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A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus
BACKGROUND: Polymicrobial keratitis with fungus and bacteria can lead to blindness and is challenging to treat. Here, we introduce a case of fungal keratitis caused by two different strains in addition to definite bacterial super-infection caused by an α-Streptococcus sp., and describe the importanc...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345249/ https://www.ncbi.nlm.nih.gov/pubmed/28279173 http://dx.doi.org/10.1186/s12941-017-0187-z |
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author | Hotta, Fumika Eguchi, Hiroshi Nishimura, Keiko Kogiso, Masahiro Ishimaru, Mayumi Kusaka, Shunji Shimomura, Yoshikazu Yaguchi, Takashi |
author_facet | Hotta, Fumika Eguchi, Hiroshi Nishimura, Keiko Kogiso, Masahiro Ishimaru, Mayumi Kusaka, Shunji Shimomura, Yoshikazu Yaguchi, Takashi |
author_sort | Hotta, Fumika |
collection | PubMed |
description | BACKGROUND: Polymicrobial keratitis with fungus and bacteria can lead to blindness and is challenging to treat. Here, we introduce a case of fungal keratitis caused by two different strains in addition to definite bacterial super-infection caused by an α-Streptococcus sp., and describe the importance of microscopic examination. CASE PRESENTATION: A 74-year-old woman, who had a past history of infection with leprosy, presented with conjunctival hyperaemia, pain, and corneal opacity in her right eye. Under the presumptive diagnosis of infectious keratitis, corneal scrapings were stained by various reagents and inoculated on several agar plates. Microscopic findings of the scrapings revealed fungi and a small number of Gram-positive cocci. Multiple anti-fungal therapies with levofloxacin ophthalmic solution were administered. Although empiric treatment was initially effective, keratitis recurred 10 days after its initiation. Repeated corneal scraping revealed an abundance of Gram-positive chain cocci and a small amount of fungi, resulting in the switching of an antibiotic medication from levofloxacin to moxifloxacin and cefmenoxime. Keratitis resolved gradually after the conversion. Stemphylium sp., Acremonium sp., and α-Streptococcus sp. were simultaneously isolated from the corneal scrapings. CONCLUSIONS: To the best of our knowledge, this is the first case of fungal keratitis caused by Stemphylium sp., and also the first case of super-infection in the cornea caused by two different fungi and one bacterium. Microscopic examination of the corneal scrapings was beneficial in rapid decision of changing to appropriate drug according to the dominancy of pathogenicity. |
format | Online Article Text |
id | pubmed-5345249 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-53452492017-03-14 A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus Hotta, Fumika Eguchi, Hiroshi Nishimura, Keiko Kogiso, Masahiro Ishimaru, Mayumi Kusaka, Shunji Shimomura, Yoshikazu Yaguchi, Takashi Ann Clin Microbiol Antimicrob Case Report BACKGROUND: Polymicrobial keratitis with fungus and bacteria can lead to blindness and is challenging to treat. Here, we introduce a case of fungal keratitis caused by two different strains in addition to definite bacterial super-infection caused by an α-Streptococcus sp., and describe the importance of microscopic examination. CASE PRESENTATION: A 74-year-old woman, who had a past history of infection with leprosy, presented with conjunctival hyperaemia, pain, and corneal opacity in her right eye. Under the presumptive diagnosis of infectious keratitis, corneal scrapings were stained by various reagents and inoculated on several agar plates. Microscopic findings of the scrapings revealed fungi and a small number of Gram-positive cocci. Multiple anti-fungal therapies with levofloxacin ophthalmic solution were administered. Although empiric treatment was initially effective, keratitis recurred 10 days after its initiation. Repeated corneal scraping revealed an abundance of Gram-positive chain cocci and a small amount of fungi, resulting in the switching of an antibiotic medication from levofloxacin to moxifloxacin and cefmenoxime. Keratitis resolved gradually after the conversion. Stemphylium sp., Acremonium sp., and α-Streptococcus sp. were simultaneously isolated from the corneal scrapings. CONCLUSIONS: To the best of our knowledge, this is the first case of fungal keratitis caused by Stemphylium sp., and also the first case of super-infection in the cornea caused by two different fungi and one bacterium. Microscopic examination of the corneal scrapings was beneficial in rapid decision of changing to appropriate drug according to the dominancy of pathogenicity. BioMed Central 2017-03-09 /pmc/articles/PMC5345249/ /pubmed/28279173 http://dx.doi.org/10.1186/s12941-017-0187-z Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Hotta, Fumika Eguchi, Hiroshi Nishimura, Keiko Kogiso, Masahiro Ishimaru, Mayumi Kusaka, Shunji Shimomura, Yoshikazu Yaguchi, Takashi A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus |
title | A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus |
title_full | A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus |
title_fullStr | A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus |
title_full_unstemmed | A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus |
title_short | A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus |
title_sort | super-infection in the cornea caused by stemphylium, acremonium, and α-streptococcus |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345249/ https://www.ncbi.nlm.nih.gov/pubmed/28279173 http://dx.doi.org/10.1186/s12941-017-0187-z |
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