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A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus
Fumika Hotta1, Hiroshi Eguchi2, Keiko Nishimura3
1Department of Ophthalmology, Sakai Hospital Kindai University, 2-7-1 Harayamadai, Minami-ku, Sakai, Osaka, 590-0132, Japan.
Background:
Polymicrobial keratitis with fungus and bacteria can lead to blindness and is challenging to treat. Here, we introduce a case of fungal keratitis caused by two different strains in addition to definite bacterial super-infection caused by an α-Streptococcus sp., and describe the importance of microscopic examination.
Case Presentation:
A 74-year-old woman, who had a past history of infection with leprosy, presented with conjunctival hyperaemia, pain, and corneal opacity in her right eye. Under the presumptive diagnosis of infectious keratitis, corneal scrapings were stained by various reagents and inoculated on several agar plates. Microscopic findings of the scrapings revealed fungi and a small number of Gram-positive cocci. Multiple anti-fungal therapies with levofloxacin ophthalmic solution were administered. Although empiric treatment was initially effective, keratitis recurred 10 days after its initiation. Repeated corneal scraping revealed an abundance of Gram-positive chain cocci and a small amount of fungi, resulting in the switching of an antibiotic medication from levofloxacin to moxifloxacin and cefmenoxime. Keratitis resolved gradually after the conversion. Stemphylium sp., Acremonium sp., and α-Streptococcus sp. were simultaneously isolated from the corneal scrapings.
Conclusions:
To the best of our knowledge, this is the first case of fungal keratitis caused by Stemphylium sp., and also the first case of super-infection in the cornea caused by two different fungi and one bacterium. Microscopic examination of the corneal scrapings was beneficial in rapid decision of changing to appropriate drug according to the dominancy of pathogenicity.
Insights
This case study highlights a rare polymicrobial keratitis involving two fungal strains and a bacterial infection. Prompt microscopic examination guided effective treatment, preventing blindness from this challenging corneal infection.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Polymicrobial keratitis, involving both fungal and bacterial pathogens, presents a significant challenge in treatment and can lead to blindness.
- Fungal keratitis, especially when complicated by bacterial super-infection, requires accurate and timely diagnosis for effective management.
Observation:
- A 74-year-old female with a history of leprosy presented with symptoms suggestive of infectious keratitis.
- Initial corneal scrapings revealed fungi and Gram-positive cocci, leading to antifungal and levofloxacin treatment.
- Recurrence of keratitis prompted repeat scraping, which showed a shift in microbial dominance to Gram-positive cocci and fungi, necessitating a change in antibiotic therapy.
Findings:
- The case involved a unique polymicrobial keratitis caused by Stemphylium sp., Acremonium sp., and α-Streptococcus sp.
- Microscopic examination of corneal scrapings was instrumental in identifying the causative agents and guiding timely therapeutic modifications.
- Successful resolution was achieved after switching from levofloxacin to moxifloxacin and cefmenoxime, alongside antifungal treatment.
Implications:
- This case underscores the importance of prompt and accurate microscopic examination of corneal scrapings in diagnosing and managing polymicrobial keratitis.
- The findings highlight the potential for complex fungal and bacterial co-infections in the cornea and the need for adaptable treatment protocols.
- Early identification of microbial dominance through microscopy can facilitate rapid changes in medication, improving patient outcomes in severe keratitis cases.
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