title: Successful Medical Management of Presumptive Pythium insidiosum Keratitis.
abstract: OBJECTIVE
  To describe the previously unreported successful treatment of presumptive Pythium keratitis (PK) with medical therapy alone.
  
  
  METHODS
  A 42-year-old female homemaker presented to us with a 15-day history of pain and redness in the right eye after a trivial injury. Her vision was 20/80 at presentation. Slit-lamp biomicroscopy revealed a central, dense and dry-looking, grayish-white infiltrate reaching mid stroma. The infiltrate had feathery margins and was surrounded by multiple tentacle-like lesions and peripherally expanding pinhead-sized subepithelial lesions. The contralateral eye was essentially normal. Diagnostic corneal scraping on smears revealed broad, aseptate, hyaline filaments with ribbon-like folds; very characteristic of Pythium species. Confocal imaging revealed fungal filaments. Based on corroborative evidence, a diagnosis of presumptive PK was made. She was administered a combination therapy consisting of eye drop linezolid 0.2% 1 hourly, azithromycin 1% 2 hourly, atropine sulfate 1% thrice daily, and oral azithromycin 500 mg once daily for 3 days in a week.
  
  
  RESULTS
  After initial worsening in the form of stromal expansion, regression of pinhead-sized lesions was seen with onset of scarring by as early as day 4 of intense medical therapy. The tentacle-like lesions did not worsen. On day 8, significant resolution was noted with scarring, and by the end of 2 weeks, the entire stromal lesion had scarred and complete resolution of expanding tentacles was observed in 3 weeks.
  
  
  CONCLUSIONS
  Presumptive Pythium keratitis of the patient completely resolved with antibacterial treatment alone. It is pertinent for ophthalmologists to be aware of this new treatment regimen.
authors.affiliation: *Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India; and †Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Ramappa
authors.forename: Ritu
authors.initials: R
authors.lastname: Nagpal
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
authors.forename: Sunita
authors.initials: S
authors.lastname: Chaurasia
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001285:Atropine / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015822:Eye Infections, Parasitic / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D000069349:Linezolid / Q000627:therapeutic use; D009184:Mydriatics / Q000627:therapeutic use*; D009883:Ophthalmic Solutions; D058968:Pythiosis / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D011775:Pythium / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D009184:Mydriatics; D009883:Ophthalmic Solutions; D001285:Atropine; D017963:Azithromycin; D000069349:Linezolid