[Advances in clinical diagnosis and treatment of pythium keratitis]

Area of Science:

• Ophthalmology
• Infectious Diseases
• Mycology

Background:

• Pythium insidiosum, an aquatic oomycete, causes Pythium insidiosum keratitis (PIK).
• PIK presents as aggressive corneal ulcers, often mistaken for fungal keratitis, potentially leading to blindness.
• Endemic in tropical/subtropical regions, PIK incidence rises during monsoon seasons, linked to water exposure and plant trauma.

Purpose of the Study:

• To review the epidemiology, etiology, clinical features, diagnosis, and treatment of PIK.
• To provide a clinical management reference for PIK, particularly in regions with rare reported cases like China.

Main Methods:

• Literature review summarizing existing studies on PIK.
• Analysis of diagnostic techniques including corneal scrapings, PCR, metagenomic sequencing, and confocal microscopy.
• Evaluation of treatment strategies, focusing on antibiotic efficacy and surgical interventions.

Main Results:

• PIK is characterized by rapid corneal ulceration and dissolution, often misdiagnosed.
• Diagnostic methods vary, with advanced techniques like metagenomic sequencing offering improved identification.
• Antibiotics, particularly linezolid and azithromycin, are first-line treatments due to poor response to antifungals; severe cases may need keratoplasty.

Conclusions:

• Effective management of PIK requires accurate diagnosis and appropriate antibiotic therapy.
• Understanding PIK's epidemiology and risk factors is crucial for prevention and early intervention.
• This review highlights the need for increased awareness and tailored clinical approaches for PIK.