[Fungal Keratitis Associated with Curvularia lunata: First Case Report from Türkiye].
| Title: | [Fungal Keratitis Associated with Curvularia lunata: First Case Report from Türkiye]. |
|---|---|
| Transliterated Title: | Curvularia lunata’ya Bağlı Gelişen Fungal Keratit: Türkiye’den İlk Olgu Raporu. |
| Authors: | Öner SZ; Pamukkale University Faculty of Medicine, Department of Medical Microbiology, Denizli, Türkiye.; Küçükakın Yaka S; Pamukkale University Faculty of Medicine, Department of Medical Microbiology, Denizli, Türkiye.; Akçaoğlu T; Pamukkale University Faculty of Medicine, Department of Ophtalmology, Denizli, Türkiye.; Vural C; Pamukkale University Faculty of Science and Arts, Department of Biology, Molecular Biology Section, Denizli, Türkiye.; Yılmaz U; Pamukkale University Faculty of Medicine, Department of Ophtalmology, Denizli, Türkiye.; Ergin Ç; Pamukkale University Faculty of Medicine, Department of Medical Microbiology, Denizli, Türkiye. |
| Source: | Mikrobiyoloji bulteni [Mikrobiyol Bul] 2023 Oct; Vol. 57 (4), pp. 690-697. |
| Publication Type: | Case Reports; English Abstract; Journal Article |
| Language: | Turkish |
| Journal Info: | Publisher: Ankara Mikrobiyoloji Dernegi Country of Publication: Turkey NLM ID: 7503830 Publication Model: Print Cited Medium: Print ISSN: 0374-9096 (Print) Linking ISSN: 03749096 NLM ISO Abbreviation: Mikrobiyol Bul Subsets: MEDLINE |
| Imprint Name(s): | Publication: Ankara : Ankara Mikrobiyoloji Dernegi; Original Publication: Ankara. |
| MeSH Terms: | Eye Infections, Fungal*/complications ; Eye Infections, Fungal*/diagnosis ; Eye Infections, Fungal*/drug therapy ; Keratitis*/complications ; Keratitis*/drug therapy; Antifungal Agents/therapeutic use ; Aged ; Female ; Humans ; Agar ; Curvularia |
| Abstract: | Fungal keratitis is a medical emergency that is among the most common causes of blindness in developing countries. The type of the agent may vary depending on the geographical conditions under which the patient lives, trauma exposure, the use of contact lenses and profession. Curvularia spp. is a saprophytic genus that rarely causes systemic disease in humans and has 250 species identified to date. They proliferate in soil and plants and spread to the environment with their spores and the formation of blackish and fluffy colonies is its most well-known morphological feature. There may be difficulties in cultivating brown (dematiaceous) fungi. Due to the similarity between the genera, conventional methods remain inadequate for diagnosis. In this report, a case of fungal keratitis associated with C.lunata was presented. Seventy-five years-old female patient admitted to the hospital with the symptoms of stinging pain, blurred vision, and swelling in the right eye. Her symptoms had begun four days ago after her eye was hit by a plant. The patient who had a history of peripheral neuropathy due to diabetes mellitus (DM) was hospitalized with a preliminary diagnosis of keratitis, and in the cultures of the patient's corneal scraping samples, the filamentous, black pigment-forming colonies of the pathogen growing on 5% sheep blood agar and potato dextrose agar showing an aerial hyphal structure, were stained with lactophenol cotton blue and examined under the microscope. The microscopic examination revealed geniculate conidiophores with brown pigmentation. On top of these structures were tetralocular macroconidia, one of which appeared to be larger than the main axis. The fungus was subjected to molecular identification with the prediagnosis of Curvularia/Bipolaris. DNA extraction of the ITS region polymerase chain reaction amplification and Sanger sequencing were performed for molecular identification. Sanger sequencing identified the agent to be Curvularia lunata with a similarity rate of 99.79% (NCBI-GenBank Nucleotide ID: OR365075). In vitro antifungal susceptibility of C.lunata was evaluated by microdilution method. Itraconazole and amphotericin B showed higher activity against C.lunata compared to other antifungals while fluconazole was the least active antifungal. Intrastromal and subconjunctival voriconazole injection was applied to the patient who was unresponsive to empirically initiated oral moxifloxacin and different topical treatments (vancomycin, ceftazidime, flucanozole, ganciclovir, cyclopentolate hydrochloride, hyaluronic acid and trehalose). After injection, right penetrating keratoplasty was applied due to increased thinning of the ulcerated area. No pathogen was detected in cultures taken after keratoplasty. Rare fungi should be considered in cases of keratitis that are difficult to treat. Fungal keratitis caused by brown fungi are clinically similar to each other and effective treatment protocols cannot be implemented without a species identification. Identification of the pathogen will enable genus-specific treatment. This will also help prevent complications that may occur. This article aims to present a case of fungal keratitis associated with C.lunata. |
| Substance Nomenclature: | 9002-18-0 (Agar); 0 (Antifungal Agents) |
| SCR Organism: | Curvularia lunata |
| Entry Date(s): | Date Created: 20231027 Date Completed: 20231031 Latest Revision: 20231031 |
| Update Code: | 20260130 |
| DOI: | 10.5578/mb.20239957 |
| PMID: | 37885397 |
| Database: | MEDLINE |
Case Reports; English Abstract; Journal Article