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Pythium insidiosum keratitis - A review
Bharat Gurnani1, Kirandeep Kaur2, Anitha Venugopal3
1Cataract, Cornea, External Disease, Trauma and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
Indian Journal of Ophthalmology
|March 25, 2022
Summary
Pythium insidiosum, a fungal mimic, causes increasing keratitis cases. Early diagnosis via molecular methods and prompt treatment with antibacterials, not antifungals, are crucial for better outcomes.
Area of Science:
- Ophthalmology
- Medical Mycology
- Infectious Diseases
Background:
- Pythium insidiosum, an oomycete, is increasingly recognized as a cause of keratitis, particularly in Asia.
- It mimics fungal keratitis clinically and morphologically, complicating diagnosis and treatment.
- Rising case numbers are linked to improved diagnostics and research.
Purpose of the Study:
- To review the epidemiology, clinical presentation, diagnostic methods, and treatment strategies for Pythium insidiosum keratitis.
- To highlight distinguishing clinical features and current diagnostic advancements.
- To discuss evolving treatment paradigms, including the role of antibacterials.
Main Methods:
- Literature review of Pythium insidiosum keratitis cases and studies.
- Analysis of clinical features, diagnostic modalities (microscopy, culture, molecular methods), and treatment outcomes.
- Synthesis of information on epidemiology and pathogenesis.
Main Results:
- Pythium keratitis shares features with fungal keratitis (infiltrates, hypopyon) but has unique signs like reticular dots and limbal spread.
- Traditional diagnosis relies on culture, but molecular methods (PCR, confocal microscopy) offer faster results.
- In vitro studies suggest antibacterials (linezolid, azithromycin) may be more effective than antifungals.
Conclusions:
- Pythium insidiosum keratitis requires high clinical suspicion due to its mimicry of fungal infections.
- Accurate and timely diagnosis, increasingly reliant on molecular techniques, is essential.
- Current evidence suggests a shift towards antibacterial therapy as a first-line treatment, alongside early surgical intervention in refractory cases.
