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2011 OMIG Abstract 18

Outbreak of Paecilomyces keratitis in South Florida
G. Amescua, D. Miller, L.H. Suh, R.K. Forster
Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL

Purpose: To describe the clinical presentation and course of patients with Paecilomyces keratitis at our institution during a recent outbreak.

Methods: A retrospective review of microbiologic records from January 1, 2007 through August 1, 2011 (4.5 years), was performed, identifying all patients with corneal ulceration and a culture-positive for Paecilomyces species. Medical records of 21 patients were reviewed for clinical characteristics, microbiologic features and treatment regimens.

Results: A total of 21 cases of Paecilomyces keratitis were included in this study, compared to 13 cases seen at our institution from January of 2000 to December 2006 (seven years). Fifteen of the 21 patients presented with a non-therapeutic contact lens associated keratitis; 1 patient with a therapeutic associated contact lens; 1 patient after cataract surgery; 2 cases after organic trauma and 2 cases with unknown risk factors. Antimicrobial medications administered prior to Paecilomyces diagnosis were antibacterial in all cases. No distinct preponderance of any one brand of either contact lens or solution was identified. The microbiological cultures to date identified Paecilomyces lilacinus in 8 cases, Paecilomyces variotii in 1 case and species not further identifiable in the rest of the cases. Paecilomyces lilacenus was resistant to natamycin and amphothericin B in vitro. Patients with a delayed onset of treatment had a tendency for prolonged treatment until cure. Patients with early diagnosis and treatment with topical voriconazole had a tendency for better outcome. Therapeutic penetrating keratoplasty was required in 7 of the 21 patients, with recurrence of the fungal keratitis in 1 patient.

Conclusions: Paecilomyces is an unusual organism in the etiology of infectious keratitis. An increase in the number of cases has been noted in South Florida. Most of the patients presented in the setting soft contact lens wear. A delay in proper diagnosis and intervention may contribute to a prolonged treatment course. The use of topical voriconazole is recommended for the treatment of Paecilomyces keratitis.

Disclosure: N

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