TY - JOUR
T1 - Pathogenesis and Outcome of Paecilomyces Keratitis
AU - Yuan, Xiaoyong
AU - Wilhelmus, Kirk R.
AU - Matoba, Alice Y.
AU - Alexandrakis, George
AU - Miller, Darlene
AU - Huang, Andrew J.W.
N1 - Funding Information:
This study was supported by the Sid W. Richardson Foundation, Fort Worth, Texas; Research to Prevent Blindness Inc, New York, New York; and Core Grants EY02520 and EY014801 from the National Institutes of Health, Bethesda, Maryland. The authors indicate no financial conflict of interest. Involved in design of study (K.R.W., A.J.W.H.); conduct of study (X.Y., K.R.W., A.Y.M., G.A., D.M., A.J.W.H.); data collection and management (X.Y., G.A., D.M.); data analysis and interpretation (X.Y., K.R.W., G.A., A.J.W.H.); preparation of the manuscript (X.Y., K.R.W., G.A., A.J.W.H.); and review and approval of the manuscript (X.Y., K.R.W., A.Y.M., G.A., D.M., A.J.W.H.). Components of this study were reviewed by the Institutional Review Board and the Institutional Animal Care and Use Committee of Baylor College of Medicine, conformed to policies of the Human Subjects Medical Sciences Subcommittee of the University of Miami, and complied with HIPAA regulations.
PY - 2009/4
Y1 - 2009/4
N2 - Purpose: To examine the clinical pathology and management of Paecilomyces lilacinus keratitis. Design: Observational case series, literature review, and laboratory study. Methods: Characteristics and outcome of 17 patients with laboratory-confirmed Paecilomyces keratitis treated at 2 referral centers were combined with 25 previously reported cases. Experimental models were developed by topically inoculating a human corneal isolate of P. lilacinus onto murine eyes and onto human donor corneas. Results: Of 42 reported eyes with Paecilomyces keratitis, 13 (31%) were associated with chronic keratopathy or previous ocular surgery, 11 (26%) followed corneal trauma, and 10 (24%) occurred in soft contact lens wearers. Medical cure occurred in 13 (31%), including 9 of 31 eyes (29%) treated with natamycin or amphotericin B. Penetrating keratoplasty or other surgery was performed in 29 (69%). In vitro testing of P. lilacinus indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole. Experimental inoculation after superficial scarification established moderately severe corneal paecilomycosis by hyphae and conidia in immunosuppressed mice and in explanted donor corneas. Conclusions: P. lilacinus is an emerging fungal pathogen that infects corneal tissue by filamentous invasion with occasional intrastromal sporulation. P. lilacinus keratitis does not reliably respond to natamycin or amphotericin B and has often required therapeutic keratoplasty, but topical azole antifungal agents such as voriconazole appear promising.
AB - Purpose: To examine the clinical pathology and management of Paecilomyces lilacinus keratitis. Design: Observational case series, literature review, and laboratory study. Methods: Characteristics and outcome of 17 patients with laboratory-confirmed Paecilomyces keratitis treated at 2 referral centers were combined with 25 previously reported cases. Experimental models were developed by topically inoculating a human corneal isolate of P. lilacinus onto murine eyes and onto human donor corneas. Results: Of 42 reported eyes with Paecilomyces keratitis, 13 (31%) were associated with chronic keratopathy or previous ocular surgery, 11 (26%) followed corneal trauma, and 10 (24%) occurred in soft contact lens wearers. Medical cure occurred in 13 (31%), including 9 of 31 eyes (29%) treated with natamycin or amphotericin B. Penetrating keratoplasty or other surgery was performed in 29 (69%). In vitro testing of P. lilacinus indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole. Experimental inoculation after superficial scarification established moderately severe corneal paecilomycosis by hyphae and conidia in immunosuppressed mice and in explanted donor corneas. Conclusions: P. lilacinus is an emerging fungal pathogen that infects corneal tissue by filamentous invasion with occasional intrastromal sporulation. P. lilacinus keratitis does not reliably respond to natamycin or amphotericin B and has often required therapeutic keratoplasty, but topical azole antifungal agents such as voriconazole appear promising.
UR - http://www.scopus.com/inward/record.url?scp=62649133744&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2008.11.016
DO - 10.1016/j.ajo.2008.11.016
M3 - Article
C2 - 19195638
AN - SCOPUS:62649133744
SN - 0002-9394
VL - 147
SP - 691-696.e3
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 4
ER -