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Lasiodiplodia keratitis: A case series of 27 patients
Smruti R Priyadarshini1, Alluri Himabindu1, Srikant K Sahu1
1Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India.
Purpose:
To review 27 cases of microbial keratitis caused by Lasiodiplodia theobromae presenting to a tertiary eye care center in eastern India over seven-year period and analyze the risk factors, clinical profile, microbiological characteristics, treatment, and outcome of patients.
Method:
This is a retrospective review of 27 cases of microbial keratitis diagnosed with Lasiodiplodia theobromae between November 2015 and October 2022. Data were retrieved using the electronic medical record system. Additional outcomes such as average time of resolution, frequency, type, and outcome of surgical interventions, wherever performed, were also analyzed. Descriptive statistics were used to interpret the demographic data.
Results:
The mean age of patients was 56.8 ± 18.7 years (range: 23-86), the male: female ratio was 2.4:1, and the average follow-up was 90.2 days. Eleven (40.7%) patients had a history of trauma, and 16 (59.3%) presented with a large infiltrate (>6 mm). Samples from all the patients were culture-positive for Lasiodiplodia theobromae , of which 26 (96.3%) were corneal scrapings and one (4%) was a half-corneal button. Eight (29.6%) patients had coexisting bacterial infections. Successful management was achieved in 12 eyes (66.7%) with medical treatment alone (topical natamycin, n = 7; topical natamycin + oral ketoconazole, n = 3; and topical natamycin + topical gatifloxacin, n = 2). However, surgical intervention was required for nine (33.3%) eyes.
Conclusion:
Medical management with natamycin was effective in treating patients with Lasiodiplodia keratitis. However, advanced cases necessitated surgical intervention for complete resolution.
Insights
This study found natamycin effective for Lasiodiplodia keratitis treatment. Advanced cases of fungal eye infections required surgery for full recovery, highlighting the need for prompt medical intervention.
Area of Science:
- Ophthalmology
- Medical Mycology
- Infectious Diseases
Background:
- Microbial keratitis is a significant cause of vision loss worldwide.
- Lasiodiplodia theobromae is an emerging fungal pathogen causing ocular infections.
- Understanding the clinical spectrum and management of Lasiodiplodia keratitis is crucial for effective treatment.
Purpose of the Study:
- To review 27 cases of Lasiodiplodia theobromae-induced microbial keratitis.
- To analyze risk factors, clinical presentation, and microbiological characteristics.
- To evaluate treatment outcomes and identify predictors of success.
Main Methods:
- Retrospective review of 27 microbial keratitis cases caused by Lasiodiplodia theobromae (Nov 2015 - Oct 2022).
- Data collected from electronic medical records, including demographics, clinical findings, and treatment.
- Descriptive statistics used to analyze patient data and treatment outcomes.
Main Results:
- The average patient age was 56.8 years, with a male predominance (2.4:1).
- Trauma history (40.7%) and large corneal infiltrates (>6 mm) were common presentations.
- Topical natamycin-based medical treatment achieved successful outcomes in 66.7% of eyes; 33.3% required surgical intervention.
Conclusions:
- Medical management, particularly with topical natamycin, is effective for Lasiodiplodia keratitis.
- Advanced or severe cases may necessitate surgical intervention for complete resolution.
- Early diagnosis and appropriate treatment are vital for managing fungal keratitis.
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