Öz
Asuman Özkan, Serdar Susever, Zayre Erturan, Meltem Uzun, Nilufer Alparslan, Yasemin Oz, Yıldız Yeğenoğlu Dematiaceous fungi have been reported among the common etiologic agents of keratitis. We herein report a case of keratitis due to Scedosporium apiospermum identified by conventional methods and confirmed by molecular methods. A 68-year-old male who attended the Ophthalmology Clinic at Istanbul University, Faculty of Medicine Hospital, presented with pain, lacrimation and a ‘foreign body\' sensation in the left eye with six weeks' duration. The samples which were taken from corneal tissue, contact lens and anterior chamber were inoculated on Sabouraud dextrose agar (SDA) and brain heart infusion (BHI) agar. On the third day of incubation, a phaeoid mold was observed on the plate which was inoculated with corneal tissue sample at 27°C. The strain was identified as Scedosporium spp with conventional methods and confirmed as S. apiospermum by a molecular method. Infection was successfully treated with voriconazole eyedrop (1%) after pre-diagnosis. Molecular diagnostic methods may be applied for the definitive diagnosis of the pathogen of fungal keratitis and the selection of the appropriate antifungal agent.
Anahtar Kelimeler
Kaynakça
- Wilhelmus KR, Jones DB. Curvularia keratitis. Tr Am Ophth Soc 2001;99:111-132.
- Javey G, Zuravleff JJ, Yu VL. Fungal infections of the eye. In: Anaissie EJ, Mc Ginnis MR, Pfaller MA’s Clinical Mycology, 2nd edn. Philadelphia: Churchill Livingstone Press, 2009:623- 641.
- Prats CH, Tello FL, San Jose AB, Otaolaumuchi JS, Baines JPO. Voriconazole in fungal keratitis caused by Scedospo- rium apiospermum. Ann Pharmacother 2004;38:414-417.
- İrkeç M, Bozkurt B. Göz Enfeksiyonları. In: Topçu AW, Söyletir G, Doğanay M. eds. Enfeksiyon Hastalıkları ve Mikrobiyolo- jisi, 3rd edn. Istanbul: Nobel Tıp Kitabevleri: 2008:1583-1596. (In Turkish)
- Guarro J, Kantarcioglu AS, Horre R, et al. Scedosporium ap- iospermum: changing clinical spectrum of therapy-refractory opportunist. Med Mycol 2006;44:295-327.
- Hinrikson HP, Hurst SF, Lott TJ, Warnock DW, Morrison CJ. Assesment of ribosomal large-subunit D1-D2, internal tran- scribed spacer 1 and internal transcribed spacer 2 regions as targets for molecular identification of medically important Aspergillus species. J Clin Microbiol 2005;43:2092-2103.
- Larone Dh. Medically Important Fungi, 5th edn. Washington: ASM Press, 2011:208-213.
- Husain S, Munoz P, Forrest G, et al. Infections due to Sce- dosporium apiospermum and Scedosporium prolificans in transplant recipients: Clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis 2005;40:89-99.
- Sundaram BM, Badrinath S, Subramanian S. Studies on my- cotic keratitis. Mycoses 1989;32:568-572.
- Rosa RH J, Miller D, Alfonso EC. The changing spec- trum of fungal keratitis in South Florida. Ophthalmology 1994;101:1005-1013.
- Kantarcıoğlu SA, Yücel A. Pseudallescheriasis cases identi- fied at Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty and European Confederation of Medical Mycology (ECMM) Pseudallescheriasis Study Group. Cerrahpaşa J Med 2005;36:90-96.
- Yücel A. Scedosporium apiospermum (Monosporium apios- permum)’dan ileri gelen bir göz mikozu. Türk Mikrobiyol Cem Derg 1989; 19:25-29. (In Turkish)
- Erdem Ü, Bağkesen H, Durukan AH, Saraçlı MA, Hürme- riç V, Bayraktar MZ. Total korneal erime ile seyreden man- tar keratitli bir olgunun klinik izlemi. Gülhane Tıp Dergisi 2005;47:135-139. (In Turkish)
- Direkel S, Otağ F, Aslan G, Ulger M, Emekdaş G. Identifica- tion of filamentous fungi isolated from clinical samples by two different methods and their susceptibility results. Mikrobiyol Bul 2012;46:65-78. (In Turkish)
- Sicilia MJL, Lacomba MS, Cuesta FS, Pedraza RS, Gomez TN, Roman MC. Scedosporium apiospermum keratitis. Rev Iberoam Micol 2003;20:68-70.
- Ozdemir HG, Oz Y, Ilkit M, Kiraz N. Antifungal susceptibility of ocular fungal pathogens recovered from around the world against itraconazole, voriconazole, amphotericin B, and ca- spofungin. Med Mycol 2012;50:130-135.
Öz
Dematiyöz mantarlar keratit nedeni olarak sık saptanan etiyolojik etkenler arasında yer alır. Burada konvansiyonel yöntemlerle tanımlanan ve moleküler yöntemle doğrulanan Scedosporium apiospermum’un neden olduğu keratit olgusu sunuldu. Altmışsekiz yaşındaki bir erkek hasta İ.Ü. İstanbul Tıp Fakültesi Göz Hastalıkları kliniğine sol gözünde altı haftadır devam eden ağrı, batma, sulanma ve yabancı cisim hissi ile başvurdu. Hastadan alınan kornea, kontakt lens ve ön kamara örnekleri Sabouraud dextrose agar (SDA) ve beyin kalp infüzyon (BHI) agar besiyerlerlerine doğrudan ekim yapıldı. İnkübasyonun üçüncü gününde 27°C’de inkübe edilen korneal örneğin ekim yapıldığı besiyerlerinde feoid bir küf üremesi oldu. Suş konvansiyonel yöntemlerle Scedosporium spp olarak tanımlandı ve moleküler tanı yöntemi ile de S. apiospermum olarak doğrulandı. Olgu ön tanı aldığı üçüncü günden itibaren %1 vorikanozol göz damlası ile başarılı bir şekilde tedavi edildi. Fungal keratit olgularında doğru tanı ve uygun antifungal ajanın seçimi için moleküler yöntemler uygulanabilir
Anahtar Kelimeler
Kaynakça
- Wilhelmus KR, Jones DB. Curvularia keratitis. Tr Am Ophth Soc 2001;99:111-132.
- Javey G, Zuravleff JJ, Yu VL. Fungal infections of the eye. In: Anaissie EJ, Mc Ginnis MR, Pfaller MA’s Clinical Mycology, 2nd edn. Philadelphia: Churchill Livingstone Press, 2009:623- 641.
- Prats CH, Tello FL, San Jose AB, Otaolaumuchi JS, Baines JPO. Voriconazole in fungal keratitis caused by Scedospo- rium apiospermum. Ann Pharmacother 2004;38:414-417.
- İrkeç M, Bozkurt B. Göz Enfeksiyonları. In: Topçu AW, Söyletir G, Doğanay M. eds. Enfeksiyon Hastalıkları ve Mikrobiyolo- jisi, 3rd edn. Istanbul: Nobel Tıp Kitabevleri: 2008:1583-1596. (In Turkish)
- Guarro J, Kantarcioglu AS, Horre R, et al. Scedosporium ap- iospermum: changing clinical spectrum of therapy-refractory opportunist. Med Mycol 2006;44:295-327.
- Hinrikson HP, Hurst SF, Lott TJ, Warnock DW, Morrison CJ. Assesment of ribosomal large-subunit D1-D2, internal tran- scribed spacer 1 and internal transcribed spacer 2 regions as targets for molecular identification of medically important Aspergillus species. J Clin Microbiol 2005;43:2092-2103.
- Larone Dh. Medically Important Fungi, 5th edn. Washington: ASM Press, 2011:208-213.
- Husain S, Munoz P, Forrest G, et al. Infections due to Sce- dosporium apiospermum and Scedosporium prolificans in transplant recipients: Clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis 2005;40:89-99.
- Sundaram BM, Badrinath S, Subramanian S. Studies on my- cotic keratitis. Mycoses 1989;32:568-572.
- Rosa RH J, Miller D, Alfonso EC. The changing spec- trum of fungal keratitis in South Florida. Ophthalmology 1994;101:1005-1013.
- Kantarcıoğlu SA, Yücel A. Pseudallescheriasis cases identi- fied at Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty and European Confederation of Medical Mycology (ECMM) Pseudallescheriasis Study Group. Cerrahpaşa J Med 2005;36:90-96.
- Yücel A. Scedosporium apiospermum (Monosporium apios- permum)’dan ileri gelen bir göz mikozu. Türk Mikrobiyol Cem Derg 1989; 19:25-29. (In Turkish)
- Erdem Ü, Bağkesen H, Durukan AH, Saraçlı MA, Hürme- riç V, Bayraktar MZ. Total korneal erime ile seyreden man- tar keratitli bir olgunun klinik izlemi. Gülhane Tıp Dergisi 2005;47:135-139. (In Turkish)
- Direkel S, Otağ F, Aslan G, Ulger M, Emekdaş G. Identifica- tion of filamentous fungi isolated from clinical samples by two different methods and their susceptibility results. Mikrobiyol Bul 2012;46:65-78. (In Turkish)
- Sicilia MJL, Lacomba MS, Cuesta FS, Pedraza RS, Gomez TN, Roman MC. Scedosporium apiospermum keratitis. Rev Iberoam Micol 2003;20:68-70.
- Ozdemir HG, Oz Y, Ilkit M, Kiraz N. Antifungal susceptibility of ocular fungal pathogens recovered from around the world against itraconazole, voriconazole, amphotericin B, and ca- spofungin. Med Mycol 2012;50:130-135.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 3 Sayı: 01 |