Pathogenesis and outcome of Paecilomyces keratitis.
OBJECTIVE
To examine the clinical pathology and management of Paecilomyces lilacinus keratitis.


METHODS
Observational case series, literature review, and laboratory study.


METHODS
Characteristics and outcome of 17 patients with laboratory-confirmed Paecilomyces keratitis treated at 2 referral centers were combined with 25 previously reported cases. Experimental models were developed by topically inoculating a human corneal isolate of P. lilacinus onto murine eyes and onto human donor corneas.


RESULTS
Of 42 reported eyes with Paecilomyces keratitis, 13 (31%) were associated with chronic keratopathy or previous ocular surgery, 11 (26%) followed corneal trauma, and 10 (24%) occurred in soft contact lens wearers. Medical cure occurred in 13 (31%), including 9 of 31 eyes (29%) treated with natamycin or amphotericin B. Penetrating keratoplasty or other surgery was performed in 29 (69%). In vitro testing of P. lilacinus indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole. Experimental inoculation after superficial scarification established moderately severe corneal paecilomycosis by hyphae and conidia in immunosuppressed mice and in explanted donor corneas.


CONCLUSIONS
P. lilacinus is an emerging fungal pathogen that infects corneal tissue by filamentous invasion with occasional intrastromal sporulation. P. lilacinus keratitis does not reliably respond to natamycin or amphotericin B and has often required therapeutic keratoplasty, but topical azole antifungal agents such as voriconazole appear promising.
Yuan
Xiaoyong
X
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.
Wilhelmus
Kirk R
KR
Matoba
Alice Y
AY
Alexandrakis
George
G
Miller
Darlene
D
Huang
Andrew J W
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000209:etiology* / Q000628:therapy; D004195:Disease Models, Animal; D015821:Eye Infections, Fungal / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology* / Q000628:therapy; D010866:Natamycin / Q000627:therapeutic use; D010143:Paecilomyces / Q000302:isolation & purification*; D014019:Tissue Donors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D010866:Natamycin