Resistant Fusarium Keratitis Progressing to Endophthalmitis
Resistant Fusarium Keratitis Progressing to Endophthalmitis
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DOI：
10.1097/icl.0b013e318235c5af
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发表时间：
2012-09-01
影响因子：
2.3
通讯作者：
Hsu, Hugo Y.
中科院分区：
文献类型：
--
作者：
Edelstein, Sean L.;Akduman, Levent;Hsu, Hugo Y.
目标：报告一例多重耐药镰刀菌角膜炎发展为眼内炎，最终需要眼球摘除术的病例。方法：病例报告和文献复习。分离鉴定和敏感性测试进行了真菌测试实验室在圣安东尼奥，TX.Results：一个52岁的软接触透镜佩戴者角膜擦伤，并开发了角膜浸润。角膜刮片检查发现丝状菌丝，有分隔和分生孢子。尽管局部使用那他霉素、阿替霉素B和全身使用氟康唑进行了积极的抗真菌治疗，但角膜炎进展，并进行了穿透性角膜移植术。角膜按钮的组织学分析显示后弹力层破裂，两侧有高碘酸希夫阳性真菌菌丝。移植物的复发性感染和进展为眼内炎通过重复玻璃体内注射阿替霉素B、重复穿透性角膜移植术和睫状体平坦部玻璃体切除术治疗。即使在全身使用伊曲康唑、伏立康唑和泊沙康唑以及局部使用伏立康唑后，感染仍在进展，需要进行眼球摘除术。分离鉴定和药敏试验发现了一个多药耐药镰刀菌solani物种复杂，部分敏感纳他霉素only.Conclusions：多药耐药镰刀菌属是罕见的，可能有毁灭性的后果，在晚期角膜炎进展为眼内炎的患者。如此广泛的多药耐药性是令人惊讶的，因为抗真菌治疗的耐药性据说是罕见的。经验性抗真菌治疗通常使用一种或多种抗真菌药物，而不检查抗真菌药物的敏感性。鉴于人们越来越担心耐药菌株的出现，我们提出了一个较低的阈值来检查无反应真菌感染的敏感性。
Objective: To report a case of multidrug-resistant Fusarium sp keratitis that progressed to endophthalmitis and that eventually required enucleation.Methods: Case report and literature review. Isolate identification and susceptibility testing were performed by the Fungus Testing Laboratory at San Antonio, TX.Results: A 52-year-old soft contact lens wearer had a corneal abrasion and developed a corneal infiltrate. Examination of corneal scrapings revealed filamentous hyphae with septation and conidia. Despite aggressive antifungal therapy with topical natamycin, amphotericin B, and systemic fluconazole, the keratitis progressed, and a penetrating keratoplasty was performed. Histopathologic analysis of the corneal button showed disruption of Descemet's membrane with periodic acid-Schiff-positive fungal hyphae on both sides. Recurrent infection of the graft and progression to endophthalmitis was treated with repeated intravitreal amphotericin B injections, repeat penetrating keratoplasties, and pars plana vitrectomies. Even after systemic use of itraconazole, voriconazole, and posaconazole and topical use of voriconazole, the infection progressed and an enucleation was required. Isolate identification and susceptibility testing found a multidrug-resistant Fusarium solani species complex, partially sensitive to natamycin only.Conclusions: Multidrug-resistant Fusarium sp is rare and may have devastating consequences in patients with advanced keratitis progressing to endophthalmitis. Such an extensive multidrug resistance is surprising in that resistance to antifungal treatment is supposedly rare. Empirical antifungal therapy is usually instituted using one or more antifungal agents, without checking antifungal sensitivities. In light of the growing concern for increased emergence of resistant strains, we propose a lower threshold to check for sensitivities in the face of unresponsive fungal infections.