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A super-infection in the cornea caused by Stemphylium, Acremonium, and α-Streptococcus.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords

Acremonium

Keratitis

Microscopic examination

Pathogenicity

Stemphylium

Super-infection

α-Streptococcus

Journal Title annals of clinical microbiology and antimicrobials
Publication Year Start




PMID- 28279173
OWN - NLM
STAT- MEDLINE
DA  - 20170310
DCOM- 20170317
LR  - 20170317
IS  - 1476-0711 (Electronic)
IS  - 1476-0711 (Linking)
VI  - 16
IP  - 1
DP  - 2017 Mar 09
TI  - A super-infection in the cornea caused by Stemphylium, Acremonium, and
      alpha-Streptococcus.
PG  - 11
LID - 10.1186/s12941-017-0187-z [doi]
AB  - 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 alpha-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 alpha-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.
FAU - Hotta, Fumika
AU  - Hotta F
AD  - Department of Ophthalmology, Sakai Hospital Kindai University, 2-7-1 Harayamadai,
      Minami-ku, Sakai, Osaka, 590-0132, Japan.
FAU - Eguchi, Hiroshi
AU  - Eguchi H
AD  - Department of Ophthalmology, Sakai Hospital Kindai University, 2-7-1 Harayamadai,
      Minami-ku, Sakai, Osaka, 590-0132, Japan. [email protected]
FAU - Nishimura, Keiko
AU  - Nishimura K
AD  - Department of Ophthalmology, Shikoku Medical Center for Children and Adults,
      2-1-1 Senyu-cho, Zentsuji, Kagawa, 765-8507, Japan.
FAU - Kogiso, Masahiro
AU  - Kogiso M
AD  - Department of Ophthalmology, Shikoku Medical Center for Children and Adults,
      2-1-1 Senyu-cho, Zentsuji, Kagawa, 765-8507, Japan.
FAU - Ishimaru, Mayumi
AU  - Ishimaru M
AD  - Department of Ophthalmology, Shikoku Medical Center for Children and Adults,
      2-1-1 Senyu-cho, Zentsuji, Kagawa, 765-8507, Japan.
FAU - Kusaka, Shunji
AU  - Kusaka S
AD  - Department of Ophthalmology, Sakai Hospital Kindai University, 2-7-1 Harayamadai,
      Minami-ku, Sakai, Osaka, 590-0132, Japan.
FAU - Shimomura, Yoshikazu
AU  - Shimomura Y
AD  - Department of Ophthalmology, Kindai University Hospital, 377-2 Ohnohigashi,
      Osakasayama, Osaka, 589-8511, Japan.
FAU - Yaguchi, Takashi
AU  - Yaguchi T
AD  - Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku,
      Chiba, 260-8673, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170309
PL  - England
TA  - Ann Clin Microbiol Antimicrob
JT  - Annals of clinical microbiology and antimicrobials
JID - 101152152
RN  - 0 (Anti-Infective Agents)
RN  - 0 (Fluoroquinolones)
RN  - 6GNT3Y5LMF (Levofloxacin)
RN  - KBZ4844CXN (Cefmenoxime)
RN  - U188XYD42P (moxifloxacin)
SB  - IM
MH  - Acremonium/drug effects/*growth & development/pathogenicity
MH  - Aged
MH  - Anti-Infective Agents/therapeutic use
MH  - Cefmenoxime/therapeutic use
MH  - Coinfection/*diagnosis/drug therapy/microbiology/pathology
MH  - Cornea/drug effects/microbiology/pathology
MH  - Eye Infections, Fungal/*diagnosis/drug therapy/microbiology/pathology
MH  - Female
MH  - Fluoroquinolones/therapeutic use
MH  - Humans
MH  - Keratitis/*diagnosis/drug therapy/microbiology/pathology
MH  - Levofloxacin/therapeutic use
MH  - Saccharomycetales/drug effects/*growth & development/pathogenicity
MH  - Streptococcus/drug effects/*growth & development/pathogenicity
PMC - PMC5345249
OTO - NOTNLM
OT  - *Acremonium
OT  - *Keratitis
OT  - *Microscopic examination
OT  - *Pathogenicity
OT  - *Stemphylium
OT  - *Super-infection
OT  - *alpha-Streptococcus
EDAT- 2017/03/11 06:00
MHDA- 2017/03/18 06:00
CRDT- 2017/03/11 06:00
PHST- 2016/09/20 [received]
PHST- 2017/03/06 [accepted]
AID - 10.1186/s12941-017-0187-z [doi]
AID - 10.1186/s12941-017-0187-z [pii]
PST - epublish
SO  - Ann Clin Microbiol Antimicrob. 2017 Mar 9;16(1):11. doi:
      10.1186/s12941-017-0187-z.

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