Darren Shu Jeng Ting1, Giuseppe Bignardi, Roland Koerner, Luciane D Irion, Elizabeth Johnson, Stephen J Morgan, Saurabh Ghosh. 1. Sunderland Eye Infirmary (D.S.J.T., S.J.M., and S.G.), Sunderland, United Kingdom; Department of Microbiology (G.B. and R.K.), Sunderland Royal Hospital, Sunderland, United Kingdom; Histopathology Department (L.D.I.), Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; and Mycology Reference Laboratory (E.J.), Public Health England South West Laboratory, Bristol, United Kingdom.
Abstract
OBJECTIVES: To report the first case of fungal keratitis caused by Cryptococcus curvatus after penetrating keratoplasty (PK) in an immunocompetent patient and to describe its therapeutic challenge and long-term outcome. METHODS: An interventional case report. RESULTS: A 54-year-old female patient underwent right PK for lattice dystrophy. At 5-year post-PK, she developed a polymicrobial keratitis caused by Candida parapsilosis, and Stenotrophomonas maltophilia at the peripheral graft, which was successfully treated with topical antibiotic and antifungal drops. One year later, another fungal keratitis occurred which apparently resolved with antifungal treatment but recurred in an unusual fashion and required a repeat PK revealing the diagnosis of C. curvatus keratitis. This was confirmed by microbiological culture on Sabouraud dextrose agar, nuclear ribosomal repeat regional sequencing of the D1-D2 and internal transcribed spacer regions, and histopathological examination. Various topical, intracorneal, and systemic antifungal treatments had been attempted but failed to resolve the infection completely, necessitating a subsequent third PK. A further recurrence was noted 16-month post-third PK, which was eradicated with multiple topical and intracorneal antifungal treatment, and direct cryotherapy to the corneal abscess. No further recurrence of C. curvatus was noted at 4-year follow-up. CONCLUSIONS: Cryptococcus curvatus should be added to the known list of organisms capable of causing fungal keratitis. Our experience suggests that this type of organism could cause low-grade, grumbling infection, which may however be exceptionally difficult to treat. Long-term eradication of this rare fungal keratitis could be potentially achieved by intensive ocular and systemic antifungal treatment, repeat therapeutic keratoplasties, and focal cryotherapy.
OBJECTIVES: To report the first case of fungal keratitis caused by Cryptococcus curvatus after penetrating keratoplasty (PK) in an immunocompetent patient and to describe its therapeutic challenge and long-term outcome. METHODS: An interventional case report. RESULTS: A 54-year-old female patient underwent right PK for lattice dystrophy. At 5-year post-PK, she developed a polymicrobial keratitis caused by Candida parapsilosis, and Stenotrophomonas maltophilia at the peripheral graft, which was successfully treated with topical antibiotic and antifungal drops. One year later, another fungal keratitis occurred which apparently resolved with antifungal treatment but recurred in an unusual fashion and required a repeat PK revealing the diagnosis of C. curvatus keratitis. This was confirmed by microbiological culture on Sabouraud dextrose agar, nuclear ribosomal repeat regional sequencing of the D1-D2 and internal transcribed spacer regions, and histopathological examination. Various topical, intracorneal, and systemic antifungal treatments had been attempted but failed to resolve the infection completely, necessitating a subsequent third PK. A further recurrence was noted 16-month post-third PK, which was eradicated with multiple topical and intracorneal antifungal treatment, and direct cryotherapy to the corneal abscess. No further recurrence of C. curvatus was noted at 4-year follow-up. CONCLUSIONS:Cryptococcus curvatus should be added to the known list of organisms capable of causing fungal keratitis. Our experience suggests that this type of organism could cause low-grade, grumbling infection, which may however be exceptionally difficult to treat. Long-term eradication of this rare fungal keratitis could be potentially achieved by intensive ocular and systemic antifungal treatment, repeat therapeutic keratoplasties, and focal cryotherapy.
Authors: Darren Shu Jeng Ting; Jessica Cairns; Bhavesh P Gopal; Charlotte Shan Ho; Lazar Krstic; Ahmad Elsahn; Michelle Lister; Dalia G Said; Harminder S Dua Journal: Front Med (Lausanne) Date: 2021-08-11
Authors: Darren Shu Jeng Ting; Charlotte Shan Ho; Rashmi Deshmukh; Dalia G Said; Harminder S Dua Journal: Eye (Lond) Date: 2021-01-07 Impact factor: 3.775
Authors: Anna Song; Rashmi Deshmukh; Haotian Lin; Marcus Ang; Jodhbir S Mehta; James Chodosh; Dalia G Said; Harminder S Dua; Darren S J Ting Journal: Front Med (Lausanne) Date: 2021-07-07
Authors: Darren Shu Jeng Ting; Charlotte Shan Ho; Jessica Cairns; Ahmad Elsahn; Mouhamed Al-Aqaba; Tim Boswell; Dalia G Said; Harminder Singh Dua Journal: Br J Ophthalmol Date: 2020-06-24 Impact factor: 4.638
Authors: Darren Shu Jeng Ting; Mohamed Galal; Bina Kulkarni; Mohamed S Elalfy; Damian Lake; Samer Hamada; Dalia G Said; Harminder S Dua Journal: J Fungi (Basel) Date: 2021-11-12
Authors: Darren Shu Jeng Ting; Roger W Beuerman; Harminder S Dua; Rajamani Lakshminarayanan; Imran Mohammed Journal: Front Immunol Date: 2020-05-22 Impact factor: 7.561