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Pathogenesis and outcome of Paecilomyces keratitis

Xiaoyong Yuan1, Kirk R Wilhelmus, Alice Y Matoba

  • 1Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

American Journal of Ophthalmology
|February 7, 2009
PubMed
Abstract

Insights

Paecilomyces lilacinus keratitis is an emerging fungal infection. Treatment with natamycin or amphotericin B is often ineffective, with voriconazole showing promise.

Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Paecilomyces lilacinus is an emerging fungal pathogen causing keratitis.
  • Risk factors include chronic keratopathy, ocular surgery, corneal trauma, and contact lens wear.

Purpose of the Study:

  • To investigate the clinical pathology and management strategies for Paecilomyces lilacinus keratitis.

Main Methods:

  • Observational case series and literature review of 42 cases.
  • Laboratory study including in vitro antifungal susceptibility testing.
  • Experimental inoculation in murine eyes and human donor corneas.

Main Results:

  • 31% of cases were associated with chronic keratopathy or surgery, 26% with trauma, and 24% with contact lens wear.
  • Medical cure was achieved in 31% of cases, with limited success for natamycin/amphotericin B.
  • In vitro studies showed resistance to natamycin/amphotericin B but susceptibility to ketoconazole and voriconazole.

Conclusions:

  • Paecilomyces lilacinus keratitis presents with filamentous invasion and sporulation.
  • Natamycin and amphotericin B are not reliably effective; therapeutic keratoplasty is often required.
  • Topical azole antifungals, particularly voriconazole, demonstrate potential for treating this infection.

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