Pathogenesis and Outcome of Paecilomyces Keratitis

Xiaoyong Yuan, Kirk R. Wilhelmus, Alice Y. Matoba, George Alexandrakis, Darlene Miller, Andrew J W Huang

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Purpose: To examine the clinical pathology and management of Paecilomyces lilacinus keratitis. Design: Observational case series, literature review, and laboratory study. Methods: Characteristics and outcome of 17 patients with laboratory-confirmed Paecilomyces keratitis treated at 2 referral centers were combined with 25 previously reported cases. Experimental models were developed by topically inoculating a human corneal isolate of P. lilacinus onto murine eyes and onto human donor corneas. Results: Of 42 reported eyes with Paecilomyces keratitis, 13 (31%) were associated with chronic keratopathy or previous ocular surgery, 11 (26%) followed corneal trauma, and 10 (24%) occurred in soft contact lens wearers. Medical cure occurred in 13 (31%), including 9 of 31 eyes (29%) treated with natamycin or amphotericin B. Penetrating keratoplasty or other surgery was performed in 29 (69%). In vitro testing of P. lilacinus indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole. Experimental inoculation after superficial scarification established moderately severe corneal paecilomycosis by hyphae and conidia in immunosuppressed mice and in explanted donor corneas. Conclusions: P. lilacinus is an emerging fungal pathogen that infects corneal tissue by filamentous invasion with occasional intrastromal sporulation. P. lilacinus keratitis does not reliably respond to natamycin or amphotericin B and has often required therapeutic keratoplasty, but topical azole antifungal agents such as voriconazole appear promising.

Original languageEnglish
JournalAmerican Journal of Ophthalmology
Volume147
Issue number4
DOIs
StatePublished - Apr 1 2009

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Paecilomyces
Keratitis
Natamycin
Amphotericin B
Cornea
Tissue Donors
Hydrophilic Contact Lens
Azoles
Penetrating Keratoplasty
Clinical Pathology
Ketoconazole
Fungal Spores
Corneal Transplantation
Hyphae
Antifungal Agents
Theoretical Models
Referral and Consultation
Voriconazole

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Yuan, X., Wilhelmus, K. R., Matoba, A. Y., Alexandrakis, G., Miller, D., & Huang, A. J. W. (2009). Pathogenesis and Outcome of Paecilomyces Keratitis. American Journal of Ophthalmology, 147(4). https://doi.org/10.1016/j.ajo.2008.11.016

Pathogenesis and Outcome of Paecilomyces Keratitis. / Yuan, Xiaoyong; Wilhelmus, Kirk R.; Matoba, Alice Y.; Alexandrakis, George; Miller, Darlene; Huang, Andrew J W.

In: American Journal of Ophthalmology, Vol. 147, No. 4, 01.04.2009.

Research output: Contribution to journalArticle

Yuan, X, Wilhelmus, KR, Matoba, AY, Alexandrakis, G, Miller, D & Huang, AJW 2009, 'Pathogenesis and Outcome of Paecilomyces Keratitis', American Journal of Ophthalmology, vol. 147, no. 4. https://doi.org/10.1016/j.ajo.2008.11.016
Yuan, Xiaoyong ; Wilhelmus, Kirk R. ; Matoba, Alice Y. ; Alexandrakis, George ; Miller, Darlene ; Huang, Andrew J W. / Pathogenesis and Outcome of Paecilomyces Keratitis. In: American Journal of Ophthalmology. 2009 ; Vol. 147, No. 4.
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