Mycopathologia

, Volume 183, Issue 3, pp 603–609 | Cite as

Exophiala dermatitidis Endophthalmitis: Case Report and Literature Review

  • Mónika Homa
  • Palanisamy Manikandan
  • Veerappan Saravanan
  • Rajaraman Revathi
  • Raghavan Anita
  • Venkatapathy Narendran
  • Kanesan Panneerselvam
  • Coimbatore Subramanian Shobana
  • Mohammed Al Aidarous
  • László Galgóczy
  • Csaba Vágvölgyi
  • Tamás Papp
  • László Kredics
Short Communication

Abstract

We report a case of a 59-year-old male patient with a postoperative fungal infection of the left eye. A dark-pigmented yeast, Exophiala dermatitidis (previously known as Wangiella dermatitidis), was identified from the culture of the biopsy taken from the posterior capsule. The infection was successfully eradicated by a combination of surgical and medical (i.e., voriconazole and fluconazole) treatment. This is the first report of successfully treated E. dermatitidis endophthalmitis, which demonstrates that a prompt and aggressive antifungal therapy combined with surgical intervention is necessary to prevent vision loss in cases of endophthalmitis due to Exophiala species. Beside the case description, we also aim to provide a literature review of previously reported eye infections caused by Exophiala species in order to help the future diagnosis and management of the disease.

Keywords

Dematiaceous fungi Exophiala Keratitis Endophthalmitis Antifungal susceptibility 

Notes

Acknowledgements

This study was supported by the “Lendület” Grant of the Hungarian Academy of Sciences (LP2016-8/2016) and the Project GINOP-2.3.2-15-2016-00035 (Széchenyi 2020 Programme). LG is supported by the Postdoctoral Excellence Programme (PD 120808) of the Hungarian National Research, Development and Innovation Office (NKFI Office). PM would like to thank Deanship of Scientific Research at Majmaah University, Kingdom of Saudi Arabia, for supporting this work under Project No. 37/106.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

For this type of study formal consent is not required.

References

  1. 1.
    Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivakumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol. 2007;14:61–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Chakrabarti A, Shivaprakash MR, Singh R, Tarai B, George VK, Fomda BA, Gupta A. Fungal endophthalmitis: fourteen years’ experience from a center in India. Retina. 2008;28:1400–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Zeng JS, Sutton DA, Fothergill AW, Rinaldi MG, Harrak MJ, de Hoog GS. Spectrum of clinically relevant Exophiala species in the United States. J Clin Microbiol. 2007;45:3713–20.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kondori N, Gilljam M, Lindblad A, Jönsson B, Moore ERB, Wennerås C. High rate of Exophiala dermatitidis recovery in the airways of patients with cystic fibrosis is associated with pancreatic insufficiency. J Clin Microbiol. 2011;49:1004–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chowdhary A, Meis JF, Guarro J, de Hoog GS, Kathuria S, Arendrup MC, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll AH, Hope WW, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson MD, Roilides E, Skiada A, Tortorano AM, Ullmann AJ, Verweij PE, Cornely OA, Cuenca-Estrella M, European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group.; European Confederation of Medical Mycology. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect. 2014;20:47–75.CrossRefPubMedGoogle Scholar
  6. 6.
    Ben-Simon GJ, Barequet IS, Grinbaum A. More than tears in your eyes (Exophiala jeanselmei keratitis). Cornea. 2002;21:230–1.CrossRefPubMedGoogle Scholar
  7. 7.
    Pospísil L, Skorkovská S, Moster M. Corneal phaeohyphomycosis caused by Wangiella dermatitidis. Ophthalmologica. 1990;201:128–32.CrossRefPubMedGoogle Scholar
  8. 8.
    Al-Hedaithy SS, Al-Kaff AS. Exophiala jeanselmei keratitis. Mycoses. 1993;36:97–100.CrossRefPubMedGoogle Scholar
  9. 9.
    Patel SR, Hammersmith KM, Rapuano CJ, Cohen EJ. Exophiala dermatitidis keratitis after laser in situ keratomileusis. J Cataract Refract Surg. 2006;32:681–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Leung EH, Moskalewicz R, Parada JP, Kovach KJ, Bouchard C. Exophiala jeanselmei keratitis after laser in situ keratomileusis. J Cataract Refract Surg. 2008;34:1809–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Saeedi OJ, Iyer SA, Mohiuddin AZ, Hogan RN. Exophiala jeanselmei keratitis: case report and review of literature. Eye Contact Lens. 2013;39:410–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Aggarwal S, Yamaguchi T, Dana R, Hamrah P. Exophiala phaeomuriformis fungal keratitis: case report and in vivo confocal microscopy findings. Eye Contact Lens. 2015.  https://doi.org/10.1097/ICL.0000000000000193.Google Scholar
  13. 13.
    Li EY, Yuen HK, Lung DC. Subconjunctival mycetoma as an unusual cause of tears with black deposits. Arch Ophthalmol. 2010;128:1371–2.CrossRefPubMedGoogle Scholar
  14. 14.
    Margo CE, Fitzgerald CR. Postoperative endophthalmitis caused by Wangiella dermatitidis. Am J Ophthalmol. 1990;110:322–33.CrossRefPubMedGoogle Scholar
  15. 15.
    Benaoudia F, Assouline M, Pouliquen Y, Bouvet A, Guého E. Exophiala (Wangiella) dermatitidis keratitis after keratoplasty. Med Mycol. 1999;37:53–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Hofling-Lima AL, Freitas D, Fischman O, Yu CZ, Roizenblatt R, Belfort R Jr. Exophiala jeanselmei causing late endophthalmitis after cataract surgery. Am J Ophthalmol. 1999;128:512–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Clamp MF, Jumper JM, Ku CW, McDonald HR, Johnson RN, Fu AD, Lujan BJ, Cunningham ET Jr. Chronic exogenous Exophiala dermatitidis endophthalmitis. Retin Cases Brief Rep. 2014;8:265–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Quintero-Estades JA, Walter S, Valenzuela F, Amescua G. Delayed-onset postoperative endophthalmitis secondary to Exophiala. BMJ Case Rep. 2015.  https://doi.org/10.1136/bcr-2014-208680.PubMedPubMedCentralGoogle Scholar
  19. 19.
    White TJ, Burns S, Lee S, Taylor J. Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, editors. PCR protocols: a guide to methods and applications. New York: Academic Press Inc; 1990. p. 315–22.Google Scholar
  20. 20.
    Bonfield JK, Smith KF, Staden R. A new DNA sequence assembly program. Nucleic Acids Res. 1995;23:4992–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hall TA. BioEdit: a user-friendly biological sequence alignment editor and analysis program for Windows 95/98/NT. Nucleic Acids Symp Ser. 1999;41:95–8.Google Scholar
  22. 22.
    Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ. Basic local alignment search tool. J Mol Biol. 1990;215:403–10.CrossRefPubMedGoogle Scholar
  23. 23.
    Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. In: Approved standard CLSI document M38-A2. Wayne: CLSI; 2008.Google Scholar
  24. 24.
    Manikandan P, Varga J, Kocsubé S, Anita R, Revathi R, Németh TM, Narendran V, Vágvölgyi C, Panneer Selvam K, Shobana CS, Babu Singh YR, Kredics L. Epidemiology of Aspergillus keratitis at a tertiary care eye hospital in South India and antifungal susceptibilities of the causative agents. Mycoses. 2013;56:26–33.CrossRefPubMedGoogle Scholar
  25. 25.
    Krizsán K, Tóth E, Nagy LG, Galgóczy L, Manikandan P, Chandrasekaran M, Kadaikunnan S, Alharbi NS, Vágvölgyi C, Papp T. Molecular identification and antifungal susceptibility of Curvularia australiensis, C. hawaiiensis and C. spicifera isolated from human eye infections. Mycoses. 2015;58:603–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Homa M, Shobana CS, Singh YR, Manikandan P, Selvam KP, Kredics L, Narendran V, Vágvölgyi C, Galgóczy L. Fusarium keratitis in South India: causative agents, their antifungal susceptibilities and a rapid identification method for the Fusarium solani species complex. Mycoses. 2013;56:501–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Hassan AS, Al-Hatmi AM, Shobana CS, van Diepeningen AD, Kredics L, Vágvölgyi C, Homa M, Meis JF, de Hoog GS, Narendran V, Manikandan P, IHFK Working Group. Antifungal susceptibility and phylogeny of opportunistic members of the genus Fusarium causing human keratomycosis in South India. Med Mycol. 2016;54:287–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Mónika Homa
    • 1
    • 2
  • Palanisamy Manikandan
    • 3
    • 4
    • 5
  • Veerappan Saravanan
    • 3
  • Rajaraman Revathi
    • 3
  • Raghavan Anita
    • 3
  • Venkatapathy Narendran
    • 3
  • Kanesan Panneerselvam
    • 6
  • Coimbatore Subramanian Shobana
    • 7
  • Mohammed Al Aidarous
    • 4
  • László Galgóczy
    • 2
  • Csaba Vágvölgyi
    • 2
  • Tamás Papp
    • 1
    • 2
  • László Kredics
    • 2
  1. 1.MTA-SZTE “Lendület” Fungal Pathogenicity Mechanisms Research GroupSzegedHungary
  2. 2.Department of Microbiology, Faculty of Science and InformaticsUniversity of SzegedSzegedHungary
  3. 3.Aravind Eye Hospital and Postgraduate Institute of OphthalmologyCoimbatoreIndia
  4. 4.Department of Medical Laboratory Sciences, College of Applied Medical SciencesMajmaah UniversityAl Majma’ahSaudi Arabia
  5. 5.Greenlink Analytical and Research Laboratory India Private LimitedCoimbatoreIndia
  6. 6.Research Department of MicrobiologyM. R. Government Arts CollegeMannargudi, Tiruvarur DistrictIndia
  7. 7.Department of MicrobiologyPSG College of Arts and ScienceCoimbatoreIndia

Personalised recommendations