Abstract

Volume.116 Number.7

Original article : Clinical science

Clinical Manifestations，Treatment and Outcome of Ocular Infections Caused by Paecilomyces Species
Hideaki Kawakami1, Hiroko Inuzuka1, Kiyofumi Mochizuki2, Nobumichi Takahashi2, Toshihiro Muto3, Kiyofumi Ohkusu4, Takashi Yaguchi5, Kazuko Nishimura5
1 Department of Ophthalmology, Gifu Municipal Hospital
2 Department of Ophthalmology, Gifu University Graduate School of Medicine
3 Department of Clinical Laboratory, Gifu Municipal Hospital
4 Department of Microbiology, Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine
5 Research Center for Pathogenic Fungi and Microbial Toxicoses, Chiba University

Purpose: To report the predisposing factors, patient background, treatment and outcomes of ocular infections caused by Paecilomyces spp. in Japan.
Methods: We reviewed the medical records and the published literature in Japan on ocular infections caused by microbiologically-proven Paecilomyces spp. Nineteen eyes of 18 patients; 4 eyes of 4 of our patients and 15 eyes of 14 published Japanese patients were studied.
Results: Ten men and 8 women (9OD, 8OS, 1OU) were diagnosed with ocular infections caused by Paecilomyces spp. The mean age was 69 years (range 33 to 90 years). The initial diagnosis of ocular infection caused by Paecilomyces spp. was keratitis in 14 eyes and endophthalmitis in 5 eyes. The final diagnosis was keratitis in 2 eyes, keratitis with involvement of the anterior segment of the eye, i.e., hypopyon or corneal rupture, in 12 eyes, and endophthalmitis in 5 eyes. The predisposing factors had a history of ocular surgery, corneal trauma and soft contact lens use. Other factors were diabetes and old age. The infections developed more often in the fall and winter. The identified Paecilomyces spp. had a high sensitivity to micafungin and voriconazole, but low sensitivity to amphotericin B, flucytosine and fluconazole. The prognosis of Paecilomyces spp. ocular infections was very poor, viz., final vision was counting fingers or worse in 60%, ocular perforation in 42%, and eye enucleation in 11%. The percentage of eyes with a final visual acuity worse than counting fingers was 0% in those with keratitis, 50% in those with involvement of the anterior segment, and 100% in those with endophtalmitis (p=0.0446). Among the antifungal agents, the percentage of cases with final vision of counting fingers or worse was 90% with fluconazole, 80% with itraconazole, 100% with miconazole, and 71% with voriconazole.
Conclusion: The results show that if the Paecilomyces spp. infection spreads intraocularly, it is difficult to mitigate the clinical damage even with antifungal agents with high sensitivity.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 116: 613-622, 2012.

Key words
Paecilomyces lilacinus, Keratitis, Endophthalmitis, Antifungal agents, Drug sensitivity
Reprint requests to
Hideaki Kawakami, M.D.　Department of Ophthalmology, Gifu Municipal Hospital. 7-1 Kashima-cho, Gifu-shi 500-8513, Japan
Received: 17 October 2011. Accepted in revised form: 30 January 2012.
Nihon Ganka Gakkai Zasshi 116: 613-622,2012