Título

PAECILOMYCES KERATITIS: A CHALLENGING INFECTION

Objetivo

To analyze cases of ocular infections caused by Purpureocillium lilacinum, formerly called Paecilomyces. This peculiar ocular infection is difficult to treat, the optimal antifungal treatment remains unknown to date, and the outcomes are generally poor.

Método

Case study with retrospective review of the medical records. Fungal isolates were identified by sequencing ITS and Elongation Factor DNA regions. Antifungal susceptibility testing was performed by using CLSI microbroth dilution.

Resultado

Thirteen patients were analyzed including: six episodes of endophthalmitis (four after phacoemulsification with intraocular lens implantation, one after intravitreal injection of antivascular endothelial growth factor drugs, and one of unknown cause), six episodes of keratitis (two associated with soft contact lens wear, one after trauma, one after LASIK, and two of unknown cause) and one case where only culture data was available. Patients were simultaneously treated with topical and systemic antifungal drugs (amphotericin B, voriconazole, ketoconazole, itraconazole, fluconazole, and posaconazole). Despite antifungal therapy, six patients required one or two therapeutic corneal grafts; one required enucleation. Geometric mean of minimum inhibitory concentration for itraconazole was 8 μg/ml, for voriconazole 0.34 μg/ml, for posaconazole 0.65 μg/ml, and for amphotericin B 12.25 μg/ml

Conclusão

Voriconazole and posoconazole seems to be the best antifungal drugs to treat Purpureocillium isolated from eye infections. Clinical relevance of susceptibility testing for filamentous fungi is still controversial, but it might support the potential for initial medical treatment of this otherwise devastating form of oculomycosis.