Pythium insidiosum keratitis in Israel.
OBJECTIVE
To report with morphologic and phylogenetic speciation the first case from Israel of Pythium insidiosum keratitis associated with contact-lens wear.


METHODS
Case report and literature review.


RESULTS
A 21-year-old man with a history of contact-lens use and water exposure was hospitalized in Israel for a corneal ulcer. The ulcer progressed despite intensive antibiotics. He flew home to the United States for further care. Examination revealed a corneal ulcer with hypopyon. The infection progressed despite intensive medical therapy, and a therapeutic penetrating keratoplasty was performed. Histology and cornea cultures from the host cornea revealed sparsely septate, branching hyphae, consistent with P. insidiosum. DNA sequencing of the Pythium isolate supported the clinical history that the infection was acquired outside of the United States. Despite intensive medical therapy and a second corneal transplant, the ulcer progressed, ultimately requiring enucleation.


CONCLUSIONS
This is the first reported case of culture-proven, contact lens-related Pythium keratitis originating from Israel. Pythium is a fungus-like, aquatic oomycete found in tropical climates. Human pythiosis is uncommon but associated with high morbidity. Case reports describe surgical cure of Pythium keratitis, but this case recurred despite two penetrating keratoplasties and maximal antifungal therapy. In cases of presumed fungal keratitis that do not respond to antifungals, the fungus should be sent for speciation because early surgical intervention is the only means to save the eye in ocular pythiosis.
Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
Tasha Y
TY
Tanhehco
Rebecca C
RC
Stacy
Leonel
L
Mendoza
Marlene L
ML
Durand
Frederick A
FA
Jakobiec
Kathryn A
KA
Colby
D000867:Anterior Chamber; D000935:Antifungal Agents / Q000627:therapeutic use; D003261:Contact Lenses / Q000009:adverse effects*; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D015353:Eye Enucleation; D006801:Humans; D007557:Israel; D007634:Keratitis / Q000382:microbiology*; D015948:Keratoplasty, Penetrating; D008297:Male; D058968:Pythiosis / Q000150:complications* / Q000209:etiology* / Q000473:pathology; D011775:Pythium / Q000235:genetics / Q000302:isolation & purification*; D012008:Recurrence; D012086:Reoperation; D017422:Sequence Analysis, DNA; D013492:Suppuration / Q000382:microbiology; D055815:Young Adult
D000935:Antifungal Agents