Treatment of corneal ulcers and endophthalmitis caused by yeast fungi

Abstract

Aim: To analyze the pathogenesis, clinical features, and treatment algorithm of fungal corneal ulcer with endophthalmitis to increase medical alertness and reduce the unjustified use of antibacterial and corticosteroid therapy in corneal diseases of various etiologies, leading to the development of secondary ophthalmomycosis.

Results: The pathogenesis was analyzed, and the characteristic clinical symptoms of severe fungal corneal ulcer and endophthalmitis caused by Candida albicans were described. Intensive, long-term, unjustified antibacterial and corticosteroid therapy caused a prolonged course of herpetic corneal ulcer, as well as the addition of a secondary bacterial infection, and led to the development of severe corneal ulcer and fungal endophthalmitis in a 13-year-old child.

Conclusion: The required maximum medical alertness and early, accurate clinical differential diagnosis between bacterial and fungal corneal ulcer, as well as the rapid flow of ophthalmomycosis and false-negative results of sowing content conjunctival sac entail expansion of the range and quantity of antibacterial drugs used in the absence of positive dynamics of antibiotic therapy and an increased frequency of secondary fungal infection.

The clinical symptoms of a severe fungal corneal ulcer with endophthalmitis described in this report contribute to the early diagnosis of ophthalmomycosis before the type of pathogen is identified by laboratory methods, which makes it possible to start antifungal therapy earlier and avoid corneal perforation and eye loss. In most countries, due to the lack of an ocular form of antifungal drugs, for local treatment of corneal candidiasis, a 0.2% solution of fluconazole intended for intravenous administration is installed in the eyes.

Keywords

fungal corneal ulcers / fungal endophthalmitis / laboratory diagnostics / bacterial corneal ulcer / herpetic corneal ulcer of the prolonged course / PCR / Herpes simplex virus / Epstein-Barr virus / Human herpes virus type 6

References

[1] Skryabina YV, Astakhov YS, Konenkova YS, et al. Diagnosis and treatment of fungal keratitis. Part I. Ophthalmology Journal. 2018;11(3):63–73. (In Russ). doi: 10.17816/OV11363-73

[2] Скрябина Е.В., Астахов Ю.С., Коненкова Я.С., и др. Диагностика и лечение грибкового кератита. Часть I // Офтальмологические ведомости. 2018. Т. 11, №3. С. 63–73. doi: 10.17816/OV11363-73

[3] Keay LJ, Gower EW, Iovieno A, et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study. Ophthalmology. 2011;118(5):920–926. doi: 10.1016/j.ophtha.2010.09.011

[4] Keay L.J., Gower E.W., Iovieno A., et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study // Ophthalmology. 2011. Vol. 118, N5. P. 920–926. doi: 10.1016/j.ophtha.2010.09.011

[5] Krichevskaya GI, Kovaleva LA, Zyurnyayeva ID, et al. The Effectiveness of PCR in Diagnosis of Fungal Keratitis. Ophthalmology in Russia. 2020;17(4):824–829. (In Russ). doi: 10.18008/1816-5095-2020-4-824-829

[6] Кричевская Г.И., Ковалева Л.А., Зюрняева И.Д., и др. Эффективность ПЦР-диагностики грибковых кератитов // Офтальмология. 2020. Т. 17, №4. С. 824–829. doi: 10.18008/1816-5095-2020-4-824-829

[7] Delyagin VM, Melnikova MB, Pershin BS, et al. Fungal damage of eyes (diagnosis and treatment). Prakticheskaya meditsina. 2015;(2):100–105. (In Russ).

[8] Делягин В.М., Мельникова М.Б., Першин Б.С., и др. Грибковое поражение глаз (диагностика, лечение) // Практическая медицина. 2015. №2. С. 100–105.

[9] Iskenderli VB. The importance of the etiological structure of causative agents in the development and maintenance of different clinical forms of ophthalmic mycosis living in Azerbaijan. Biomeditsina. 2018;(2):10–12. (In Russ).

[10] Искендерли В.Б. Значимость этиологической структуры возбудителей в развитии и поддержании разных клинических форм офтальмомикозов // Биомедицина. 2018. №2. С. 10–12.

[11] Poltanova TI, Belousova NY. Recurrence of fungal keratitis in corneal transplant. Kazan medical journal. 2018;99(1): 148-150. (In Russ). doi: 10.17816/KMJ2018-148

[12] Полтанова Т.И., Белоусова Н.Ю. Рецидив грибкового кератита в роговичном трансплантате // Казанский медицинский журнал. 2018. Т. 99, №1. С. 148–150. doi: 10.17816/KMJ2018-148

[13] Obrubov AS, Belskaia KI. Pharmacotherapy of fungal keratitis. Fyodorov journal of ophthalmic surgery. 2018;(1):98–102. (In Russ). doi: 10.25276/0235-4160-2018-1-98-102

[14] Обрубов А.С., Бельская К.И. Фармакотерапия грибковых кератитов (обзор литературы) // Офтальмохирургия. 2018. №1. С. 98–102. doi: 10.25276/0235-4160-2018-1-98-102

[15] Astakhov YS, Skryabina YV, Konenkova YS, et al. Mycotic keratitis diagnosis and treatment. Ophthalmology journal. 2013;6(2):75–80. (In Russ). doi: 10.17816/OV2013275-80

[16] Астахов Ю.С., Скрябина Е.В., Коненкова Я.С., и др. Диагностика и лечение грибковых кератитов // Офтальмологические ведомости. 2013. Т. 6, №2. C. 75–80. doi: 10.17816/OV2013275-80

[17] Peyman GA, Lee PJ, Seal DV. Endophthalmitis: diagnosis and treatment. London: Taylor & Francis; 2004. 278 p.

[18] Peyman G.A., Lee P.J., Seal D.V. Endophthalmitis: diagnosis and treatment. London: Taylor & Francis, 2004. 278 p.

[19] Neroev VV, Katargina LA, Kovaleva LA, et al. Clinical aspects of bacterial corneal ulcer prolonged course, the role of herpes viruses in its pathogenesis, treatment. Ophthalmology in Russia. 2019;16(1S):40–44. (In Russ.) doi: 10.18008/1816-5095-2019-1S-40-44

[20] Нероев В.В., Катаргина Л.А., Ковалева Л.А., и др. Клинические аспекты бактериальной язвы роговицы затяжного течения, роль вирусов герпеса в её патогенезе, тактика лечения // Офтальмология. 2019. Т. 16, №1S. С. 40–44. doi: 10.18008/1816-5095-2019-1S-40-44

[21] Kovaleva LA, Krichevskaya GI, Balackaya NV. Bacterial corneal ulcers, causes of prolonged course, tactics of treatment. Point of View. East – West. 2018;(4):51–53. (In Russ). doi: 10.25276/2410-1257-2018-4-51-53

[22] Ковалева Л.А., Кричевская Г.И., Балацкая Н.В. Бактериальная язва роговицы: причины затяжного течения, тактика лечения // Научно-практический журнал «Точка зрения. Восток-Запад». 2018. №4. С. 51–53. doi: 10.25276/2410-1257-2018-4-51-53

[23] Neroev VV, Slepova OS, Kovaleva LA, Krichevskaya GI. Optimizing etiological diagnostics and improving the efficiency of treating centralized infectious corneal ulcers. Russian Ophthalmological Journal. 2017;10(3):56–61. (In Russ). doi: 10.21516/2072-0076-2017-10-3-56-61

[24] Нероев В.В., Слепова О.С., Ковалева Л.А., Кричевская Г.И. Оптимизация этиологической диагностики и повышение эффективности лечения инфекционных язв роговицы центральной локализации // Российский офтальмологический журнал. 2017. Т. 10, №3. С. 56–61. doi: 10.21516/2072-0076-2017-10-3-56-61

[25] Patent RUS №2623069. 2016. Byul. №34. Neroev VV, Kovaleva LA, Krichevskaya GI. Sposob opredeleniya pokazanii k provedeniyu protivogerpeticheskoi terapii pri tsentral’nykh bakterial’nykh yazvakh rogovitsy s zatyazhnym techeniem. Available from: http://www.findpatent.ru/patent/262/2623069.html (In Russ).

[26] Патент РФ на изобретение №2623069, 2016. Нероев В.В., Ковалева Л.А., Кричевская Г.И. Способ определения показаний к проведению противогерпетической терапии при центральных бактериальных язвах роговицы с затяжным течением. Режим доступа: http://www.findpatent.ru/patent/262/2623069.html. Дата обращения: 12.11.2020.

[27] Behrens-Baumann W. Mycosis of the eye and its adnexa. Developments in ophthalmology, Vol. 32. Basel: S. Karger AG; 1999. 201 p. doi: 10.1159/isbn.978-3-318-00462-5

[28] Behrens-Baumann W. Mycosis of the eye and its adnexa. Developments in Ophthalmology, Vol. 32. Basel: S. Karger AG, 1999. 201 p. doi: 10.1159/isbn.978-3-318-00462-5

[29] Manzouri B, Vafidis GC, Wyse R. Pharmacotherapy of fungal eye infections. Expert Opin Pharmacother. 2001;2(11): 1849–1857. doi: 10.1517/14656566.2.11.1849

[30] Manzouri B., Vafidis G.C., Wyse R. Pharmacotherapy of fungal eye infections // Expert Opin. Pharmacother. 2001. V. 2. N 11. P. 1849–1857. doi: 10.1517/14656566.2.11.1849

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