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Clinical recommendations for the management of Pythium insidiosum keratitis

Bhupesh Bagga1, Lakshminarayanan Gowtham2, Ali R Djalilian3

  • 1Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.

The Ocular Surface
|August 20, 2025
PubMed

Insights

Pythium insidiosum causes difficult keratitis, often misdiagnosed as fungal. Antibacterial agents like linezolid show promise where antifungals fail, guiding new treatment strategies.

Area of Science:

  • Ophthalmology
  • Microbiology
  • Infectious Diseases

Background:

  • Pythium insidiosum is an emerging cause of keratitis.
  • It is frequently misdiagnosed as fungal keratitis due to similar clinical presentations.
  • Its unique cellular structure renders conventional antifungal therapies ineffective.

Purpose of the Study:

  • To provide an updated review of diagnostic techniques for Pythium insidiosum keratitis.
  • To outline current management strategies, including the use of antibacterial agents.
  • To assist clinicians in diagnosing and treating this challenging ocular infection.

Main Methods:

  • Review of in vitro and in vivo studies on Pythium insidiosum.
  • Analysis of clinical case reports and treatment outcomes.
  • Synthesis of current literature on diagnostic and therapeutic approaches.

Main Results:

  • Pythium insidiosum keratitis requires differentiation from fungal keratitis.
  • Antibacterial agents, specifically linezolid and azithromycin, demonstrate efficacy in preclinical models.
  • A shift in management from antifungal to antibacterial therapy is supported by emerging evidence.

Conclusions:

  • Accurate diagnosis is crucial for effective management of Pythium insidiosum keratitis.
  • Antibacterial agents represent a promising therapeutic option, challenging traditional antifungal approaches.
  • Updated diagnostic and management guidelines are essential for improving patient outcomes.
Keywords:
AzithromycinFungal keratitisLinezolidMicrobial keratitisPythium keratitisZoospores

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