J Korean Ophthalmol Soc.  2013 May;54(5):818-822. 10.3341/jkos.2013.54.5.818.

A Report of Five Cases of Mixed Candida and Bacterial Keratitis

• Yang YH
• You IC

• KMID: 2217053
• DOI: http://doi.org/10.3341/jkos.2013.54.5.818

Abstract

PURPOSE
To report the clinical manifestations and prognoses in 5 cases of mixed Candida and bacterial keratitis and present a literature review on mixed fungal and bacterial keratitis.
CASE SUMMARY
Five eyes of 5 patients (1 male, 4 female) diagnosed as mixed Candida and bacterial keratitis by corneal smear and culture were included in the present study. Patient mean age was 62.80 years. All patients had preexisting ocular or systemic conditions as predisposing factors for mixed Candida and bacterial keratitis. The most common Candida species isolated was Candida albicans (3 eyes, 60%), while Staphylococcus (3 eyes, 60%) was the most common mixed bacterial species. The average size of ulceration was 7.02 mm2. In 2 eyes (40%), the lesions were located at the corneal center. The depth of the infiltration was significant in all cases, and hypopyon was present in 2 eyes (40%). On the initial visit, the visual acuity was counting fingers or worse in all cases. Four eyes (80%) unresponsive to the topical and systemic treatment underwent surgical intervention but only 1 eye (20%), which had responded to the topical and systemic treatment, showed acuity improvement of more than 1 line on the final visit.
CONCLUSIONS
In managing chronically compromised cornea, the possibility of mixed infections with Candida and bacterial organisms should be considered as keratitis shows poor prognosis.

Keyword

Bacteria; Candida species; Clinical aspect; Mixed keratitis; Prognosis

MeSH Terms

Bacteria
Candida
Candida albicans
Coinfection
Cornea
Eye
Fingers
Humans
Keratitis
Male
Prognosis
Staphylococcus
Ulcer
Visual Acuity

Figure

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  Figure 1. Case 1. (A) At the initial visit, the left eye showed 6.3 mm2 sized epithelial defect with deep stromal infiltration. (B) After 2 weeks, amniotic membrane transplantation was done. (C) After 1 year, corneal perforation developed at the site of the ulceration, so corneal button graft was done on the site of corneal perforation site.

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  Figure 2. Case 2. (A) At the initial visit, the left eye showed 2.3 mm2 sized epithelial defect with deep stromal infiltration. (B) After 6 months of antifungal and antibiotic treatment, corneal lesion regressed with opacification.

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  Figure 3. Case 3. The left eye showing 4.5 mm2 sized epi-thelial defect, associated deep stromal infiltration, hypopyon and multiple filaments at the initial visit.

Reference

References

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