title: Retrospective case-series of Paecilomyces lilacinus ocular mycoses in Queensland, Australia.
abstract: BACKGROUND
  The purpose of this study was to report: (1) the varying presentation of Paecilomyces ocular infections arising in Queensland; (2) the significance of immunosuppression as a primary determinant of disease; (3) the outcomes of voriconazole use; and (4) the ongoing need for both surgical and medical management of this devastating fungal infection.
  
  
  METHODS
  A retrospective case series of 21 culture proven individuals participated in this series and were identified via a review of the pathology reporting system utilized in the Queensland public health system. All culture proven individuals were subjected to a systematic chart review.
  
  
  RESULTS
  The primary risk factor for Paecilomyces lilacinus infection is immunosuppression with 81.25 % of individuals being on some form of immunosuppression (i.e. systemic or topical). Of the cases 71.43 % had an intact epithelial surface at the time of diagnosis, and 76 % had no previous ocular history. The final visual outcomes were nine cases with HM vision or worse, three cases with 6/48-6/60 vision, three cases 6/12-6/24, and six cases with 6/12 vision or better. Despite voriconazole use rates of greater than 80 %, protracted and poor treatment outcomes continue to be commonplace.
  
  
  CONCLUSIONS
  Paecilomyces lilacinus is a filamentous fungus that has a predilection for immunosuppressed individuals. Despite in vitro and case reports demonstrating the effectiveness of voriconazole poor outcomes continue to be seen.
authors.affiliation: Ophthalmology Department, The Royal Brisbane and Women's Hospital, 10/87 Hampstead Road, Highgate Hill, Brisbane, QLD, 4101, Australia. lturner22@hotmail.com.
authors.forename: Liam Daniel
authors.initials: LD
authors.lastname: Turner
authors.affiliation: Ophthalmology Department, The Royal Brisbane and Women's Hospital, 10/87 Hampstead Road, Highgate Hill, Brisbane, QLD, 4101, Australia. dconrad@bigpond.net.au.
authors.forename: Diana
authors.initials: D
authors.lastname: Conrad
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D005260:Female; D054884:Host-Pathogen Interactions / Q000187:drug effects; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D016867:Immunocompromised Host / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D010143:Paecilomyces / Q000187:drug effects / Q000502:physiology*; D011793:Queensland; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole