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Clinical experience treating Paecilomyces lilacinus keratitis in four patients
Yu Monden1, Minoru Sugita, Ryoji Yamakawa
1Department of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Background:
Paecilomyces lilacinus is a saprobic fungus that occasionally causes keratitis in infected patients. Voriconazole, a triazole antifungal agent, is often administered to treat P. lilacinus keratitis, because it is resistant to many antifungal agents. However, some patients may not require voriconazole. Here, we report our experience of treating this infection and compare outcomes between patients treated with or without voriconazole.
Subjects:
We retrospectively reviewed four cases of infectious keratitis caused by P. lilacinus and compared treatment course and outcomes among the four cases.
Observations:
P. lilacinus was isolated from corneal cultures in all four cases. Three cases developed corneal perforation and underwent keratoplasty. Voriconazole was given in two cases with severe and refractory infection. Both required long-term treatment despite the effectiveness of voriconazole. They also had a medical history of diabetes and corticosteroid therapy. In two cases that were not treated with voriconazole, the eye conditions improved with a short treatment period (2-3 weeks). Neither of these cases had a medical history of diabetes, nor had they used corticosteroids.
Conclusion:
Although voriconazole is the most useful antifungal agent for treating P. lilacinus keratitis, this infection can be resolved by other treatments. Voriconazole should be offered to patients with diabetes and/or prior corticosteroid use.
Insights
Paecilomyces lilacinus keratitis may not always require voriconazole. This study suggests voriconazole is best for patients with diabetes or prior corticosteroid use, while others may improve with alternative treatments.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Paecilomyces lilacinus is a fungus that can cause keratitis.
- Voriconazole is a common antifungal treatment for P. lilacinus keratitis.
- However, not all patients require voriconazole for successful treatment.
Observation:
- A retrospective review of four P. lilacinus keratitis cases was conducted.
- Two severe cases with diabetes and corticosteroid use required long-term voriconazole.
- Two milder cases without these risk factors improved with shorter, alternative treatments.
Findings:
- P. lilacinus keratitis can be resolved with treatments other than voriconazole.
- Voriconazole effectiveness was noted in severe, refractory cases.
- Shorter treatment durations were effective in cases without diabetes or corticosteroid use.
Implications:
- Voriconazole should be reserved for P. lilacinus keratitis patients with specific risk factors like diabetes or corticosteroid use.
- Alternative antifungal strategies may be sufficient for less severe cases.
- This finding can help optimize antifungal therapy and reduce unnecessary drug exposure.
