova M, Kunert J. Engyodontium album, a new species of microscopic fungi for Slovakia and its keratinolytic activity. Biol Bratislava 2004;59:17-8.  Back to cited text no. 6
    
7.
Cerqueira Macedo DP, Neves RP, de Souza Motta CM, Correia Magalhaes OM. Engyodontium album fungaemia: The first reported case. Braz J Microbiol 2007;38.  Back to cited text no. 7
    
8.
Augustinsky J, Kammeyer P, Husain A, deHoog GS, Libertin CR. Engyodontium album endocarditis. J Clin Microbiol 1990;28:1479-81.  Back to cited text no. 8
    


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