Intrastromal antifungal injection as a successful modality of treatment for fungal keratitis: a case series

Fungal keratitis is a dreaded occurrence in the cornea and anterior segment given the difficulty in treating the disease. Hereby reporting 5 cases of fungal keratitis causes by virulent organisms such as Aspergillus versicolor, Aspergillus fumigatus, Phialophora sp, and Fusarium sp. A retrospective interventional case series of 5 fungal keratitis which were successfully treated by intrastromal antifungal injection performed by a single surgeon from March 2017 till April 2018. The fungal keratitis stromal abscess sizes range from largest of 3mm x 2mm to smallest of 1mmx 1mm, mostly located paracentral and one case was noted to have hypopyon measuring about 1mm. On the first week of treatment, patients noted to exhibit poor response to topical antifungal. Hence, intrastromal amphotericin B injection 5mcg/0.1ml about 0.1ml administered into the affected eye ranging from once to 3 times in all patients except for one patient; who is post-operative 1 year penetrating keratoplasty infected with Phialophora keratitis is given intrastromal amphotericin B injection 5mcg/0.1ml about 0.1ml for 3 times and intrastromal voriconazole injection 50mcg/0.1ml about 0.1ml for 3 times. Within next four weeks, all the 5 cases of fungal keratitis became completely quiet with healed epithelial defect and corneal scarring. In summary, the intrastromal antifungal injection can constitute a good modality for the treatment of recalcitrant cases of fungal keratitis, revealing highly potent antifungal effects as the medication is administrated directly to the site of keratitis, promises shorter recovery period, and early intrastromal antifungal injection also leads to quicker healing with good vision prognosis.

Cerebelite aguda por Cryptococcus em paciente imunocompetente. Relato de caso / Acute cerebellitis caused by Cryptococcus in an immunocompetent patient. Case report

A cerebelite aguda é uma condição neurológica que pode ocorrer principalmente em associação à infecção viral, bem como a outros agentes infecciosos. A criptococose cerebral é a infecção que ocorre mais comumente em pacientes imunossuprimidos, principalmente na forma de meningoencefalite. O objetivo deste estudo foi relatar um caso de cerebelite fúngica em paciente imunocompetente, condição não relatada na literatura até omomento. Paciente do gênero masculino, 30 anos, foi encaminhado para investigação de quadro agudo de náuseas, vômitos, cefaleia intensa, vertigem e ataxia da marcha. A ressonância nuclear magnética de encéfalo demonstrou imagem hipodensaisolada em cerebelo. A análise liquórica evidenciou Criptococcus em fase de gemulação. Houve melhora completa do quadro após tratamento com anfotericina B e fluconazol. A infecção fúngica por Criptococcus é condição incomum em pacientes imunocompetentes. Casos previamente relatados de criptococose não seapresentaram de forma isolada em cerebelo. De acordo com o presente estudo, quando o quadro clínico do paciente for compatível com cerebelite, é importante atentar para outras possibilidades etiológicas, que não apenas vírus ou bactérias...

Acute cerebellitis is a neurological condition that can occur especially in association with viral infection, as well as other infectious agents. Cerebral criptococcose infection most commonly occurs in immunosuppressed patients, mainly in the form of meningoencephalitis. The objective of this study was to report a case of fungal cerebellitis in an immunocompetentpatient, a condition not reported in the literature. Male patient, 30 years old, was referred for investigation of acutenausea, vomiting, severe headache, vertigo and gait ataxia. The magnetic resonance of the brain showed an isolated hypodense image in cerebellum. The analysis of the cerebral spinal fluidrevealed cryptococcus in the process of budding. There was complete improvement after treatment with anphotericin B and fluconazole. The fungal infection cryptococcus is an uncommon condition in immunocompetent patients. Previously reported cases of criptococcose were not presented in isolation in thecerebellum. According to this study, when the patient’s condition is compatible with cerebellitis, it is important to pay attention to other etiological possibilities, not just viruses or bacteria...