|Year : 2021 | Volume
| Issue : 2 | Page : 65-66
Case review of ocular scedosporiosis
Alok Agrawal, Mainak Raychaudhuri
Susrut Eye Foundation, Kolkata, West Bengal, India
|Date of Submission||15-Oct-2019|
|Date of Decision||23-Nov-2019|
|Date of Acceptance||23-Jun-2021|
|Date of Web Publication||27-Oct-2021|
Susrut Eye Foundation, Hb/36/A/1, Saltlake City, Sector 2, Kolkata - 700 106, West Bengal
Source of Support: None, Conflict of Interest: None
Fungal keratitis is one of the leading cause of corneal blindness especially in developing countries like India. It requires prompt diagnosis and vigorous management as early as possible. Any delay in the initial period can have severe consequences on the quality of life of the patient. This often happens in a patient who is immunocompromised and is therefore slow to respond to treatment. However, as evident from this article, even an immunocompetent patient can prove to be a challenging case, especially if the causative organism is a rare filamentous fungi like Scedosporium apeospermum.
Keywords: Fungal keratitis, Immunocompetent host, Scedosporium Apeospermum
|How to cite this article:|
Agrawal A, Raychaudhuri M. Case review of ocular scedosporiosis. CHRISMED J Health Res 2021;8:65-6
Fungal keratitis is one of the leading causes of corneal blindness, especially in developing countries like India. It requires prompt diagnosis and vigorous management as early as possible. Any delay in the initial period can have severe consequences on the quality of life of the patient. This often happens in a patient who is immunocompromised and is therefore slow to respond to treatment. However, as evident from this article, even an immunocompetent patient can prove to be a challenging case, especially if the causative organism is a rare filamentous fungus like Scedosporium apiospermum.
In the article when the patient first presented to the hospital, fungal keratitis was not suspected though the patient gave a history of trauma from soil matter. Fungal keratitis must always be suspected if the injury is from soil or organic matter. Any patient presenting with a corneal ulcer must be immediately subjected to Gram staining and a KOH mount to rule out the presence of fungi. The patient however was immunocompetent and did not suffer from chronic illnesses such as diabetes mellitus or hypertension.
Due to this delay in the initial period, the disease progressed rapidly and soon involved the posterior segment in the form of vitreous infiltrates, and the patient was started on oral antifungal medication. A penetrating keratoplasty failed to provide visual rehabilitation to the patient and the fungal culture detected the presence of S. apiospermum. The implanted corneal graft soon got affected and the patient had to be ultimately eviscerated to prevent further dissemination of the organism into the central nervous system.
S. apiospermum, unlike other similar species, is a rare and notorious opportunistic fungus, which affects immunocompetent patients and is known for its high resistance to conventional antifungal drugs. It is found in soil and polluted water, and commonly affects the respiratory tract, both as a localized and disseminated disease. The worldwide incidence is gradually increasing to about 10%–15% of all fungal keratitis cases, and there are about six to seven documented cases of this organism in our country. Shankar et al. reported a similar case where the patient progressed to endogenous endophthalmitis despite treatment.
The organism can be predominantly diagnosed on fungal culture and can be differentiated from other similar species based on its morphological features. Other tests include cycloheximide tolerance test, counter immunoelectrophoresis, and polymerase chain reaction. It is important to note that the organism is resistant to amphotericin B and flucytosine. Therefore, the primary treatment is with the azole group of drugs, mainly itraconazole. Another drawback is that topical antifungal treatment alone often has no effect in these cases [Figure 1] and [Figure 2].
It must therefore be kept in mind that the severity of infection caused by this organism is disastrous for the patient. Any delay in diagnosis or treatment can often result in poor outcomes, and in such a situation, an evisceration or enucleation may emerge as the only modality of treatment at our disposal. In immunocompetent patients, it is important that the practitioner keep in mind such rare diseases to ensure the best quality of treatment. Immediate staining and culture of corneal scrapings is therefore mandatory in any case of corneal ulcer, especially if there is a history of trauma with soil, organic, or vegetative matter. In keeping these small things in mind, we can prevent a lot of untoward consequences and provide the best quality of treatment to our patients.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]