Macrophomina phaseolina keratitis: treatment approach for poor response to topical natamycin

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Fungal keratitis is a significant cause of visual impairment, particularly in tropical and subtropical regions.
• Macrophomina phaseolina, a soil-dwelling fungus, can cause opportunistic infections, including rare cases of keratitis.
• Distinguishing Macrophormina keratitis from other microbial keratitis, such as Nocardia and Pythium, is crucial for effective treatment.

Purpose of the Study:

• To report a case of Macrophomina phaseolina keratitis following ocular trauma.
• To describe the clinical presentation and diagnostic challenges of this rare fungal infection.
• To evaluate the treatment response to topical voriconazole and intrastromal amphotericin B.

Main Methods:

• A middle-aged woman with a history of trauma to the left eye presented with symptoms of keratitis.
• Corneal scraping and smear analysis revealed fungal hyphae, leading to the identification of Macrophomina phaseolina.
• The patient was treated with topical natamycin and oral ketoconazole, later supplemented with topical voriconazole and intrastromal amphotericin B injections.

Main Results:

• Initial treatment with natamycin and ketoconazole was ineffective, with the infiltrates progressing in a ring pattern.
• Addition of topical voriconazole and intrastromal amphotericin B led to a positive clinical response.
• The corneal infiltrate resolved completely within five months with voriconazole monotherapy, showing no recurrence.

Conclusions:

• Macrophomina keratitis can present with clinical features mimicking other microbial infections, posing a diagnostic challenge.
• Topical voriconazole, combined with intrastromal amphotericin B, can be an effective treatment strategy for severe Macrophomina keratitis.
• This case underscores the importance of prompt mycological diagnosis and tailored antifungal therapy in managing complex keratitis cases.