Clinical Characteristics, Histopathology, and Treatment Outcomes of Pythium Keratitis: A Retrospective Cohort Study
Vilavun Puangsricharern,1,2 Patraramon Chotikkakamthorn,2 Wasee Tulvatana,1 Thanachaporn Kittipibul,2 Patchima Chantaren,2 Usanee Reinprayoon,2 Ngamjit Kasetsuwan,1,2 Vannarut Satitpitakul,2 Navaporn Worasilchai,3,4 Ariya Chindamporn3 1Department of Ophthalmology, Faculty of Medicine, Chulalongkorn...
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| Formato: | article |
| Lenguaje: | EN |
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Dove Medical Press
2021
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| Acceso en línea: | https://doaj.org/article/ebfdde7377184750afd45683287c8d4e |
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| Sumario: | Vilavun Puangsricharern,1,2 Patraramon Chotikkakamthorn,2 Wasee Tulvatana,1 Thanachaporn Kittipibul,2 Patchima Chantaren,2 Usanee Reinprayoon,2 Ngamjit Kasetsuwan,1,2 Vannarut Satitpitakul,2 Navaporn Worasilchai,3,4 Ariya Chindamporn3 1Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 2Center of Excellence for Cornea and Stem Cell Transplantation, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; 3Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 4Department of Transfusion Medicine and Clinical Microbiology, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, ThailandCorrespondence: Vilavun PuangsricharernDepartment of Ophthalmology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, Thailand, 10330 Tel +66 83-012-2999Email vilavun@hotmail.comPurpose: To identify factors associated with the prognosis in Pythium keratitis.Patients and Methods: The medical records of 25 patients (26 eyes) diagnosed with Pythium keratitis at a referral institution were reviewed. The demographic and clinical characteristics, treatment, microbiological diagnosis, histopathological features, and outcomes were recorded. The histopathological specimens were reviewed. The patients were divided into a globe removal group and a globe salvage group. Univariate analysis was used to identify factors associated with poor outcomes.Results: Fifteen eyes (57.7%) were removed. Patients in the globe removal group were on average 16.4 years older (95% CI 6.98 to 25.88) than those in the globe salvage group, received the first medication (either topical antifungals or antibiotics) later than one day after the onset of symptoms (RR = 2.75, 95% CI 1.18 to 6.42), and had a maximal diameter of the infiltration area ≥ 6 mm (RR = 3.14, 95% CI 1.17 to 8.45). The globe removal group showed satellite, multifocal, or total corneal infiltration patterns (RR = 2.82, 95% CI 1.03 to 7.74) and a hypopyon (RR = 3.43, 95% CI 1.26 to 9.35) as risk factors. The histopathological examination showed a higher density of Pythium in the globe removal group than the globe salvage group (median 376 (interquartile range 323, 620) versus 107 (interquartile range 16, 260) hyphae per high power field; P = 0.035).Conclusion: The risk of globe removal in patients with Pythium keratitis increased with age, delayed initial topical antifungal or antibiotic treatment, advanced disease at presentation, and dense Pythium hyphae infiltration of the cornea. Early recognition and treatment are critical to successfully eradicate the infection.Keywords: eye evisceration, eye infections, keratoplasty, penetrating, oomycetes, prognostic factors |
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