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Corneal transplant infection by Paecilomyces lilacinus
Abstract:
Paecilomyces lilacinus was cultured from an ulcerated corneal transplant, sections of which, following surgical removal, revealed dense mycelial growth throughout the corneal remnant and penetrating Descemet's membrane. PAS-stained sections showed, in addition to the hyphae, numerous small, ovoid elements consistent with conidia of P. lilacinus. Infection apparently had spread to the transplant from the recipient's cornea. The fungal isolate proved resistant, in vitro, to amphotericin B, 5-fluorocytosine, and pimaricin, but sensitive to ketoconazole and moderately sensitive to miconazole. Following a second transplant and intensive antifungal therapy, the infection appears to have been eliminated.
Insights
A corneal transplant was infected by Paecilomyces lilacinus, a fungus resistant to common antifungals. Successful treatment involved ketoconazole and miconazole after a second transplant.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis can compromise corneal transplants.
- Paecilomyces lilacinus is an opportunistic fungal pathogen.
Observation:
- Paecilomyces lilacinus was identified in an ulcerated corneal transplant.
- Histopathology revealed fungal hyphae and conidia penetrating corneal tissues, including Descemet's membrane.
- The infection appeared to originate from the recipient's native cornea.
Findings:
- The isolated Paecilomyces lilacinus demonstrated in vitro resistance to amphotericin B, 5-fluorocytosine, and pimaricin.
- The fungus was sensitive to ketoconazole and moderately sensitive to miconazole.
- Successful treatment was achieved following a second corneal transplant and intensive antifungal therapy.
Implications:
- This case highlights the potential for Paecilomyces lilacinus to cause severe corneal transplant infections.
- Antifungal susceptibility testing is crucial for guiding treatment of resistant fungal keratitis.
- Ketoconazole and miconazole show promise in treating Paecilomyces lilacinus infections.