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First Report of Neocucurbitaria unguis-hominis Keratitis
Nerea Sáenz-Madrazo1,2, Azucena Baeza1, Jesús Guinea3,4,5,6
1Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
Abstract:
Coelomycetous fungi are among the emerging causes of infections and have been involved in many kinds of infections, including keratitis and endophtalmitis. Here, we present the first case of keratitis caused by Neocucurbitaria unguis-hominis, a coelomycetous fungus belonging to the family Cucurbitariaceae. In this case report, we describe the clinical presentation of a 56-year-old woman, a regular contact lens wearer, who was treated for pain in her right eye and fixed spot vision after an injury with plant debris. On examination, a corneal ulcer was observed, the foreign body was removed, and topical eye-drop therapy was started. After an initial improvement, the patient returned three weeks later due to a recurrence of discomfort in her right eye, observing the persistence of the corneal ulcer. Corneal scrapings were taken for culture, growing a filamentous fungus after seven days, which was identified by sequencing the fungal internal transcribed spacer region. It should be noted that microbiological identification of the coelomycetes in the clinical laboratory is not easy because of their difficulty in sporulating, making molecular techniques based on the amplification and sequencing of appropriate phylogenetic markers essential. Identification of these fungi is mandatory in order to optimise treatment due to the difficulty in eradicating them with antifungal treatment, requiring surgery in 50% of cases.
Insights
This case report details the first instance of keratitis caused by Neocucurbitaria unguis-hominis, a coelomycetous fungus. Early identification and molecular techniques are crucial for treating these difficult-to-eradicate fungal eye infections.
Area of Science:
- Medical Mycology
- Ophthalmology
- Infectious Diseases
Background:
- Coelomycetous fungi are increasingly recognized as significant pathogens causing various infections, including severe ocular conditions like keratitis and endophthalmitis.
- Accurate identification of coelomycetous fungi in clinical settings is challenging due to their poor sporulation, often necessitating advanced molecular methods.
Observation:
- A 56-year-old female contact lens wearer presented with a corneal ulcer and vision loss after ocular injury from plant debris.
- Initial treatment provided temporary relief, but the corneal ulcer recurred, prompting further investigation.
Findings:
- Culture of corneal scrapings revealed a filamentous fungus, identified via internal transcribed spacer sequencing as Neocucurbitaria unguis-hominis, a coelomycetous fungus.
- This represents the first documented case of keratitis caused by this specific fungal species.
Implications:
- The difficulty in eradicating coelomycetous fungal infections, often requiring surgical intervention in 50% of cases, underscores the importance of precise microbiological diagnosis.
- Molecular identification techniques are essential for optimizing treatment strategies and improving patient outcomes for these emerging fungal pathogens.
