Retrospective case-series of Paecilomyces lilacinus ocular mycoses in Queensland, Australia.

Abstract

BACKGROUND:

The purpose of this study was to report: (1) the varying presentation of Paecilomyces ocular infections arising in Queensland; (2) the significance of immunosuppression as a primary determinant of disease; (3) the outcomes of voriconazole use; and (4) the ongoing need for both surgical and medical management of this devastating fungal infection.

METHODS:

A retrospective case series of 21 culture proven individuals participated in this series and were identified via a review of the pathology reporting system utilized in the Queensland public health system. All culture proven individuals were subjected to a systematic chart review.

RESULTS:

The primary risk factor for Paecilomyces lilacinus infection is immunosuppression with 81.25 % of individuals being on some form of immunosuppression (i.e. systemic or topical). Of the cases 71.43 % had an intact epithelial surface at the time of diagnosis, and 76 % had no previous ocular history. The final visual outcomes were nine cases with HM vision or worse, three cases with 6/48-6/60 vision, three cases 6/12-6/24, and six cases with 6/12 vision or better. Despite voriconazole use rates of greater than 80 %, protracted and poor treatment outcomes continue to be commonplace.

CONCLUSIONS:

Paecilomyces lilacinus is a filamentous fungus that has a predilection for immunosuppressed individuals. Despite in vitro and case reports demonstrating the effectiveness of voriconazole poor outcomes continue to be seen.

• Authors: Liam Daniel Turner, Diana Conrad
• Journal: BMC research notes (BMC Res Notes) Vol. 8 Pg. 627 (Oct 31 2015) ISSN: 1756-0500 [Electronic] England
• PMID: 26521140 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antifungal Agents
• Voriconazole

Topics

• Adult
• Aged
• Antifungal Agents (therapeutic use)
• Combined Modality Therapy
• Eye Infections, Fungal (drug therapy, microbiology, surgery)
• Female
• Host-Pathogen Interactions (drug effects)
• Humans
• Immune Tolerance (drug effects)
• Immunocompromised Host (drug effects)
• Male
• Middle Aged
• Mycoses (drug therapy, microbiology, surgery)
• Paecilomyces (drug effects, physiology)
• Queensland
• Retrospective Studies
• Treatment Outcome
• Visual Acuity (physiology)
• Voriconazole (therapeutic use)
• Young Adult