Posters

Case report: fungal keratitis – the importance of clinical diagnosis when microbiology is unsuccessful

Poster Details

First Author: E.Halbwirth AUSTRIA

Co Author(s):    S. Moussa   M. Dietrich   V. Steiner   H. Reitsamer           

Abstract Details

Purpose:

Microbiological results of corneal scrapings often show negative results although the patient presents with a typical clinical picture. This case should show what additional diagnostic methods are available and what clinical features are indicative due to the frequent difficult pathogen identification in microbial keratitis.

Setting:

Case Report, University Eye Clinic Salzburg/ Austria, SALK, Paracelsus Medical University

Methods:

We treated a 29-year-old woman with a contact lens associated keratitis. There was a strong suspicion of keratomycosis and special treatment was given but the microbiological results were still missing. The evidence of fungal keratitis was confirmed due to the typical image in confocal microscopy. Despite intensive antifungal therapy, the keratomycosis was progressive and a keratoplasty a chaud was necessary. Since then, the patient is recurrence-free.

Results:

Multiple samplings of PCR for mycotic, bacterial or HSV-1/2 DNA showed negative results. In the confocal microscopy parallel hyperreflective lines in the stroma which are indicative for fungal hyphae were detected. Postoperatively, histological examination (PAS-staining) of the recipient cornea showed fungal hyphae, but no species could be defined. A panfungal PCR of the recipient cornea finally showed the DNA of Aureobasidium pullulans.

Conclusions:

Despite multiple negative results of the samples in microbiology one should rely on the clinical diagnosis and continue a successful treatment plan. Further, alternative diagnostic tools should be used. A good cooperation with microbiology and pathology is important to optimize diagnostics for pathogen detection. In this way, the treatment can soon be specifically adapted and possible consequential damage can be avoided.

Financial Disclosure:

None