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Neda Baniasadi, Andrea Cruzat, Deborah Witkin, Rebecca Stacy, Frederick A. Jakobiec, James Chodosh, Pedram Hamrah; In Vivo Confocal Microscopy for Paecilomyces Lilacinus and Candida Parapsilosis Fungal keratitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5856.
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To assess the role of confocal microscopy for in vivo detection and diagnosis of Paecilomyces Lilacinus and Candida Parapsilosis in patients with fungal keratitis.
Laser in vivo confocal microscopy (IVCM) was performed in patients with microbiologically proven fungal keratitis. IVCM images of fungal elements in patients were correlated with microbiological and pathological results, as well as with IVCM of culture plates. IVCM images of fungal elements were analyzed and compared to previously described reports for other fungi.
IVCM of corneal infiltrates in two patients with Paecilomyces Lilacinus keratitis revealed hyper-reflective hyphae. Hyphae were between 101-346 µm length, 3-5 µm width, and branched at an angle of 30° to 90° at 200 µm depth in one patient, and were between 87-132 µm length, 1-2 µm width, without branching at 500 µm depth in another patient. IVCM of two patients with Candida Parapsilosis demonstrated characteristic small, round hyper-reflective elements of 3-4 µm diameters. IVCM performed on Sabouraud glucose agar plates of these patients revealed comparable features and characteristics for both Paecilomyces Lilacinus and Candida Parapsilosis, confirming the origin of fungal elements in IVCM images of patients. Further, Giemsa staining of corneas of two patients that underwent corneal transplantation demonstrated similar features for both fungi. Comparison of images for both fungal species to IVCM images of other fungi revealed distinct features for both species.
Paecilomyces Lilacinus and Candida Parapsilosis produce distinct images on IVCM, both in patients as well as on culture plates. Interestingly, the same species produces distinct images, correlating to the depth of fungal elements in the cornea. These findings may aid in early diagnosis and treatment of cases of deep-seeded fungal infiltrates, where routine microbiological work-up may not yield positive results, and thus may lead to better outcomes.
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