| Severe Arthrographis kalrae Keratomycosis in an Immunocompetent Patient. | |
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MedLine Citation:
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PMID: 21045668 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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PURPOSE: : To describe a severe case of keratomycosis caused by Arthrographis kalrae requiring repeated keratoplasty. METHODS: : A 42-year-old otherwise healthy soft contact lens wearer developed a unilateral central corneal ulcer. Treatment with topical and systemic voriconazole is described. RESULTS: : Repeated microbiological testing of ocular swabs (culture) initially yielded Candida albicans. Under treatment with topical clotrimazole, the ulcer progressed, and a corneal perforation required a keratoplasty à chaud. For prophylaxis, the patient received fluconazole systemically and continuous topical clotrimazole. However, in 2 weeks time, the mycotic infiltrates penetrated the corneal transplant and led to a second keratoplasty only 1 month after the first one. In the meantime, the microbiological analysis of the first keratoplasty revealed A. kalrae, which was sensitive to voriconazole. High-dose serum level-controlled systemic voriconazole and topical voriconazole were able to stabilize, but not eliminate the infection. About 1 year after the start of the voriconazole therapy, treatment had to be discontinued because of side effects. Mycotic infiltrates increased, and even an intracameral voriconazole injection could not prevent a third and a fourth keratoplasty. CONCLUSIONS: : Ocular infection with A. kalrae is very rare. The microbiological differentiation of A. kalrae can be difficult. Because a broad spectrum of fungi is sensitive to voriconazole, the early topical and possibly systemic treatment is a reasonable therapeutic option when a mycotic infection of the eye is suspected, even before the causative fungus is identified. |
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Authors:
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Bettina C Thomas; Stefan Zimmermann; Hans-Eberhard Völcker; Gerd U Auffarth; Stefan Dithmar |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Cornea Volume: 30 ISSN: 1536-4798 ISO Abbreviation: Cornea Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-02-10 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8216186 Medline TA: Cornea Country: United States |
Other Details:
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Languages: eng Pagination: 364-6 Citation Subset: IM |
Affiliation:
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From the Departments of *Ophthalmology; and †Medical Microbiology and Hygiene, University of Heidelberg, Germany. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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