Abstract
Purpose
To report the clinical manifestations and prognoses in 5 cases of mixed Candida and bacterial keratitis and pres-ent a literature review on mixed fungal and bacterial keratitis.
Case summary
Five eyes of 5 patients (1 male, 4 female) diagnosed as mixed Candida and bacterial keratitis by corneal smear and culture were included in the present study. Patient mean age was 62.80 years. All patients had preexisting ocu-lar or systemic conditions as predisposing factors for mixed Candida and bacterial keratitis. The most common Candida species isolated was Candida albicans (3 eyes, 60%), while Staphylococcus (3 eyes, 60%) was the most common mixed bacterial species. The average size of ulceration was 7.02 mm2. In 2 eyes (40%), the lesions were located at the corneal center. The depth of the infiltration was significant in all cases, and hypopyon was present in 2 eyes (40%). On the initial visit, the visual acuity was counting fingers or worse in all cases. Four eyes (80%) unresponsive to the topical and systemic treatment underwent surgical intervention but only 1 eye (20%), which had responded to the topical and systemic treat-ment, showed acuity improvement of more than 1 line on the final visit.
References
1. Hassan HM, Papanikolaou T, Mariatos G, et al. Candida albicans keratitis in an immunocompromised patient. Clin Ophthalmol. 2010; 4:1211–5.
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2. Sun RL, Jones DB, Wilhelmus KR. Clinical characteristics and outcome of Candida keratitis. Am J Ophthalmol. 2007; 143:1043–5.
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3. Ahn M, Yoon KC, Ryu SK, et al. Clinical aspects and prognosis of mixed microbial (bacterial and fungal) keratitis. Cornea. 2011; 30:409–13.
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4. Kim JH, Shin HH, Song JS, Kim HM. Infectious keratitis caused by Stenotrophomonas maltophilia and yeast simultaneously. Cornea. 2006; 25:1234–6.
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Figure 1.
Case 1. (A) At the initial visit, the left eye showed 6.3 mm2 sized epithelial defect with deep stromal infiltration. (B) After 2 weeks, amniotic membrane transplantation was done. (C) After 1 year, corneal perforation developed at the site of the ulceration, so corneal button graft was done on the site of corneal perforation site.
![jkos-54-818f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-818f1.gif)
Figure 2.
Case 2. (A) At the initial visit, the left eye showed 2.3 mm2 sized epithelial defect with deep stromal infiltration. (B) After 6 months of antifungal and antibiotic treatment, corneal lesion regressed with opacification.
![jkos-54-818f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-818f2.gif)
Figure 3.
Case 3. The left eye showing 4.5 mm2 sized epi-thelial defect, associated deep stromal infiltration, hypopyon and multiple filaments at the initial visit.
![jkos-54-818f3.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-818f3.gif)
Table 1.
Data from 5 cases of mixed infection with Candida species and bacterial keratitis