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Sphaeropsis subglobosa keratomycosis--first reported case.

C M Kirkness1, D V Seal, Y M Clayton

  • 1Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, England.

Cornea
|January 1, 1991
PubMed
Summary

A bamboo-related eye injury led to a rare fungal infection, Sphaeropsis subglobosa keratomycosis. The infection recurred after treatment, requiring surgery to clear the persistent fungal keratitis and endophthalmitis.

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Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Recurrent keratomycosis, a fungal infection of the cornea, poses a significant challenge in clinical practice.
  • The coelomycete fungus Sphaeropsis subglobosa is identified as a novel human pathogen responsible for a severe case of keratomycosis.
  • Corneal injuries, particularly those associated with horticultural activities and contaminated materials like bamboo, are potential risk factors for fungal implantation.

Observation:

  • A patient presented with keratitis following a corneal injury from a frayed bamboo cane, with splinters lodging in the cornea.
  • Initial topical clotrimazole therapy was successful, but the infection recurred 39 months later as keratitis, progressing to endophthalmitis.
  • Surgical intervention, specifically penetrating keratoplasty, was required for complete eradication of the fungal infection.

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Findings:

  • Sphaeropsis subglobosa, previously unrecognized as a human pathogen, was isolated from the infected corneal tissue.
  • The fungus did not develop resistance to clotrimazole but survived in a dormant state deep within the corneal stroma.
  • The recurrent nature of the infection highlights the potential for fungal elements to persist despite initial treatment.

Implications:

  • Sphaeropsis subglobosa should be considered in the differential diagnosis of keratomycosis, especially in cases linked to bamboo or horticultural injuries.
  • This case underscores the importance of thorough evaluation and management of corneal foreign bodies, particularly those from plant material.
  • Understanding the pathogenesis and persistence mechanisms of S. subglobosa is crucial for developing effective therapeutic strategies against this emerging fungal pathogen.