RESUMO
PURPOSE: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. METHODS: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. RESULTS: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). CONCLUSION: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.
Assuntos
Úlcera da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Infecções Oculares Fúngicas , Ceratite , Humanos , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Antifúngicos/uso terapêutico , Estudos Retrospectivos , Ceratite/etiologia , Ceratite/microbiologia , Ceratoplastia Penetrante/efeitos adversos , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Úlcera da Córnea/tratamento farmacológicoRESUMO
Abstract This is a case of bilateral and simultaneous Acremonium keratitis related to intermittent and alternating eye soft contact lens use, which has a delayed diagnose, presented amphotericin B resistance with persistent hypopyon and had a positive response to topical natamycin. Besides the unusual presentation, there was no history of trauma or contact with vegetable matter, usually associated to the majority of cases of keratomicosys by filamentous fungi.
Resumo Trata-se de um caso de ceratite bilateral e simultânea por Acremonium relacionada ao uso intermitente e sem respeitar a lateralidade do uso de lentes de contato gelatinosas. Houve diagnóstico tardio, apresentando resistência a anfotericina B e hipópio persistente, com resposta positiva a natamicina tópica. Além da forma incomum de apresentação, não houve histórico de trauma ou contato com material vegetal, associado à maioria dos casos de ceratite por fungos filamentosos.
Assuntos
Humanos , Feminino , Idoso , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Lentes de Contato/efeitos adversos , Ceratite/etiologia , Ceratite/microbiologia , Atropina/uso terapêutico , Acremonium/isolamento & purificação , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Anfotericina B/uso terapêutico , Natamicina/uso terapêutico , Itraconazol/uso terapêutico , Hifas , Farmacorresistência Fúngica , Microscopia com Lâmpada de Fenda , Ceratite/diagnóstico , Ceratite/terapiaRESUMO
ABSTRACT Endogenous endophthalmitis is a rare, and frequently devastating, ophthalmic disease. It occurs mostly in immunocompromised patients, or those with diabetes mellitus, cancer or intravenous drugs users. Candida infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within days to weeks of fungemia. The association of treatment for pancreatitis with endophthalmitis is unusual. Treatment with broad-spectrum antibiotics and total parenteral nutrition may explain endogenous endophthalmitis. We report the case of a patient with pancreatitis treated with broad-spectrum antibiotics and total parenteral nutrition who developed bilateral presumed Candida endogenous endophthalmitis that was successfully treated with vitrectomy and intravitreal amphotericin B.
RESUMO Endoftalmite endógena é uma condição oftalmológica rara e frequentemente devastadora. Ocorre principalmente em pacientes imunocomprometidos, diabéticos, com neoplasias ou usuários de drogas intravenosas. Infecção por Candida é a causa mais comum de endoftalmite endógena. A candidíase ocular ocorre de dias a semanas após a fungemia. A associação de endoftalmite e o tratamento para pancreatite é rara. O tratamento com antibióticos de amplo espectro e alimentação parenteral total podem explicar uma endoftalmite endógena. Neste estudo, reportamos o caso de um paciente com pancreatite tratado com antibióticos de amplo espectro e alimentação parenteral total que desenvolveu endoftalmite endógena bilateral presumida por Candida que foi tratado com sucesso com vitrectomia e injeção intravítrea de amfotericina B.
Assuntos
Humanos , Masculino , Adulto , Infecções Oculares Fúngicas/cirurgia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Endoftalmite/cirurgia , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Pancreatite/complicações , Pancreatite/tratamento farmacológico , Vitrectomia , Candida , Candidíase/tratamento farmacológico , Angiofluoresceinografia , Infecções Oculares Fúngicas/etiologia , Fluconazol/uso terapêutico , Anfotericina B/uso terapêutico , Endoftalmite/etiologia , Administração Oral , Ultrassonografia , Nutrição Parenteral , Injeções Intravítreas , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure. AIMS: The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection. METHODS: We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48h of hospital admission. RESULTS: We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%). CONCLUSIONS: CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality.
Assuntos
Candidíase Invasiva/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Brasil/epidemiologia , Candidemia/epidemiologia , Candidemia/etiologia , Candidemia/microbiologia , Candidíase Invasiva/etiologia , Candidíase Invasiva/microbiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Suscetibilidade a Doenças , Endocardite/epidemiologia , Endocardite/etiologia , Endocardite/microbiologia , Endoftalmite/epidemiologia , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Candida endophthalmitis is related to immunosuppression state, intravenous catheters, invasive procedures and parenteral feeding. It is estimated that between 2% and 10% of endophthalmitis are endogenous, within fungal etiology the most frequently isolated microorganism is Candida albicans. The infection by C. dubliniensis is reported in less than 2 % of the cases of infection by Candida at systemic level and few reported cases of endophthalmitis. The clinical presentation is poor vision , vitritis, cottony deposits, chorioretinitis, and necrosis. The confirmatory diagnosis must be made with vitreous culture and the treatment is based on combination of vitrectomy and intravitreal antifungal. CLINICAL CASE: It is reported a case of a patient with enterocutaneous fistula, long hospital stay with parental nutrition that cause endophthalmitis without immunosuppression. CONCLUSIONS: Endogenous endophthalmitis by C. dubliniensis is barely documented in the literature. Candida endophthalmitis should always be considered in patients with risk factors, in order to provide timely diagnosis and appropriate management, yet the prognosis in these patients is poor for function and organ preservation and for life from complications involving these patients from associated pathologies.
Introducción: los casos de endoftalmitis por Candida se relacionan con estados de inmunodepresión, catéteres intravenosos, procedimientos invasivos y alimentación parenteral. Se estima que entre el 2 % y el 10 % de las endoftalmitis son endógenas. Dentro de la etiología fúngica, Candida albicans es el microorganismo más frecuentemente aislado. La infección por C. dubliniensis se reporta en menos del 2 % de los casos de infección por Candida a nivel sistémico y hay pocos casos reportados de endoftalmitis. La presentación clínica consiste en baja visual, vitreítis, depósitos algodonosos, coriorretinitis y necrosis retiniana. El diagnóstico confirmatorio se debe realizar con cultivo vítreo y el tratamiento se basa en la combinación de antifúngicos intravítreos y vitrectomía. Caso clínico: se trata paciente con fistula enterocutánea larga estancia intrahospitalaria con NPT que cursa con endoftalmitis bilateral sin inmunodepresión. Conclusiones: la endoftalmitis por Candida siempre debe tomarse en cuenta en pacientes con factores de riesgo para poder brindar un diagnóstico oportuno y un adecuado manejo. Aun así, el pronóstico en estos pacientes es malo para la función, la conservación del órgano y para la vida debido a las complicaciones por patologías asociadas.
Assuntos
Candidíase/diagnóstico , Endoftalmite/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Candidíase/etiologia , Candidíase Cutânea/complicações , Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Feminino , Dermatoses do Pé/complicações , Humanos , México , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
After drawing a dose from an closed bevacizumab (Avastin) bottle, a fungus-like foreign body was observed inside. Samples from the vial were cultured in Sabouraud Emmons media. Growth of multiple light brown colonies with dark pigment was observed after 10 days. The species was identified as Scytalidium sp.Vial, analysis reported that the seal was lacking proper identification measures and that the label, batch number and expiry date did not correspond to a genuine product. Chemical analysis showed no protein, but 3% of polyethylene glycol, citrate and ethanol. Counterfeit bevacizumab is a real situation that poses a significant risk for ophthalmology and oncology patients. The medical community should be aware of this situation in order to enforce adequate preventive measures.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Neovascularização de Coroide/tratamento farmacológico , Medicamentos Falsificados/efeitos adversos , Contaminação de Medicamentos , Embalagem de Medicamentos , Infecções Oculares Fúngicas/etiologia , Fungos/crescimento & desenvolvimento , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Bevacizumab , Infecções Oculares Fúngicas/microbiologia , Fungos/isolamento & purificação , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
BACKGROUND: Some of the most common precipitating events for keratomycoses (fungal keratitis), include surgical trauma (after cornea transplantation), the use of contaminated contact lenses or alterations in lacrimal secretions. Diagnosis and treatment (to avoid loss of vision) for these type of infections are challenging. OBJECTIVE: Retrospective review of the diagnosis, epidemiology, etiology and response to treatment in 219 patients with fungal keratitis in Mexico. METHODS: We have studied the diagnosis, epidemiology, etiology and response to treatment in 219 patients from different states in the Mexican Republic in the Cornea Department at an Ophthalmology Hospital in Mexico D.F. RESULTS: Trauma was the precipitating event in 77 patients (36%), of which 12 (5.4%) were due to surgical trauma; 152 patients (64.8%) did not report any prior trauma. There were 165 male (75.3%) and 54 female (24.6%) patients, with an average age of 46 years old. For clinical and visual treatment patients were treated with topical and oral antifungals and surgery. One or more surgeries were performed on a total of 81 patients (36.9%). A total of 62 patients (28.3%) received a corneal transplant, and 19 patients (8.7%) were subjected to conjunctival flap or scleral-conjunctival surgery. CONCLUSIONS: In Mexico, keratomycoses affect mostly male patients in a 4:1 ratio over females. Fusarium solani was the most frequent agent of fungal keratitis in our study (37.2%), and the highest number of corneal ulcers and eviscerations (26%) was present in patients infected by Aspergillus. The best therapeutic responses were with combination of topical antifungals against dematiaceous fungi.
Assuntos
Infecções Oculares Fúngicas/epidemiologia , Ceratite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Lentes de Contato/efeitos adversos , Lentes de Contato/microbiologia , Transplante de Córnea , Suscetibilidade a Doenças , Síndromes do Olho Seco/complicações , Contaminação de Equipamentos , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/cirurgia , Feminino , Hospitais Especializados/estatística & dados numéricos , Humanos , Lactente , Ceratite/tratamento farmacológico , Ceratite/etiologia , Ceratite/microbiologia , Ceratite/cirurgia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To describe the clinical characteristics, diagnosis, treatment, and visual outcome of 61 cases of Fusarium keratitis in Mexico. METHODS: Retrospective, comparative study of 61 patients with clinically and culture-confirmed Fusarium keratitis, who were attended at an eye hospital in Mexico City from 1981 to 2001. RESULTS: Fusarium solani was the main causal agent in 83.6% of cases. Trauma history was observed in 57.4% and a history of agricultural activity in 34.4%. Signs were redness (100%), epithelial defects (98.3%), superficial corneal ulcer (95.1%), anterior chamber inflammation (91.8%), and satellite infiltrates (75.4%). In 50% of cases, the treatment was topical ketoconazole 2%; in 34.2% of cases, additional topical antifungal preparations were used. A total of 77% of patients improved and 23% worsened. Conjunctival flap was indicated in 4 of 61 patients (6.5%), and 14 of 61 patients (23%) underwent penetrating keratoplasty. Two of 61 patients were treated with tectonic keratoplasty. Evisceration surgeries were practiced in 14 of 61 patients (22.9%). The final visual acuity after medical or medical/surgical therapy, was no light perception (NLP) in 19 patients (33.33%), light perception (LP) to hand movements (HM) in 18 patients (31.57%), 20/400 to 20/200 in 1 patient (1.75%), 20/150 to 20/60 in 5 patients (8.77%), and 20/40 to 20/20 in 14 patients (24.56%). Four patients were lost to follow-up. CONCLUSIONS: Fusarium is the most common cause of fungal keratitis in Mexico. Most cases (43/54, 79.6%) improved with topical antifungal therapy (either monotherapy or combined). We suggest surgical therapy with conjunctival flap or penetrating keratoplasty in advanced cases, when there has been poor response to medical therapy or a very low final visual acuity.
Assuntos
Infecções Oculares Fúngicas , Fusarium , Adolescente , Adulto , Idoso , Agricultura , Antifúngicos/uso terapêutico , Criança , Úlcera da Córnea/microbiologia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/terapia , Feminino , Humanos , Ceratite/microbiologia , Ceratite/patologia , Ceratoplastia Penetrante/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To report two cases of infectious keratitis that developed 2 and 6 years after LASIK. METHODS: Case 1 was a 56-year-old woman who presented with redness and decreased vision in the right eye 6 years after LASIK. Slit-lamp examination revealed inflammation of the flap interface, a partially detached flap, anterior chamber reaction, and hypopyon. Corneal scrapings were taken. Case 2 was a 23-year-old woman who presented with pain and a corneal infiltrate in the left eye 36 hours after eye trauma. She had undergone bilateral LASIK 2 years prior. The condition worsened despite treatment, and a flap amputation was performed. RESULTS: Cultures revealed Pseudomonas mesophilic and Fusarium solani, respectively. Keratitis in case 1 resolved after 21 days of fortified antibiotic therapy. Visual acuity of 20/40 was achieved after antibiotic treatment in case 2. CONCLUSIONS: These case reports demonstrate the risk of microbial keratitis occurring years after LASIK and emphasize the need for lifelong postoperative vigilance by patient and physician.
Assuntos
Úlcera da Córnea/etiologia , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Fúngicas/etiologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Micoses/etiologia , Infecções por Pseudomonas/etiologia , Adulto , Antibacterianos/uso terapêutico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Feminino , Fusarium/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/tratamento farmacológico , Pseudomonas/isolamento & purificação , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Retalhos Cirúrgicos/microbiologiaRESUMO
PURPOSE: To report an uncommon case of multifocal choroiditis as the result of disseminated Cryptococcus neoformans infection in a patient who is HIV-positive. DESIGN: Interventional case report. METHODS: A 27-year-old HIV-positive woman with fever, headache, and vomiting was examined. Lumbar puncture was performed and revealed C neoformans infection. Her condition evolved with sudden bilateral blindness and deafness. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. RESULTS: Postmortem examination showed disseminated C neoformans infection. Histologic examination of the eyes confirmed the presence of C neoformans in the choroiditis. CONCLUSION: Multifocal choroiditis in C neoformans infection is a rare ophthalmic manifestation. The recognition of this condition by ophthalmologists can help physicians to diagnose a disseminated and fatal disease.
Assuntos
Corioidite/microbiologia , Criptococose/etiologia , Cryptococcus neoformans/isolamento & purificação , Infecções Oculares Fúngicas/etiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Antifúngicos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Antivirais/uso terapêutico , Cegueira/etiologia , Líquido Cefalorraquidiano/microbiologia , Corioidite/diagnóstico , Corioidite/tratamento farmacológico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Surdez/etiologia , Quimioterapia Combinada , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Evolução Fatal , Feminino , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/microbiologia , Humanos , Punção EspinalRESUMO
PURPOSE: To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). METHODS: The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara or Intacs) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. RESULTS: Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantation for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. CONCLUSIONS: Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.
Assuntos
Substância Própria/cirurgia , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Fúngicas/etiologia , Ceratite/etiologia , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Adulto , Bactérias/isolamento & purificação , Remoção de Dispositivo , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/cirurgia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/cirurgia , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/cirurgia , Ceratocone/cirurgia , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato , Próteses e Implantes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To describe an unusual case of disseminated sporotrichosis with intraocular involvement. DESIGN: Interventional case report. RESULTS: An 18-year-old man presented with disseminated ulcerated skin lesions. Fundus examination showed fluffy opacities in the vitreous and a retinal granuloma in the left eye. Biopsy of the skin lesion and lymph node showed the presence of numerous fungus cells. Culture was positive for the diagnosis of disseminated sporotrichosis. CONCLUSION: Although intraocular infection due to Sporothrix schenckii is uncommon, it can occur in case of disseminated sporotrichosis. Systemic therapy is a successful means to control skin and ocular sporotrichosis.
Assuntos
Infecções Oculares Fúngicas/etiologia , Granuloma/microbiologia , Doenças Retinianas/microbiologia , Sporothrix/isolamento & purificação , Esporotricose/complicações , Adolescente , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Oftalmopatias/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Humanos , Masculino , Doenças Retinianas/diagnóstico , Doenças Retinianas/tratamento farmacológico , Pele/microbiologia , Esporotricose/diagnóstico , Esporotricose/tratamento farmacológico , Corpo Vítreo/efeitos dos fármacos , Corpo Vítreo/microbiologia , Corpo Vítreo/patologiaRESUMO
PURPOSE: To describe a rare case of bilateral Candida keratitis after contact lens use following bilateral penetrating keratoplasty (PK). METHODS: A 40-year-old female with a clinical diagnosis of Sjögren's syndrome was being followed for corneal thinning in both eyes. She suffered a spontaneous bilateral perforation and underwent penetrating keratoplasty. Therapeutic contact lenses were prescribed for both eyes owing to persistent epithelial defects. Two months later, a biomicroscopic examination revealed corneal infiltrates. RESULTS: A corneal tissue sample, saline, and contact lens cultures were all positive for Candida albicans. Topical and systemic antifungal therapy successfully cleared the infection in the right eye; however, the left eye underwent another corneal graft surgery. CONCLUSIONS: Infectious fungal keratitis may be a complication of wearing therapeutic contact lenses after PK, in a patient with Sjögren's syndrome. The pre-existing eye disease is an important associated factor in cases of yeast infection; therefore, adequate care of these patients and careful follow-up after PK are indicated as measures to prevent early infections.
Assuntos
Candida albicans/isolamento & purificação , Candidíase , Lentes de Contato/efeitos adversos , Infecções Oculares Fúngicas , Ceratite/microbiologia , Adulto , Antifúngicos/administração & dosagem , Candidíase/etiologia , Candidíase/terapia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/terapia , Feminino , Humanos , Ceratite/terapia , Ceratoplastia Penetrante , Soluções Oftálmicas , Resultado do TratamentoRESUMO
La cirugía refractiva es una técnica difundida universalmente, esta técnica es bastante segura, sin embargo, en ocasiones podemos tener complicaciones, y estas pueden ser desde sencillas en su manejo, hasta tener un desenlace fatal. Nosotros reportamos cinco pacientes que desarrollaron micosis corneal, en alguno de los cortes de la cirugía refractiva (queratotomía radiada). Se les aisló, se tipificó y se practicaron estudios histopatológicos en los 5 pacientes. En todos se comprobó la presencia de hongo Fusarium solani. Como es sabido, la infección por este hongo es una de las queratitis micóticas más agresivas. Se manejaron con antimicóticos, transplante y un caso terminó en ptisis bulbi después de manejar su endoftalmitis. Este artículo motiva al cirujano oftalmólogo a extremar precauciones aun en técnicas tan sencillas como la refractiva
Assuntos
Humanos , Masculino , Feminino , Adulto , Córnea/cirurgia , Infecções Oculares Fúngicas/etiologia , Ceratotomia Radial/efeitos adversosRESUMO
Rhino-orbital-cerebral mucormycosis is a disease that is frequently fatal. A 39-year-old man with diabetic ketoacidosis was referred to the authors' ophthalmic service with fever, orbital apex syndrome in the right eye, lethargy, and a black eschar in the palate. He was treated with systemic and local (intraconal) amphotericin B and his ketoacidosis was controlled; exenteration was not performed. Biopsy of the palate proved mucormycosis. Eighteen months later the patient was still alive and had a blind, anatomically preserved right eye with ptosis and intact extraocular muscle function without proptosis or pain. The authors propose this alternative means of treatment to achieve higher doses of the drug at the site of infection and better cosmetic and psychological results.
Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infecções Oculares Fúngicas/tratamento farmacológico , Mucormicose/tratamento farmacológico , Órbita/efeitos dos fármacos , Doenças Orbitárias/tratamento farmacológico , Doenças dos Seios Paranasais/tratamento farmacológico , Adulto , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Biópsia , Cetoacidose Diabética/complicações , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/etiologia , Humanos , Masculino , Mucormicose/diagnóstico , Mucormicose/etiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/microbiologia , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/microbiologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: A 30-year-old patient with the acquired immunodeficiency syndrome (AIDS) had limbal nodules and multifocal choroidal lesions. METHODS: A biopsy of the limbal nodules was performed. RESULTS: The biopsy showed Cryptococcus neoformans surrounded by thick mucinous capsules without inflammatory cell infiltration. CONCLUSION: In the differential diagnosis of limbal mass in patients with AIDS, cryptococcal infection should be considered.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Doenças da Coroide/microbiologia , Doenças da Córnea/microbiologia , Criptococose/etiologia , Infecções Oculares Fúngicas/etiologia , Limbo da Córnea/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Doenças da Coroide/tratamento farmacológico , Corioidite/etiologia , Doenças da Córnea/tratamento farmacológico , Criptococose/tratamento farmacológico , Cryptococcus neoformans/isolamento & purificação , Diagnóstico Diferencial , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Masculino , Hemorragia Retiniana/etiologiaRESUMO
Se presenta un caso de endoftalmitis micótica del ojo derecho en un paciente de 26 años, que había sufrido una úlcera traumática la cual se perforó a pesar del tratamiento local y general con antimicóticos. Se debieron realizar sucesivos colgajos conjuntivales para lograr curación, también se utilizó como último recurso una lente de contacto terapéutica. Del material obtenido por raspado de la úlcera de córnea y del humor vítreo se aisló Acremonium kiliense. El tratamiento médico-quirúrgico fue prolongado debido a la agresividad del hongo; se logró salvar la integridad del globo ocular
Assuntos
Humanos , Acremonium/isolamento & purificação , Fluconazol/uso terapêutico , Infecções Oculares Fúngicas/etiologia , Acremonium/patogenicidade , Fluconazol/administração & dosagem , Infecções Oculares Fúngicas/tratamento farmacológicoRESUMO
Se presenta un caso de endoftalmitis micótica del ojo derecho en un paciente de 26 años, que había sufrido una úlcera traumática la cual se perforó a pesar del tratamiento local y general con antimicóticos. Se debieron realizar sucesivos colgajos conjuntivales para lograr curación, también se utilizó como último recurso una lente de contacto terapéutica. Del material obtenido por raspado de la úlcera de córnea y del humor vítreo se aisló Acremonium kiliense. El tratamiento médico-quirúrgico fue prolongado debido a la agresividad del hongo; se logró salvar la integridad del globo ocular (AU)
Assuntos
Humanos , Infecções Oculares Fúngicas/etiologia , Acremonium/isolamento & purificação , Fluconazol/uso terapêutico , Infecções Oculares Fúngicas/tratamento farmacológico , Acremonium/patogenicidade , Fluconazol/administração & dosagemRESUMO
Los hongos oportunistas son agentes causales de infecciones de córnea en individuos sanos que, frecuentemente, realizan tareas al aire libre y están expuestos a sufrir traumatismos por algún tipo de vegetal. También afectan ojos con alteraciones físicas predisponentes. Se estudiaron 65 pacientes con lesiones de córnea durante el período comprendido entre enero de 1989 y julio de 1992. Las técnicas de laboratorio que se realizaron consistieron en el examen directo de las muestras clínicas y los cultivos. Del total de materiales sólo 9 (13,85%) mostraron la presencia de hongos. El mayor porcentaje de aislamiento correspondió a Fusarium solani (7.69%) seguido por Aspergilus fumigatus (3.08%), Acremonium s.p. (1.54%), Cladosporium s.p. (1.54%). Los pacientes fueron tratados con miconazol, ketoconazol y un caso con natamicina que es la droga de elección para las infecciones oculares debidas a hongos. Merece destacarse la importancia de la búsqueda de estos hongos en infecciones oculares así como la rapidez en el diagnóstico del agente microbiano. De esta manera no sólo se acelera la cura de la afección sino que se reducen los riesgos de complicación y pérdida de la visión