PURPOSE: To describe the previously unreported successful treatment of presumptive Pythium keratitis (PK) with medical therapy alone. METHODS: A 42-year-old female homemaker presented to us with a 15-day history of pain and redness in the right eye after a trivial injury. Her vision was 20/80 at presentation. Slit-lamp biomicroscopy revealed a central, dense and dry-looking, grayish-white infiltrate reaching mid stroma. The infiltrate had feathery margins and was surrounded by multiple tentacle-like lesions and peripherally expanding pinhead-sized subepithelial lesions. The contralateral eye was essentially normal. Diagnostic corneal scraping on smears revealed broad, aseptate, hyaline filaments with ribbon-like folds; very characteristic of Pythium species. Confocal imaging revealed fungal filaments. Based on corroborative evidence, a diagnosis of presumptive PK was made. She was administered a combination therapy consisting of eye drop linezolid 0.2% 1 hourly, azithromycin 1% 2 hourly, atropine sulfate 1% thrice daily, and oral azithromycin 500 mg once daily for 3 days in a week. RESULTS: After initial worsening in the form of stromal expansion, regression of pinhead-sized lesions was seen with onset of scarring by as early as day 4 of intense medical therapy. The tentacle-like lesions did not worsen. On day 8, significant resolution was noted with scarring, and by the end of 2 weeks, the entire stromal lesion had scarred and complete resolution of expanding tentacles was observed in 3 weeks. CONCLUSIONS: Presumptive Pythium keratitis of the patient completely resolved with antibacterial treatment alone. It is pertinent for ophthalmologists to be aware of this new treatment regimen.
PURPOSE: To describe the previously unreported successful treatment of presumptive Pythiumkeratitis (PK) with medical therapy alone. METHODS: A 42-year-old female homemaker presented to us with a 15-day history of pain and redness in the right eye after a trivial injury. Her vision was 20/80 at presentation. Slit-lamp biomicroscopy revealed a central, dense and dry-looking, grayish-white infiltrate reaching mid stroma. The infiltrate had feathery margins and was surrounded by multiple tentacle-like lesions and peripherally expanding pinhead-sized subepithelial lesions. The contralateral eye was essentially normal. Diagnostic corneal scraping on smears revealed broad, aseptate, hyaline filaments with ribbon-like folds; very characteristic of Pythium species. Confocal imaging revealed fungal filaments. Based on corroborative evidence, a diagnosis of presumptive PK was made. She was administered a combination therapy consisting of eye drop linezolid 0.2% 1 hourly, azithromycin 1% 2 hourly, atropine sulfate 1% thrice daily, and oral azithromycin 500 mg once daily for 3 days in a week. RESULTS: After initial worsening in the form of stromal expansion, regression of pinhead-sized lesions was seen with onset of scarring by as early as day 4 of intense medical therapy. The tentacle-like lesions did not worsen. On day 8, significant resolution was noted with scarring, and by the end of 2 weeks, the entire stromal lesion had scarred and complete resolution of expanding tentacles was observed in 3 weeks. CONCLUSIONS: Presumptive Pythiumkeratitis of the patient completely resolved with antibacterial treatment alone. It is pertinent for ophthalmologists to be aware of this new treatment regimen.
Authors: Erico S Loreto; Juliana S M Tondolo; Daniele C Oliveira; Janio M Santurio; Sydney H Alves Journal: Antimicrob Agents Chemother Date: 2018-02-23 Impact factor: 5.191
Authors: Erico S Loreto; Juliana S M Tondolo; Francielli P K de Jesus; Camila M Verdi; Carla Weiblen; Maria I de Azevedo; Glaucia D Kommers; Janio M Santurio; Régis A Zanette; Sydney H Alves Journal: Antimicrob Agents Chemother Date: 2018-12-21 Impact factor: 5.191
Authors: Juliana S M Tondolo; Érico S Loreto; Pauline C Ledur; Francielli P K Jesus; Taiara M Silva; Glaucia D Kommers; Sydney H Alves; Janio M Santurio Journal: PLoS One Date: 2017-05-19 Impact factor: 3.240