September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
PAECILOMYCES KERATITIS:A CHALLENGING INFECTION
Author Affiliations & Notes
  • Aline Couto
    Ophthalmology, Paulista School of Medicine , São Paulo, Sao Paulo, Brazil
  • Maria Cecilia Zorat-Yu
    Ophthalmology, Paulista School of Medicine , São Paulo, Sao Paulo, Brazil
  • Ana Luisa Hofling-Lima
    Ophthalmology, Paulista School of Medicine , São Paulo, Sao Paulo, Brazil
  • Denise de Freitas
    Ophthalmology, Paulista School of Medicine , São Paulo, Sao Paulo, Brazil
  • Footnotes
    Commercial Relationships   Aline Couto, None; Maria Zorat-Yu, None; Ana Hofling-Lima, None; Denise de Freitas, None
  • Footnotes
    Support  Do not use
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 342. doi:
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      Aline Couto, Maria Cecilia Zorat-Yu, Ana Luisa Hofling-Lima, Denise de Freitas; PAECILOMYCES KERATITIS:A CHALLENGING INFECTION. Invest. Ophthalmol. Vis. Sci. 2016;57(12):342.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Paecilomycessp are filamentous fungi found worldwide as a saprophytic fungus commonly found in vegetables, fruit, soil, and vegetation.This environmental mold occasionally contaminates biomaterials.Half of all reported paecilomycotic infections affect the eye, and many are refractory to conventional antifungal agents, most are attributable to P. lilacinus, which occurs by external invasion. P. keratitis is also an infectious complication of contact lens wear and eye surgery.Fungal identification is important since antifungal resistance differs among Paecilomyces species.

Methods : We did a retrospective study between the 1995-2015 of the clinical and laboratory features of 21 patients developing Paecilomyces keratitis treated at the External Eye Diseases and Cornea Service of Paulista School of Medicine, São Paulo Hospital, UNIFESP.Review of medical records looking for patient’s demographic characteristics, including month that the disease happened, risk factors, clinical and surgical treatment and complications.We reviewed the laboratory results, including species identification.We also did a review of the pertinent literature and, in the early future, we will do the minimum inhibitory concentrations of isolates against different antifungal drugs.

Results : We analyzed 21 patients.Five were male, 16 were female. Age varied from 21 a 90 years (mean of 50 years, median of 51,5).The Paecilomyces keratitis had modal distribution in May, July and October, without relation with main stations favorable to fungal desease.In partial analysis most patients developed this infection after surgical procedures, followed by ocular trauma and contact lens.The main prescription topical antifungal drugs were amphotericin B associated with miconazole or monotherapy.They also were subjected to intracameral injection with amphotericin B or associated miconazole.Despite of clinical treatment, most part of all followed with worsening symptoms and were submitted keratoplasty, two cases needed to evisceration and enucleation.

Conclusions : Paecilomyces is a fungal pathogen that infects frequently corneal tissue P.lilacinus keratitis does not reliably respond to most frequently applied antifungal treatment and has often required therapeutic keratoplasty.Paecilomyces keratitis has been considered one of the most difficult eye infection for treatment.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Paecilomyces lilacinus keratitis before surgical treatment

Paecilomyces lilacinus keratitis before surgical treatment

 

Patient after surgery treatment with keratoplasty

Patient after surgery treatment with keratoplasty

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