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Published on: February 15, 2019
Influence of corticosteroid on experimentally induced keratomycosis
1Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN 37232-2540.
Abstract:
To assess the effect of corticosteroid on the establishment of experimentally induced keratomycoses, rabbits were injected subconjunctivally with triamcinolone acetonide on two successive days before inoculation with Candida albicans, Aspergillus fumigatus, or Fusarium solanae. Whereas isolate recovery rates declined steadily in normal control corneas, they remained stable over 15 days in corticosteroid-treated corneas. Clinically, inflammation was equivalent (A fumigatus and F solanae) or significantly less (C albicans; P = .001) until the 10th day. At 15 days, inflammation in corticosteroid-treated corneas was significantly worse in animals infected with A fumigatus (P = .003) or F solanae (P = .02). Inflammatory signs correlated inconsistently with isolate recovery. Pathogenicity of the infecting organism appears to be important in determining the degree to which corticosteroid is able to mask clinical signs of infection while enhancing fungal replication.
Insights
Corticosteroid treatment enhanced fungal replication and masked inflammation in rabbit keratomycosis models. This immunosuppression prolonged fungal presence, potentially worsening outcomes with certain fungal pathogens.
Area of Science:
- Ophthalmology
- Mycology
- Immunology
Background:
- Fungal keratitis is a serious ocular infection.
- Corticosteroids are sometimes used to manage ocular inflammation.
- The impact of corticosteroids on fungal keratitis establishment and progression requires further investigation.
Purpose of the Study:
- To evaluate the effect of corticosteroid administration on the establishment and progression of experimental fungal keratitis in rabbits.
- To assess the influence of corticosteroid on fungal isolate recovery and clinical signs of inflammation.
Main Methods:
- Rabbits received subconjunctival triamcinolone acetonide injections prior to inoculation with Candida albicans, Aspergillus fumigatus, or Fusarium solanae.
- Fungal isolate recovery rates and clinical inflammatory signs were monitored over 15 days.
- Comparison between corticosteroid-treated and normal control corneas.
Main Results:
- Corticosteroid treatment maintained stable fungal isolate recovery rates compared to declining rates in controls.
- Initial inflammation was reduced or equivalent in corticosteroid-treated corneas for most fungal species.
- By day 15, inflammation was significantly worse in corticosteroid-treated corneas infected with Aspergillus fumigatus or Fusarium solanae.
- Clinical signs of inflammation did not consistently correlate with fungal isolate recovery.
Conclusions:
- Corticosteroids can enhance fungal replication and mask early clinical signs of keratomycosis.
- The pathogenicity of the fungal organism influences the interplay between corticosteroid-induced immunosuppression and fungal growth.
- Corticosteroid use in fungal keratitis may prolong infection and potentially worsen outcomes, depending on the causative agent.
