Scedosporium apiospermum에 의한 진균각막염 1예
A Case of Fungal Keratitis Scedosporium apiospermum
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목적: Scedosporium apiospermum 에 의한 각막염 1예를 경험하여 이를 보고하고자 한다. 증례요약: 화분을 교체하다가 흙이 눈에 들어간 후 발생한 우안의 시력저하 및 충혈로 10일간의 개인의원 치료에도 호전이 없어 내원한70세 남자 환자에서 각막찰과표본을 얻어 그람염색 및 배양검사, KOH 도말검사를 시행하였다. 배양검사상 Scedosporium apiospermum 이 검출되었고, 목시플록사신 항생제와 fluconazole, amphotericin B 점안 항진균제로 치료하다 병변의 호전이 보이지 않아, fluconazole 을 voriconazole로 변경하여 점안 치료 후 치료 2개월째 각막에 경미한 혼탁만을 남기고 완전히 치료되었다. 결론: 토양이나 오염된 물, 부패한 식물에 노출된 후 발생한 각막궤양으로 내원한 환자에서 흔하지는 않지만 원인으로 Scedosporium apiospermum에 의한 각막염을 고려해야 하겠으며, fluconazole에 반응하지 않는 진균 각막염에서는 voriconazole이 진균각막염의치료로 고려되어야 하겠다.
Abstract
Purpose: To report a case of fungal keratitis caused by Scedosporium apiospermum. Case summary: A 70-year-old man visited our clinic with complaints of redness and decreased visual acuity in his right eye caused by a soil gotten into an eye while gardening 10 days ago. The patient had previously been treated in a local clinic but did not show significant clinical improvement. Bacterial and fungal staining, culture, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Scedosporium apiospermum. The patient was treated with topical moxifloxacin antibiotics, fluconazole, amphotericin B antifungal agents. However, the lesion was not improved, so antifungal therapy was switched to topical voriconazole. After two months of treatment, the infection was resolved with mild scarring. Conclusions: Although it is a rare pathogen, Scedosporium apiospermum should be considered as a potential pathogen in patients presenting with corneal ulceration due to trauma from an object contaminated by soil, polluted water, or spoiled plant contact. And we suggest that topical application of voriconazole may be a good alternative treatment for patient with fungal keratitis in which no improvement despite a conventional antifungal agent, fluconazole.
참고문헌 (19)
- O’Day DM, "Selection of appropriate antifungal therapy", Cornea, 6, pp.238~245 (1987)
- Leber TH, "Keratomycosis aspergillina als ursache von hypopyonkeratitis", Graefes Arch Ophthalmol, 25, pp.285~301 (1879)
- Jurkunas U, "Fungal keratitis: changing pathogens and risk factors", Cornea, 28, pp.638~643 (2009)
- Al-Badriyeh D, "Successful salvage treatment of Scedosporium apiospermum keratitis with topical voriconazole after failure of natamycin", Ann Pharmacother, 43, pp.1139~1142 (2009)
- Wu Z, "Fungal keratitis caused by Scedosporium apiospermum: report of two cases and review of treatment", Cornea, 21, pp.519~523 (2002)
- Thomas PA, "Mycotic keratitis--an underestimated mycosis", J Med Vet Mycol, 32, pp.235~256 (1994)
- Cortez KJ, "Infections caused by Scedosporium spp", Clin Microbiol Rev, 21, pp.157~197 (2008)
- 윤서영, "분자유전학적 방법으로 확진된 Scedosporium apiospermum 각막염 1예", Annals of Laboratory Medicine, 28(4), pp.307~311 (2008), 대한진단검사의학회
- Ponchel C, "Fungal keratitis caused by Scedosporium apiospermum", J Fr Ophthalmol, 30, pp.933~937 (2007)
- Verweij PE, "Aspergillus, Fusarium, and other opportunistic moniliaceous fungi, In Manual of Clinical Microbiology", pp.1821~1822 (2007), ASM Press
- Hahn YH, "Epidemiology of infectious keratitis(II): a multi-center study", J Korean Ophthalmol Soc, 2, pp.247~265 (2001)
- Ksiazek SM, "Fungal panophthalmitis secondary to Scedosporium apiospermum (Pseudallescheria boydii) keratitis", Am J Ophthalmol, 118, pp.531~533 (1994)
- Moshirfar M, "Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes", J Cataract Refract Surg, 3, pp.474~483 (2007)
- Lalitha P, "Risk factors for treatment outcome in fungal keratitis", Ophthalmology, 113, pp.526~530 (2006)
- 이광훈, "진균각막염에서 치료실패의 위험인자에 대한 분석", 대한안과학회지, 49(5), pp.737~742 (2008), 대한안과학회
- Sanati H, "A new triazole, voriconazole (UK-109,496), blocks sterol biosynthesis in Candida albicans and Candida krusei", Antimicrob Agents Chemother, 1, pp.2492~2496 (1997)
- Bunya VY, "Topical and oral voriconazole in the treatment of fungal keratitis", Am J Ophthalmol, 143, pp.151~153 (2007)
- Jhanji V, "Scedosporium scleritis or keratitis or both: case series", Eye Contact Lens, 5, pp.312~315 (2009)
- Srinivasan M., "Fungal keratitis", Curr Opin Ophthalmol, 15, pp.21~27 (2004)