Pythium insidiosum Keratitis: Past, Present, and Future.

Area of Science:

• Ophthalmology
• Medical Mycology
• Infectious Diseases

Background:

• Pythium insidiosum (PI) is an oomycete causing severe keratitis, often mistaken for fungal keratitis (FK).
• PI keratitis, initially geographically limited, has seen a significant increase, particularly in India.
• Its clinical presentation mimics FK, necessitating high suspicion for accurate diagnosis.

Purpose of the Study:

• To review the evolution, diagnosis, and treatment of Pythium insidiosum keratitis.
• To highlight diagnostic challenges and emerging therapeutic strategies.
• To discuss future directions in PI keratitis management.

Main Methods:

• Literature review of recent studies on PI keratitis.
• Analysis of clinical features, diagnostic modalities, and treatment outcomes.
• Comparison of PI keratitis with fungal keratitis.

Main Results:

• PI keratitis presents with unique features like reticular dot infiltrate and peripheral thinning.
• Microscopic examination and culture can be misleading; PCR is the current gold standard for diagnosis.
• Antifungals are ineffective; antibacterials demonstrate therapeutic potential.

Conclusions:

• Accurate diagnosis of PI keratitis is crucial due to its distinct etiology and treatment requirements.
• Current management focuses on antibacterials and surgical intervention (keratoplasty) for advanced cases.
• Further research is needed for improved diagnostic tools and standardized treatment protocols for PI keratitis.