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Trichophyton fungal keratitis
Abdulkarim Mohammad1, Abdulaziz Al-Rajhi, Michael D Wagoner
1Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Cornea
|December 7, 2005
Summary
This study details five cases of fungal keratitis caused by Trichophyton schoenleinii, a rare pathogen leading to aggressive corneal disease. Therapeutic penetrating keratoplasty (PKP) offered better visual outcomes in unresponsive cases.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis is a significant cause of visual impairment globally.
- Trichophyton species are uncommon causes of fungal keratitis, often associated with dermatophyte infections.
Observation:
- Five cases of fungal keratitis caused by Trichophyton schoenleinii were identified.
- The condition presented with aggressive features, including significant keratolysis due to collagenase production.
- Clinical sensitivity was noted for topical natamycin, but resistance to amphotericin B and miconazole.
Findings:
- Medical therapy alone resulted in corneal scarring and poor visual acuity (20/125 to hand motions).
- Therapeutic penetrating keratoplasty (PKP) achieved clinical cure in two patients with final visual acuity of 20/60 and 20/200.
- One patient experienced severe complications, including fungal scleritis and panophthalmitis, necessitating enucleation despite multiple PKPs.
Implications:
- Trichophyton schoenleinii can cause severe fungal keratitis with potential for corneal perforation and intraocular extension.
- Early diagnosis and prompt treatment, including PKP for medically unresponsive cases, are crucial for managing this rare but aggressive infection.
- Understanding the organism's drug sensitivities and pathogenic mechanisms is vital for effective treatment strategies.