title: Long-term follow-up after successful treatment of Pythium insidiosum keratitis in Israel.
abstract: The purpose of this project is to report a case of severe Pythium insidiosum keratitis confirmed by polymerase chain reaction (PCR), and its long-term cure after therapeutic penetrating keratoplasty. A 24-year-old woman with a history of contact lens wear and exposure to swimming pool water presented with a severe corneal abscess. She was treated with intensive fortified topical antibiotics and natamycin with limited response. Initial cultures suggested the presence of a septate mold, unclearly identified; therefore, both topical and intravenous voriconazole were administered. Despite the above treatment, there was worsening of the clinical picture. PCR assay revealed homology to Pythium insidiosum. Promptly, the patient underwent a large therapeutic penetrating keratoplasty. After five years of follow-up, the graft exhibits neither signs of rejection nor any recurrence of infection. We conclude that prompt identification of Pythium insidiosum keratitis and aggressive treatment by therapeutic penetrating keratoplasty may offer a cure to this disease.
authors.affiliation: Goldschleger Eye Institute, Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, Israel. ibarequet@hotmail.com
authors.forename: Irina S
authors.initials: IS
authors.lastname: Barequet
authors.forename: Fabio
authors.initials: F
authors.lastname: Lavinsky
authors.forename: Mordechai
authors.initials: M
authors.lastname: Rosner
mesh_terms: D000038:Abscess / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003263:Contact Lenses, Hydrophilic / Q000382:microbiology; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D004271:DNA, Fungal / Q000032:analysis; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D015948:Keratoplasty, Penetrating; D016133:Polymerase Chain Reaction; D058968:Pythiosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D011775:Pythium / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004271:DNA, Fungal