Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis
Purpose: Acanthamoeba and fungal infections can be recalcitrant to therapy - more so when the deeper layers of the corneas are involved. We describe the diagnosis and successful management strategies employed in a case of deep keratitis due to co-infection with Acanthamoeba and Cladosporium sp. Obse...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S245199362100116X |
| _version_ | 1818726507004035072 |
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| author | Anita Raghavan Arjun Velayudhan Nair Kavitha N Narendran Venkatapathy Ram Rammohan |
| author_facet | Anita Raghavan Arjun Velayudhan Nair Kavitha N Narendran Venkatapathy Ram Rammohan |
| author_sort | Anita Raghavan |
| collection | DOAJ |
| description | Purpose: Acanthamoeba and fungal infections can be recalcitrant to therapy - more so when the deeper layers of the corneas are involved. We describe the diagnosis and successful management strategies employed in a case of deep keratitis due to co-infection with Acanthamoeba and Cladosporium sp. Observations: Once the diagnosis of co-infection with both Acanthamoeba and Cladosporium was made, treatment was initiated with a combination of PHMB, chlorhexidine, natamycin, and voriconazole; to which the response was favorable. Signs of relapse with spread of the infection to the deeper plane and the presence of endothelial exudates were noted at 5 weeks. This was attributed to poor compliance. Though the response to re-initiation of therapy under direct supervision was once again favorable; it was only after the introduction of intrastromal voriconazole repeated at timely intervals that rapid and complete resolution was obtained. Conclusions: Severe keratitis due to fungi or Acanthamoeba very often requires surgical intervention. Complete resolution with medical therapy was obtained only after the introduction of intrastromal voriconazole; thereby avoiding a therapeutic keratoplasty. The addition of voriconzole both topically and particularly intrastromally facilitated faster resolution as well as restricted the duration of therapy with more toxic drugs such as phmb and chlorhexidine. |
| first_indexed | 2024-12-17T21:59:18Z |
| format | Article |
| id | doaj.art-6e1e9075c03f4ec790fff9b72baddfdf |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-17T21:59:18Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-6e1e9075c03f4ec790fff9b72baddfdf2022-12-21T21:31:01ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362021-06-0122101107Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitisAnita Raghavan0Arjun Velayudhan Nair1Kavitha N2Narendran Venkatapathy3Ram Rammohan4Corresponding author.; Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, IndiaAravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, IndiaAravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, IndiaAravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, IndiaAravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, IndiaPurpose: Acanthamoeba and fungal infections can be recalcitrant to therapy - more so when the deeper layers of the corneas are involved. We describe the diagnosis and successful management strategies employed in a case of deep keratitis due to co-infection with Acanthamoeba and Cladosporium sp. Observations: Once the diagnosis of co-infection with both Acanthamoeba and Cladosporium was made, treatment was initiated with a combination of PHMB, chlorhexidine, natamycin, and voriconazole; to which the response was favorable. Signs of relapse with spread of the infection to the deeper plane and the presence of endothelial exudates were noted at 5 weeks. This was attributed to poor compliance. Though the response to re-initiation of therapy under direct supervision was once again favorable; it was only after the introduction of intrastromal voriconazole repeated at timely intervals that rapid and complete resolution was obtained. Conclusions: Severe keratitis due to fungi or Acanthamoeba very often requires surgical intervention. Complete resolution with medical therapy was obtained only after the introduction of intrastromal voriconazole; thereby avoiding a therapeutic keratoplasty. The addition of voriconzole both topically and particularly intrastromally facilitated faster resolution as well as restricted the duration of therapy with more toxic drugs such as phmb and chlorhexidine.http://www.sciencedirect.com/science/article/pii/S245199362100116XAcanthamoebaFungiKeratitisCladosporiumCo-infection |
| spellingShingle | Anita Raghavan Arjun Velayudhan Nair Kavitha N Narendran Venkatapathy Ram Rammohan Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis American Journal of Ophthalmology Case Reports Acanthamoeba Fungi Keratitis Cladosporium Co-infection |
| title | Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis |
| title_full | Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis |
| title_fullStr | Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis |
| title_full_unstemmed | Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis |
| title_short | Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis |
| title_sort | voriconazole in the successful management of a case of acanthamoeba cladosporium keratitis |
| topic | Acanthamoeba Fungi Keratitis Cladosporium Co-infection |
| url | http://www.sciencedirect.com/science/article/pii/S245199362100116X |
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