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1.
Indian J Ophthalmol ; 69(4): 987-989, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33727474

RESUMO

A 42-year-old male patient presented with profound impairment of vision in both eyes, just as he was recovering from COVID-19. A known diabetic and hypertensive, he suffered from COVID-19 pneumonia further complicated by ARDS, septicaemia and acute kidney injury. His vision on presentation was finger counting close to face bilaterally with multiple, yellowish lesions at the posterior pole. Based on the clinical findings and previous blood culture report, it was diagnosed as candida retinitis and treated with oral and intravitreal anti-fungals. The lesions were regressing at follow-up. This is a post COVID-19 presumed candida retinitis case report.


Assuntos
/diagnóstico , Candidíase/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oportunistas/diagnóstico , Retinite/diagnóstico , Administração Oral , Adulto , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Fluconazol/uso terapêutico , Humanos , Injeções Intravítreas , Masculino , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Retinite/tratamento farmacológico , Retinite/microbiologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Voriconazol/uso terapêutico
2.
Lancet Infect Dis ; 21(3): e49-e57, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33645500

RESUMO

Fungal keratitis is a severe corneal infection that often results in blindness and eye loss. The disease is most prevalent in tropical and subtropical climates, and infected individuals are frequently young agricultural workers of low socioeconomic status. Early diagnosis and treatment can preserve vision. Here, we discuss the fungal keratitis diagnostic literature and estimate the global burden through a complete systematic literature review from January, 1946 to July, 2019. An adapted GRADE score was used to evaluate incidence papers-116 studies provided the incidence of fungal keratitis as a proportion of microbial keratitis and 18 provided the incidence in a defined population. We calculated a minimum annual incidence estimate of 1 051 787 cases (736 251-1 367 323), with the highest rates in Asia and Africa. If all culture-negative cases are assumed to be fungal, the annual incidence would be 1 480 916 cases (1 036 641-1 925 191). In three case series, 8-11% of patients had to have the eye removed, which represents an annual loss of 84 143-115 697 eyes. As fungal keratitis probably affects over a million people annually, an inexpensive, simple diagnostic method and affordable treatment are needed in every country.


Assuntos
Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/epidemiologia , Ceratite/diagnóstico , Ceratite/epidemiologia , Infecções Oculares Fúngicas/microbiologia , Fungos/isolamento & purificação , Saúde Global , Humanos , Incidência , Ceratite/microbiologia , Fatores de Risco
3.
BMJ Case Rep ; 14(2)2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579798

RESUMO

This is a rare case report of two filamentous fungi in a patient with contact lens related keratitis. An early corneal scrape may be useful in detecting multiple causative pathogens and aiding management. The main learning point is to consider fungal infections in patients with atypical ulcer appearances, as prompt diagnosis may reduce the morbidity burden.


Assuntos
Lentes de Contato/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Fungos/isolamento & purificação , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Doenças Raras/tratamento farmacológico , Antifúngicos/uso terapêutico , Infecções Oculares Fúngicas/diagnóstico , Feminino , Fusarium/isolamento & purificação , Humanos , Hypocreales/isolamento & purificação , Ceratite/diagnóstico , Pessoa de Meia-Idade , Doenças Raras/diagnóstico , Doenças Raras/microbiologia , Resultado do Tratamento , Reino Unido , Voriconazol/uso terapêutico
4.
BMC Infect Dis ; 21(1): 82, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461505

RESUMO

BACKGROUND: Keratitis due to by filamentous fungi are not easy to diagnose thus causing a delay in correct therapy. There are many descriptions of keratitis due to Candida, Fusarium and Aspergillus genera. Subramaniula genus has only recently been reported to cause human infections and there are few descriptions of eye infections due to this filamentous fungus. Diagnosis of fungal keratitis is usually based on microscopic and cultural techniques of samples obtained by corneal swabbing or scraping. Considering the amount of time required to obtain culture results it is wise to use other diagnostic methods, such as molecular analyses. Therapeutic options against these fungi are limited by low tissue penetration in the eye due to ocular barriers. We describe the first case of S. asteroides human keratitis treated with isavuconazole. CASE PRESENTATION: We describe a rare case of fungal keratitis unresponsive to antimicrobial treatment in a 65-year-old male patient without a history of diabetes or immunological diseases. He reported that the onset of symptoms occurred during a long holiday in Cape Verde Island. Initial treatment with topical antibiotics associated to steroids were ineffective, allowing a slow clinical progression of disease to corneal perforation. On admission in our Hospital, slit-lamp examination of the left eye showed conjunctival congestion and hyperemia, a large inferior corneal ulceration with brown pigment, corneal edema, about 3 mm of hypopyon and irido-lenticular synechiae. The slow clinical progression of the disease to corneal perforation and the aspect of the ulcer were consistent with a mycotic etiology. Molecular methods used on fungal colonies isolated by Sabouraud's dextrose agar cultures allowed the identification of Subramaniula asteroids from corneal scraping. Antimicrobial test showed a good susceptibility of this filamentous fungus to voriconazole and isavuconazole. Moreover, this fungal keratitis was successfully treated with isavuconazole, without side effects, observing a progressive clinical improvement. CONCLUSIONS: Molecular methods may be useful for the identification of filamentous fungal keratitis on scraping samples thus shortening the time of diagnosis. Systemic therapy by isavuconazole could be useful to treat the filamentous fungal keratitis, reducing the possible adverse effects due to the use of voriconazole by systemic administration.


Assuntos
Úlcera da Córnea/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Sordariales/isolamento & purificação , Idoso , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Úlcera da Córnea/microbiologia , Diagnóstico Diferencial , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Humanos , Masculino , Nitrilos/administração & dosagem , Nitrilos/uso terapêutico , Soluções Oftálmicas , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Triazóis/administração & dosagem , Triazóis/uso terapêutico
5.
Indian J Ophthalmol ; 69(2): 244-252, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33463566

RESUMO

Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. Methods: We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. Results: All patients were male, mean age 60.5 ± 12 (46.2-73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86-404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3-42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Conclusion: Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.


Assuntos
/epidemiologia , Infecções Oculares Fúngicas/epidemiologia , Mucorales/isolamento & purificação , Mucormicose/epidemiologia , Pandemias , Idoso , Comorbidade , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucormicose/microbiologia , Estudos Retrospectivos
6.
Ann Agric Environ Med ; 27(4): 540-543, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33356058

RESUMO

INTRODUCTION: The role of fungi in infections in immunocompromised patients is a growing problem in both diagnosis and treatment. Candida species are the most common cause of fungal, endogenous endophthalmitis and infections of the cornea. CASE STUDY: A patient was admitted to hospital due to acute inflammation of the tissue of the left orbit, 1.5 years after the corneal penetrating transplantation of the left eye with intracapsular extraction of lens and simultaneous anterior vitrectomy. The microbiological system identified: Streptococcus pyogenes, Staphylococcus aureus, and Candida glabrata in the patient. CONCLUSIONS: The factors conducive to fungal infections are: patient's old age, immune disorders and diabetes, as well as the presence of a necrotic tissue or a foreign body. All these parameters were met in this case. Only antibiotic therapy and long-term antifungal therapy, together with surgical debridement of the site of the ongoing infection produces clinical effects in such severe cases.


Assuntos
Antifúngicos/uso terapêutico , Candida glabrata/isolamento & purificação , Candidíase/diagnóstico , Desbridamento , Infecções Oculares Fúngicas/diagnóstico , Panoftalmite/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Candidíase/microbiologia , Candidíase/fisiopatologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Panoftalmite/microbiologia , Polônia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Streptococcus pyogenes/isolamento & purificação , Resultado do Tratamento
7.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372014

RESUMO

A 44-year-old Asian Indian woman presented with a history of pain and redness in the left eye for 3 weeks. Scleral congestion with a nodular swelling was present inferotemporally. Raised C reactive protein and positive antinuclear and perinuclear antineutrophil cytoplasmic antibodies suggested autoimmune scleritis. The patient was therefore managed with corticosteroids. Nevertheless, the development of severe pain associated with a scleral abscess led to a revised diagnosis of infectious scleritis. Corticosteroids therapy was halted and urgent debridement was performed. Microbiology confirmed fungal scleritis due to Coprinopsis cinerea Multiple full-thickness circumferential debridements with antifungal therapy resulted in satisfactory anatomical and visual outcomes. This case presented a unique challenge, since laboratory results were misleading, and corticosteroids resulted in a fulminant clinical course. Therefore, aggressive circumferential debridement was performed to achieve the elimination of a rare fungal aetiology of scleritis, which has not been reported previously to cause human infection.


Assuntos
Agaricales/isolamento & purificação , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/cirurgia , Esclerite/microbiologia , Esclerite/cirurgia , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Progressão da Doença , Infecções Oculares Fúngicas/tratamento farmacológico , Dor Ocular/microbiologia , Feminino , Humanos , Esclerite/tratamento farmacológico , Sulfonamidas/uso terapêutico , Tiofenos/uso terapêutico , Timolol/uso terapêutico
8.
Eye Contact Lens ; 46(6): e66-e68, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33044373

RESUMO

We report a rare case of dematiaceous fungus colonization in the therapeutic bandage contact lens (BCL), in an eye with peripheral ulcerative keratitis. Bandage contact lens removal and appropriate treatment resulted in improvement of the visual acuity and prevented the spread of fungus to the underlying ocular structures. Microbiological evaluation of the BCL showed dematiaceous fungal filaments, and the fungus was identified as Bipolaris species. In patients with pigmented plaque-like lesions, with BCL in situ, dematiaceous fungus on the undersurface of the BCL should be kept in mind. Patient education regarding the importance of frequent BCL replacement, proper ocular hygiene, and timely follow-up should be emphasized.


Assuntos
Ascomicetos/isolamento & purificação , Betacoronavirus , Lentes de Contato/microbiologia , Úlcera da Córnea/microbiologia , Infecções por Coronavirus/epidemiologia , Infecções Oculares Fúngicas/microbiologia , Micoses/microbiologia , Pneumonia Viral/epidemiologia , Idoso , Antifúngicos/uso terapêutico , Bandagens , Carboximetilcelulose Sódica/uso terapêutico , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Perda de Seguimento , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Natamicina/uso terapêutico , Pandemias , Tomografia de Coerência Óptica , Acuidade Visual
9.
Ann Agric Environ Med ; 27(3): 343-347, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955212

RESUMO

INTRODUCTION: Fungal keratitis is a severe condition which may lead to blindness. Fungal keratitis, also known mycotic keratitis or keratomycosis, has worldwide distribution, but is more common in tropical climates compared to moderate zones. In recent years, there have been several studies suggesting an increase in the number of mycotic keratitis cases in countries with a moderate climate. There is little data available with no literature review concerning fungal keratitis in European countries. OBJECTIVE: To analyse the causes, presentation, and clinico-pathological associations of fungal keratitis in a retrospective series of patients referred to the Department of Ophthalmology of the Railway Hospital in Katowice, south-west Poland, and comparing the findings to previously published studies in peer reviewed articles from other European countries published between 2000-2019. MATERIAL AND METHODS: Data were collected using the medical records of patients with fungal keratitis. Risk factors, clinical manifestation and treatment results were analysed from 45 patients (45 eyes) with fungal keratitis treated in the Department of Ophthalmology of Railway Hospital in Katowice between January 2013 - December 2017. The factors affecting the development of infection, visual acuity at baseline and at the end of treatment, as well as treatment method selection, were analysed. Literature review was performed using the Medline, Pubmed, Embase databases and Google scholar. The inclusion criteria were peer reviewed papers published between 2000-2019 which reported data from patients with fungal keratitis in at least one European country. 11 peer reviewed articles which matched the inclusion criteria were analysed. RESULTS: The mean BCVA of patients treated in the Department of Ophthalmology of the Railway Hospital in Katowice upon diagnosis was 2.3 (logMAR), compared to 1.95 (logMAR) at the end of treatment. Pearson's chi-squared test was used to establish the final mean BCVA in eyes with keratitis caused by Candida spp. compared with keratitis caused by Filamentous spp. The reviewed articles showed poor results of treatment and diagnostic difficulties in fungal keratitis. CONCLUSIONS: Fungal keratitis is a significant diagnostic and therapeutic challenge and may occur in rural and urban areas. Early and accurate diagnosis followed by proper antifungal treatment can prevent blindness and improve BCVA results.


Assuntos
Infecções Oculares Fúngicas/epidemiologia , Ceratite/epidemiologia , Adulto , Idoso , Europa (Continente)/epidemiologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Incidência , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
12.
J Mycol Med ; 30(3): 101002, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32507472

RESUMO

INTRODUCTION: Rhino-orbital-aspergillosis (ROA) is a rare but serious disease in immunocompetent patients. Diagnosis is often delayed due to the absence of specific clinical symptoms. We describe the case of a patient who presented initially with ROA which spread progressively to the right ethmoid-sphenoid sinuses and then to the brain. OBSERVATION: A 61-year-old patient with a history of well-controlled diabetes presented with a sudden severe decrease in right visual acuity. Cerebral MRI showed the presence of an infiltrate in the right orbital apex extending to the homolateral cavernous sinus without any cerebral involvement. A diagnosis of right orbital myositis was made and corticosteroid therapy was started. His symptoms worsened progressively leading to quasi-blindness. A new MRI showed the development of right sphenoid-ethmoid osteolytic lesions. A fungal aetiology was suspected and tests for fungal biomarkers found a ß-(1-3)-D-glucan level of 99pg/ml but negative galactomannan. An ethmoid biopsy was performed for histological and mycological investigations, including the detection of Aspergillus DNA by qPCR. qPCR was positive and culture resulted in the isolation of multi-sensitive Aspergillus fumigatus. Treatment was initiated with voriconazole. Due to persistence of blindness and the appearance of a lesion extending to the right frontal lobe, surgical excision was performed followed by antifungal treatment for a total duration of 1year. The patient is currently stable, but has persistence of blindness in the right eye. CONCLUSION: Invasive ROA is a rare but serious disease in immunocompetent patients which should be evoked in the differential diagnosis of a tumour or vasculitis. Early diagnosis is essential for optimal management.


Assuntos
Aspergilose/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Imunocompetência , Infecções Fúngicas Invasivas/diagnóstico , Rinite/microbiologia , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/microbiologia , Aspergillus fumigatus/isolamento & purificação , Cegueira/diagnóstico , Cegueira/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/complicações , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/microbiologia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Masculino , Pessoa de Meia-Idade , Neuroaspergilose/complicações , Neuroaspergilose/diagnóstico , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/microbiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Rinite/complicações , Rinite/diagnóstico , Rinite/tratamento farmacológico , Voriconazol/uso terapêutico
14.
Invest Ophthalmol Vis Sci ; 61(4): 48, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32347916

RESUMO

Purpose: We characterized the effects of Honokiol (HNK) on Aspergillus fumigatus-caused keratomycosis and the underlying mechanisms. HNK is known to have anti-inflammatory and antifungal properties, but the influence on fungal keratitis (FK) remains unknown. Methods: In ex vivo, minimum inhibitory concentration and Cell Count Kit-8 assay were carried out spectrophotometrically to provide preferred concentration applied in vivo. Time kill assay pointed that HNK was fungicidal and fungistatic chronologically. Adherence assay, crystal violet staining, and membrane permeability assay tested HNK effects on different fungal stages. In vivo, clinical scores reflected the improvement degree of keratitis outcome. Myeloperoxidase (MPO) assay, flow cytometry (FCM), and immunohistofluorescence staining (IFS) were done to evaluate neutrophil infiltration. Plate count detected HNK fungicidal potentiality. RT-PCR, Western blot, and enzyme-linked immunosorbent assay (ELISA) verified the anti-inflammatory activity of HNK collaboratively. Results: In vitro, MIC90 HNK was 8 µg/mL (no cytotoxicity), and Minimal Fungicidal Concentration (MFC) was 12 µg/mL for A. fumigatus. HNK played the fungistatic and fungicidal roles at 6 and 24 hours, respectively, inhibiting adherence at the beginning, diminishing biofilms formation, and increasing membrane permeability all the time. In vivo, HNK improved C57BL/6 mice outcome by reducing disease severity (clinical scores), neutrophil infiltration (MPO, FCM, and IFS), and fungal loading (plate count). RT-PCR, Western blot, and ELISA revealed that HNK downregulated mRNA and protein expression levels of Toll-like receptor-2 (TLR-2), high mobility group box 1 (HMGB1), IL-1ß, and TNF-α. Conclusions: Our study suggested HNK played antifungal and anti-inflammatory roles on keratomycosis by reducing survival of fungi, infiltration of leucocytes, and expression of HMGB1, TLR-2, and proinflammatory cytokines, providing a potential treatment for FK.


Assuntos
Anti-Infecciosos/farmacologia , Aspergilose/tratamento farmacológico , Aspergillus fumigatus/isolamento & purificação , Compostos de Bifenilo/farmacologia , Infecções Oculares Fúngicas/tratamento farmacológico , Lignanas/farmacologia , Animais , Aspergilose/diagnóstico , Western Blotting , Citocinas/efeitos dos fármacos , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Infecções Oculares Fúngicas/microbiologia , Feminino , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Camundongos , Camundongos Endogâmicos C57BL , Distribuição Aleatória , Reação em Cadeia da Polimerase em Tempo Real/métodos , Receptor 2 Toll-Like/efeitos dos fármacos , Resultado do Tratamento
15.
Int J Infect Dis ; 96: 151-153, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32339725

RESUMO

Eye damage during invasive aspergillosis is rarely described and biological diagnosis remains challenging. Here we report the case of a heart transplant recipient with ocular aspergillosis complicating disseminated aspergillosis. Although voriconazole was rapidly given, a decrease in visual acuity of the right eye was consistent with endophthalmitis, resulting in an emergency vitrectomy. The diagnosis was rapidly confirmed: laboratory results showed the presence of Aspergillus fumigatus in a vitreous sample. A series of systemic antifungal medications (liposomal amphotericin B, caspofungin, and voriconazole), several liposomal amphotericin B ocular injections, and pars plana vitrectomy resulted in a limited positive clinical outcome. Interestingly although standard mycological follow-up procedures were negative, Aspergillus antigen testing gave an index of 5.92 on vitreous humour, thus a new intraocular injection of liposomal amphotericin B was performed and voriconazole reinitiated. Ten other vitreous samples from patients without fungal infections were also tested, all showing indexes below 0.25. Although larger studies are needed, this case illustrates that galactomannan testing of vitreous humour could be useful for the diagnosis of fungal endophthalmitis if these data are confirmed in other patients, in particular, if standard mycology is negative and PCR is not available.


Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus , Endoftalmite/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Mananas/metabolismo , Corpo Vítreo/metabolismo , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/metabolismo , Endoftalmite/tratamento farmacológico , Endoftalmite/metabolismo , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/metabolismo , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual , Vitrectomia , Voriconazol/uso terapêutico
16.
Am J Ophthalmol ; 217: 38-48, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32278770

RESUMO

PURPOSE: To correlate in vivo confocal microscopy morphologic features (IVCM-MF) and Acanthamoeba cyst density (ACD) with final best-corrected visual acuity (BCVA) in Acanthamoeba keratitis (AK). DESIGN: Retrospective cohort study. METHODS: Patient demographics, treatment outcome, and corresponding IVCM-MF performed at the acute stage of infection were analyzed. Inclusion criteria were microbiological positive AK cases seen at Moorfields Eye Hospital between February 2013 and October 2017. Statistical significance was assessed by multinomial regression and multiple linear regression analysis. Main outcome measure was final BCVA. RESULTS: A total of 157 eyes (157 patients) had AK. Absence of single-file round/ovoid objects was associated with a BCVA of 6/36 to 6/9 (odds ratio [OR] 8.13; 95% confidence interval [CI], 1.55-42.56, P = .013) and ≥6/6 (OR 10.50; 95% CI, 2.12-51.92, P = .004) when compared to no perception of light to 6/60. Absence of rod/spindle objects was associated with a BCVA of ≥6/6 (OR 4.55; 95% CI, 1.01-20.45, P = .048). Deep stromal/ring infiltrate was associated with single-file round/ovoid objects (OR 7.78; 95% CI, 2.69-22.35, P < .001), rod/spindle objects (OR 7.05; 95% CI, 2.11-23.59, P = .002), and binary round/ovoid objects (OR 3.45; 95% CI, 1.17-10.14, P = .024). There was a positive association between ACD and treatment duration (ß = 0.14, P = .049), number of IVCM-MF (ß = 0.34, P = .021), and clusters of round/ovoid objects (ß = 0.29, P = .002). CONCLUSIONS: Specific IVCM-MF correlate with ACD and clinical staging of disease, and are prognostic indicators for a poorer visual outcome.


Assuntos
Ceratite por Acanthamoeba/diagnóstico , Córnea/patologia , Infecções Oculares Fúngicas/diagnóstico , Microscopia Confocal/métodos , Acuidade Visual , Acanthamoeba/genética , Ceratite por Acanthamoeba/microbiologia , Ceratite por Acanthamoeba/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Córnea/microbiologia , DNA Fúngico/análise , Infecções Oculares Fúngicas/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
17.
Am J Ophthalmol ; 215: 1-7, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32171765

RESUMO

PURPOSE: To evaluate the utility of repeat cultures at days 3 and 7 after starting antifungal medications for predicting outcomes in fungal keratitis. DESIGN: Prespecified secondary analysis of the randomized clinical Mycotic Antimicrobial Localized Injection trial. METHODS: Patients presenting to Aravind Eye Hospital, Pondicherry, India, with fungal keratitis and visual acuity worse than 20/70 received topical natamycin and were randomized to either receive intrastromal injection of voriconazole or topical therapy alone. All subjects received corneal cultures at date of presentation, day 3, and day 7. Outcome measures included 3-week and 3-month visual acuity and scar size, corneal perforation, and/or the need for therapeutic penetrating keratoplasty (TPK). Visual acuity and scar size were analyzed with multiple linear regression controlling for baseline measures. Survival analysis was used to analyze the risk of corneal perforation and/or need for TPK. RESULTS: Of the 70 study subjects with fungal keratitis, 25 of 69 (36%) remained culture positive at day 3, and 20 of 62 (32%) were culture positive at day 7. Culture positivity at day 3 conferred a hazard ratio of 2.8 for requiring TPK (P = .03) but was not a statistically significant predictor of perforation, scar size, or final visual acuity. Culture positivity at day 7 had a hazard ratio of 3.5 for requiring TPK (P = .003). Those with positive cultures at day 7 had on average 3 logMAR lines worse visual acuity at 3 months (95% confidence interval 0.9 to 5.2 logMAR lines, P = .006) and 1.1 mm larger scar size at 3 months after controlling for baseline measures (95% confidence interval 0.1 to 2.2 mm; P = .03). CONCLUSIONS: While not as predictive as day 7 cultures, culture positivity at day 3 after starting treatment is a significant predictor of the need for TPK in patients with moderate-to-severe filamentous fungal keratitis. This has applications for risk stratification, and may facilitate earlier consideration of TPK in high-risk patients.


Assuntos
Antifúngicos/uso terapêutico , Úlcera da Córnea/microbiologia , Infecções Oculares Fúngicas/microbiologia , Fungos/isolamento & purificação , Micoses/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perfuração da Córnea/diagnóstico , Substância Própria/efeitos dos fármacos , Úlcera da Córnea/tratamento farmacológico , Método Duplo-Cego , Infecções Oculares Fúngicas/tratamento farmacológico , Feminino , Humanos , Injeções Intraoculares , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Natamicina/uso terapêutico , Prognóstico , Fatores de Tempo , Acuidade Visual/fisiologia , Voriconazol/uso terapêutico , Adulto Jovem
20.
Gene ; 737: 144450, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32057930

RESUMO

Fungal keratitis is a corneal disease with a high blindness rate caused by pathogenic fungal infections. The pathogenesis of fungal keratitis and the immune response after fungal infection are still unclear. Notably, the pathological features of fungal keratitis in tree shrews are similar to those in humans. In the present study, mRNA profiling of tree shrew corneas with fungal keratitis was performed. GO and KEGG enrichment analyses were performed on the differentially expressed mRNAs, and the GO biological process ontology was used to analyze functional trends in the differentially expressed mRNAs. In total, 151 downregulated and 71 upregulated mRNAs were shared among the 7-day, 14-day and 30-day infection groups. These differentially expressed mRNAs were significantly enriched in the GO category immune response (GO: 0002376) and the KEGG pathways cytokine receptor binding (KEGG ID: tup04060) and cell adhesion (KEGG ID: tup04514). The downregulated mRNAs were significantly enriched in the corneal epithelial cell adhesion function. Fifty-eight initially upregulated mRNAs gradually decreased in expression, and these mRNAs were significantly enriched in the functions lipopolysaccharide (LPS) and antibacterial polypeptide recognition, cell differentiation, and cell rearrangement. Zeta chain of T-cell receptor associated protein kinase 70 (ZAP70), lymphocyte cytosolic protein 2 (LCP2), C-C motif chemokine and its receptor showed high degrees of connectivity in the protein-protein interaction (PPI) network. We speculate that the decrease in symptoms of tree shrew fungal keratitis may be related to the upregulation of genes involved in immune regulation and macrophage colony stimulation. This study showed that the C-C motif chemokine and its receptor may play a key role in regulating tree shrew fungal keratitis, providing a theoretical basis for studying the pathogenesis of human fungal keratitis.


Assuntos
Infecções Oculares Fúngicas/genética , Fusarium/patogenicidade , Ceratite/genética , RNA Mensageiro/genética , Tupaiidae/genética , Animais , Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia
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