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Journal of Postgraduate Medicine, Vol. 50, No. 4, October-December, 2004, pp. 309-310 Letter To Editor Colletotrichum dematium keratitis Joseph J, Fernandes M, Sharma Savitri Jhaveri Microbiology Center, Prof. Brien Holden Eye research Center, Hyderabad Eye Research Foundation, Banjara Hills, Hyderabad Code Number: jp04106 Sir, Fungal keratitis caused by rare emerging organisms pose diagnostic and therapeutic challenges. Colletotrichum spp. belonging to class Coelomycetes is one such rare fungus.[1] Although only rarely pathogenic to humans, Colletotrichum spp. have been generally associated with some form of trauma. They manifest as keratitis[2] or subcutaneous lesions,[3] although a case of invasive infection has been reported.[1] Here we report a case of fungal keratitis caused by this rare fungal species. A 25-year-old woman presented with pain, redness and decreased vision in the right eye of 15 days duration, following trauma with stones. On examination, her uncorrected visual acuity was perception of light with inaccurate projection of rays in the right eye and 20/20 in the left eye. Slit lamp biomicroscopy of the right eye revealed lid oedema with conjunctival congestion. The cornea had an epithelial defect and an underlying stromal infiltrate measuring more than 8 x 8 mm. The infiltrate was dry, raised, plaque-like with hyphate margins and surrounding corneal oedema [Figure - 1]. Scrapings from the cornea were subjected to microbiological processing as described by us earlier.[4] Direct examination of corneal scrapings in KOH/calcofluor white, Gram and Giemsa stain revealed septate, hyaline, fungal filaments with chlamydospores [Figure - 2]a. Growth of dull gray fluffy fungal colonies was observed on blood agar, chocolate agar, Sabouraud dextrose agar (SDA) and potato dextrose agar (PDA) within 24 hours. The colonies on PDA developed black granules on further incubation [Figure - 2]b. Microscopic examination of the cultures demonstrated falcate conidia (>15 mm long, 3-4 mm broad) and conidiomata, with characteristic erect, unbranched, and darkly pigmented setae [Figure - 2]c. The fungus was identified as Colletotrichum dematium.[5] On confirmation of fungal keratitis in direct smear examination on Day 1, the patient was started on 5% natamycin eye drops half hourly, 1% atropine sulfate eye drops twice daily and oral ketoconazole 200 mg twice daily. The patient was followed up for two months, and on her last visit, her best corrected visual acuity was counting fingers at one meter in the right eye, the cornea had healed completely with a vascularized scar. Several species of Colletotrichum have been reported to cause infection in humans, including keratitis.[2] The large and sickle-shaped conidia of C. dematium distinguishes it from other species of Colletotrichum but it may be confused with the macroconidia of Fusarium spp. though colony characteristics and presence of conidiomata and setae distinguish this isolate from Fusarium. The white fluffy colony with black powdery surface may mimic Aspergillus niger. Although there have been reports of successful treatment of keratitis with amphotericin B as monotherapy or in combination with nystatin and itraconazole, our patient responded to treatment with natamycin eye drops coupled with oral itraconazole. The value of natamycin eye drops in the treatment of C. dematium keratitis has also been emphasized in a recent publication wherein four patients responded to this treatment.[2] The identification of this fungus may augur a favourable prognosis with antifungal therapy and this new corneal pathogen should be considered as one of the aetiological agents of mycotic keratitis. REFERENCES
Copyright 2004 - Journal of Postgraduate Medicine The following images related to this document are available:Photo images[jp04106f1.jpg] [jp04106f2.jpg] |
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