Keratitis due to Colletotrichu gloeosporioides and Herpesvirus reactivation / Queratiris por Colletotrichum gloeosporioides y reactivación de Herpesvirus

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Archipelago keratitis: a clinical variant of recurrent herpetic keratitis?

OBJECTIVE: To describe archipelago keratitis, a presumed clinical variant of herpetic epithelial keratitis. DESIGN: Case series. PARTICIPANTS: A series of 6 patients with an unusual form of superficial keratitis. METHODS: History, including age, gender, clinical evolution, and treatment; slit-lamp biomicroscopy findings; in vivo confocal microscopy findings; and corneal epithelial scrapings were analyzed. MAIN OUTCOME MEASURES: Clinical ocular examination, a diagnostic workup including corneal scraping for herpesvirus polymerase chain reaction, in vivo confocal microscopy, and therapeutic outcome. RESULTS: The authors describe a series of 6 patients with keratitis consisting of foci of epithelial erosions associated with subepithelial nummular inflammatory infiltrates and disposed in a radial, centripetal, archipelagolike pattern originating from the limbus. All the patients had a past history of herpetic epithelial keratitis, herpetic vesicles on the ipsilateral lid, or both. Polymerase chain reaction-based screening for herpes simplex virus 1 and 2 in corneal scrapings demonstrated positive results in 2 patients. In vivo corneal confocal microscopy revealed focal areas of hyperreflective epithelial cells and hyperreflective subepithelial dendritic structures overlying activated keratocytes. All the patients improved with oral valacyclovir treatment followed by topical steroid therapy. CONCLUSIONS: Archipelago keratitis may be a new clinical variant of herpetic keratitis, reflecting herpetic dissemination from the limbus to the center of the cornea.

Successful treatment of Paecilomyces lilacinus keratitis in a patient with a history of herpes simplex virus keratitis.

PURPOSE: To report a case of Paecilomyces lilacinus keratitis, initially misdiagnosed as Penicillium sp., in a patient with a long-standing history of herpes simplex virus (HSV) keratitis. METHODS: A retrospective case report. RESULTS: A 62-year-old man developed P. lilacinus keratitis. He was treated with topical steroids for immune stromal keratitis secondary to HSV before developing the fungal keratitis. Initial corneal cultures were positive for Penicillium sp., but subsequent cultures identified P. lilacinus to be the causative organism. The patient later developed an anterior chamber abscess. Three penetrating keratoplasties, as well as intravitreal injection of amphothericin B, topical miconazole, subconjunctival miconazole, and systemic fluconazole, were required to eradicate the infection. CONCLUSION: To our knowledge, this is a first report of P. lilacinus keratitis in a patient with a previous history of HSV keratitis. The causative organism was initially reported as Penicillium sp. on 2 occasions, before the correct diagnosis was made. Paecilomyces keratitis progressed to an anterior chamber abscess in this eye. Aggressive treatment, including a therapeutic penetrating keratoplasty, intravitreal amphothericin B injection, topical miconazole, and systemic fluconazole can be successful in eradicating this extremely difficult-to-treat infection.

Polymicrobial keratitis secondary to Burkholderia ambifaria, enterococcus, and staphylococcus aureus in a patient with herpetic stromal keratitis.

PURPOSE: To report polymicrobial keratitis in a patient with herpetic stromal keratitis. The initial infecting organism, Burkholderia ambifaria, has not previously been reported to cause microbial keratitis. METHODS: Clinical evaluation and corneal culture were performed. RESULTS: A 59-year-old-man undergoing topical corticosteroid therapy for herpes simplex stromal keratitis developed corneal infection with B. ambifaria. The organism was reisolated 12 days after initiation of hourly therapy with topical levofloxacin 0.5%. At reculture Staphylococcus aureus and Enterococcus spp. were also isolated. The addition of topical amikacin and vancomycin led to resolution of the microbial keratitis. CONCLUSIONS: Burkholderia ambifaria infected a compromised cornea, exhibited an unusual sensitivity profile, and remained viable after 12 days of therapy with an antibiotic to which it was sensitive by in vitro tests.

Amniotic membrane transplantation in infectious corneal ulcer.

PURPOSE: To evaluate the efficacy of amniotic membrane transplantation in the management of treated infectious corneal ulcer in which inflammatory reactions were responsible for corneal damage. METHOD: A prospective study of 21 consecutive eyes (21 patients) was performed. Sufficient antibacterial, antifungal, or antiviral agents were applied to eradicate causative organisms before permanent or temporary amniotic membrane transplantation, or a combination of the two in few patients. The amniotic membrane was soaked in antiinfective agents before transplantation in all cases. RESULTS: After amniotic membrane transplantation, follow-up times ranged from 4 to 28 months (mean, 18 months). Clinical indications included Staphylococcus species (four cases), Pseudomonas species (five cases), Acanthamoeba species (three cases), fungus (two cases), and herpesvirus (seven cases). The corneal surface was healed successfully and recurrences of microbial infection were not noted in any case. Visual acuity was improved in cases that were nonscarring or after additional penetrating keratoplasty. CONCLUSION: Amniotic membrane transplantation seems to be a useful adjunctive surgical procedure for the management of infectious corneal ulcer by promoting wound healing and reducing inflammation.

Improvement of HSV-1 necrotizing keratitis with amniotic membrane transplantation.

PURPOSE: Stromal herpes simplex virus keratitis (HSK) is an immune-mediated disease. Previous studies have indicated that T cells, neutrophils, and macrophages contribute to the tissue damage in HSK. It has been shown that human amniotic membrane promotes epithelial wound healing and has diverse anti-inflammatory effects. In this study, the effect of amniotic membrane transplantation (AMT) on corneal wound healing and on inflammation in mice with necrotizing HSK was examined. METHODS: BALB/c mice were corneally infected with 10(5) plaque-forming units (PFU) of HSV-1 (KOS strain). In 16 mice that exhibited severe ulcerating HSK, the cornea was covered with a preserved human amniotic membrane as a patch. Corneas in 16 infected mice remained uncovered and served as a control. On days 2 and 7 after surgery, the amniotic membrane was removed (eight mice in each group), the HSV-1-infected cornea was evaluated clinically, and the eye was enucleated. Tissue sections were analyzed histologically for epithelialization and cellular infiltration and immunohistochemically with anti-CD3 mAb to T cells, anti-CD11b mAb to both macrophages and neutrophils, or anti-F4/80 mAb to macrophages. RESULTS: Profound regression of corneal inflammation and rapid closure of epithelial defects were observed clinically within 2 days in the amniotic membrane-covered eyes, whereas HSV-1 keratitis and ulceration progressed in all mice in the control group (P < 0.001). Histologically, corneal edema and inflammatory infiltration, and immunohistochemically the number of CD3(+), CD11b(+), and F4/80(+) cells in the cornea were markedly decreased at 2 and 7 days after amniotic membrane application, compared with the uncovered control corneas (P < 0.001). CONCLUSIONS: AMT promotes rapid epithelialization and reduces stromal inflammation and ulceration in HSV-1 keratitis. AMT in mice with HSV necrotizing stromal keratitis appears to be a useful model for investigating the effect and the action mechanism of human amniotic membrane.

Acremonium keratitis in a patient with herpetic neurotrophic corneal disease.

Fungi belonging to the genus Acremonium Link ex Fries 1821 are ubiquitous environmental contaminants and soil saprophytes, but are infrequent pathogens in humans. These filamentous fungi (previously known as Cephalosporium) are an uncommon cause of mycotic keratitis. As in the case of other filamentous fungi, corneal trauma with contaminated matter is the most frequent risk factor for the infection. We report in this paper a case of keratomycosis caused by Acremoniumpotronii, in a patient with a history of herpetic keratitis. Medical treatment with amphotericin B was unsuccessful and the infection eventually resolved with penetrating keratoplasty.