Medical treatment for combined Fusarium and Acanthamoeba keratitis.
OBJECTIVE
Acanthamoeba and fungal keratitis are rare ocular infections. We report cases of combined Fusarium and Acanthamoeba keratitis and the clinical course of medical treatment.


METHODS
We reviewed the medical records of patients treated for culture-proven Acanthamoeba keratitis at a referral centre, during 2001-2006.


RESULTS
Eleven consecutive patients were treated for culture-proven Acanthamoeba keratitis during the 5 years, two of whom had combined fungal infections. A 29-year-old man presented with ground-glass corneal oedema and epitheliopathy caused by contact lens use. The other patient, a 7-year-old girl, had eye trauma that led to a feathery corneal infiltrate. Both cases were treated with topical 0.02% polyhexamethylene biguanide (PHMB), 0.1% propamidine, 1% clotrimazole and 5% natamycin. Therapeutic keratoplasty was not required in either case.


CONCLUSIONS
Timely identification of the pathogen, with repeated culture and smear if necessary, as well as adequate dosage to prevent recurrence is highly recommended in order to preclude the need for therapeutic penetrating keratoplasty.
Lin
Hsin-Chiung
HC
Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan. hclinn@adm.cgmh.org.tw
Hsiao
Ching-Hsi
CH
Ma
David Hui-Kang
DH
Yeh
Lung-Kun
LK
Tan
Hsin-Yuan
HY
Lin
Meng-Yin
MY
Huang
Samuel Chao-Ming
SC
D015823:Acanthamoeba Keratitis / Q000150:complications / Q000188:drug therapy*; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D001550:Benzamidines / Q000008:administration & dosage; D001645:Biguanides / Q000008:administration & dosage; D002648:Child; D003022:Clotrimazole / Q000008:administration & dosage; D003261:Contact Lenses / Q000009:adverse effects; D003316:Corneal Diseases / Q000150:complications / Q000209:etiology; D015715:Corneal Edema / Q000150:complications / Q000209:etiology; D003320:Corneal Ulcer / Q000209:etiology; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal; D005131:Eye Injuries / Q000150:complications; D005260:Female; D005670:Fusarium; D006801:Humans; D007634:Keratitis / Q000150:complications / Q000382:microbiology*; D008297:Male; D009181:Mycoses / Q000188:drug therapy*; D010866:Natamycin / Q000008:administration & dosage; D012189:Retrospective Studies; D055815:Young Adult
D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D001550:Benzamidines; D001645:Biguanides; C031233:polihexanide; D010866:Natamycin; D003022:Clotrimazole; C005555:propamidine