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Rapid molecular diagnosis of posttraumatic keratitis and endophthalmitis caused by Alternaria infectoria
Consuelo Ferrer1, Javier Montero, Jorge L Alió
1Departamento de Biología Molecular, Universidad Miguel Hernández, Alicante, Spain. cferrer@oftalio.com
Abstract:
The first case of Alternaria infectoria ocular infection is reported. Keratitis and endophthalmitis developed after eye-perforating trauma from a lemon tree branch. Two months after surgery and empirical steroid and antibiotic treatment, diagnosis by molecular methods was performed. PCR amplification was positive for a fungus after 4 h. Antifungal treatment with amphotericin B and fluconazole was initiated immediately. DNA sequence analysis showed Alternaria infectoria to be the causal agent. After topical and systemic administration of antifungal treatment, ocular inflammation disappeared and visual acuity improved. DNA typing was found to be a useful tool to achieve early identification of the causal agent.
Insights
The first reported Alternaria infectoria fungal eye infection occurred after trauma. Molecular diagnosis and antifungal treatment led to improved vision.
Area of Science:
- Ophthalmology
- Medical Mycology
- Infectious Diseases
Background:
- Ocular trauma can lead to severe infections.
- Fungal keratitis and endophthalmitis require prompt diagnosis and treatment.
- Alternaria species are known opportunistic plant pathogens.
Observation:
- A patient developed keratitis and endophthalmitis following a lemon tree branch eye injury.
- Initial treatment with steroids and antibiotics was ineffective.
- Diagnosis was delayed for two months post-trauma.
Findings:
- Molecular methods, specifically Polymerase Chain Reaction (PCR), rapidly identified a fungal infection within 4 hours.
- DNA sequencing confirmed Alternaria infectoria as the causative agent.
- Antifungal therapy with amphotericin B and fluconazole resulted in resolution of inflammation and improved visual acuity.
Implications:
- This case highlights Alternaria infectoria as a potential cause of severe ocular infections post-trauma.
- Molecular diagnostic tools, including DNA sequencing and PCR, are crucial for early and accurate identification of fungal pathogens.
- Prompt antifungal treatment is essential for managing ocular fungal infections and preserving vision.
