结论:该病例系列将是第一个说明Pythiumsp的混合感染的病例。和角膜溃疡中的真菌种类。
目的:本案例系列旨在提醒所有人注意两种Pythiumsp的可能性。和真菌物种感染的情况下,无反应的角膜溃疡单独使用抗真菌药或抗腐败药治疗。在无反应的真菌/脓疱性角膜炎的情况下,对混合感染的怀疑增加可能有助于早期和及时的治疗。
方法:6例患者表现为真菌性或脓疱性角膜炎。他们接受了眼科检查,涂片检查,文化,和聚合酶链反应(PCR)。治疗性穿透性角膜移植术(TPK)是在用抗真菌或抗腐败药治疗后症状恶化的情况下进行的。半角膜纽扣(HCB)用于组织病理学和微生物学检查。在第一种情况下,角膜刮擦(CS)的涂片检查显示,经PCR证实;然而,构巢曲霉在培养物中生长。在第二种情况下,碘-碘化钾(IKI)染色对Pythium呈阳性;但是,Pythium和真菌的PCR均为阳性,DNA测序进一步证实了这一点。在第三种情况下,IKI染色和六氯代苯对腐霉呈阳性;然而,PCR对真菌呈阳性,经DNA测序鉴定为假丝酵母。在第四种情况下,腐霉在CS培养物中生长;然而,念珠菌sp.在HCB培养物中生长。在第五种情况下,枝孢霉sp.在CS的文化中成长;然而,TPK后从前房渗出液中生长出硫氰属植物。在第六种情况下,涂片检查发现纵隔真菌丝,和枝孢霉sp.在文化中成长;然而,经组织病理学检查,六氯代苯呈角膜炎状。
结论:在脓疱菌或真菌性角膜炎的无反应病例中,IKI和PCR等诊断模式应作为常规实践来实施,除了涂片和文化。
CONCLUSIONS: This
case series is the first to illustrate mixed infection from Pythium sp. and fungal species in corneal ulcer.
OBJECTIVE: This
case series aimed to alert all toward the possibility of both Pythium sp. and fungal species infection in
case of nonresponding corneal ulcer treated with either antifungals or antipythium drugs alone. Increased suspicion of mixed infection in
case of nonresponding fungal/ Pythium keratitis may facilitate early and prompt management.
METHODS: Six patients presented with signs of either fungal or Pythium keratitis. They underwent ophthalmological examinations, smear examinations, cultures, and polymerase chain reaction (PCR). Therapeutic penetrating keratoplasty was performed in cases where symptoms worsened after treatment with either antifungal or antipythium drugs. The half corneal button (HCB) was shared for histopathological and microbiological examinations. In the first case, smear examination from corneal scraping (CS) revealed Pythium -like filaments, which were confirmed with PCR; however, Aspergillus nidulans grew in culture. In the second case, iodine-potassium iodide (IKI) staining was positive for Pythium ; however, PCR was positive for both Pythium and fungus, which was further confirmed by DNA sequencing. In the third case, IKI staining and HCB were positive for Pythium ; however, PCR was positive for fungus, which was identified as Candida saitoana with DNA sequencing. In the fourth
case, Pythium grew in the CS culture; however, Candida sp. grew in the HCB culture. In the fifth case, Cladosporium sp. grew in culture from CS; however, Pythium insidiosum grew from the anterior chamber exudate after therapeutic penetrating keratoplasty. In the sixth case, smear examination revealed septate fungal filaments, and Cladosporium sp. grew in culture; however, HCB on histopathological examination showed features of Pythium keratitis.
CONCLUSIONS: In unresponsive cases of Pythium or fungal keratitis, diagnostic modalities such as IKI and PCR should be implemented as a routine practice, in addition to smears and cultures.