title: Fungal keratitis caused by Beauveria bassiana: drug and temperature sensitivity profiles: a case report.
abstract: BACKGROUND
  Beauveria bassiana is an entomopathogenic fungus and is a rare cause of keratitis. We present a case of fungal keratitis caused by B. bassiana that was diagnosed by in vivo confocal microscopy and in vitro corneal cultures. In addition, we determined the temperature- and drug-sensitivities of the isolated strain of B. bassiana.
  
  
  METHODS
  A 59-year-old Japanese man with a 2-month history of keratitis was examined by slit-lamp biomicroscopy, in vivo confocal microscopy, and histology and cultures of corneal scrapings. The corneal scrapings were used to determine the minimal inhibitory concentrations of different antifungal drugs and also to determine the temperature-sensitivity. In vivo confocal microscopy and histological examinations showed filamentous fungal keratitis. The characteristics of the fungal growth indicated that the keratitis was caused by B. bassiana. The keratitis responded poorly to systemic and topical voriconazole and to natamycin ointment. However, it was resolved after changing the natamycin to micafungin combined with surgical debridement. The isolated strain was sensitive to itraconazole, miconazole, micafungin, voriconazole, and resistant to flucytosine and fluconazole. It was moderately sensitive to amphotericin B, and natamycin. After 7 days in culture, the isolate grew small white colonies at 25 °C, very small colonies at 35 °C and 37 °C.
  
  
  CONCLUSIONS
  The drug-sensitivity and temperature-sensitivity profiles of B. bassiana should be helpful in the treatment of B. bassiana keratitis. Therapeutic surgery may be helpful for mycotic keratitis poorly responsive to medical therapy alone.
authors.forename: Arisa
authors.initials: A
authors.lastname: Mitani
authors.affiliation: Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan. shiraia@m.ehime-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiraishi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Atsuko
authors.initials: A
authors.lastname: Sunada
authors.forename: Akiko
authors.initials: A
authors.lastname: Ueda
authors.forename: Seishi
authors.initials: S
authors.lastname: Asari
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zheng
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D052982:Beauveria / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D007231:Infant, Newborn; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D018613:Microscopy, Confocal; D013696:Temperature
chemical_list: D000935:Antifungal Agents