Scedosporium apiospermum and Lomentospora prolificans emergent ocular infections in North India.

Abstract

Settings: Identification of the prevalent species and report clinical features, predisposing factors, and visual outcomes of ocular infections caused by Scedosporium/Lomentospora in a tertiary care eye centre North India.

Patient/study population: During a study period of 9 months from December 2022 to August 2023, eight cases of culture positive Scedosporium/Lomentospora ocular infections diagnosed were included in the study.

Observation procedure: Definitive diagnosis was established on clinical suggestion of fungal infection along with microscopic findings and culture isolation of the fungal pathogen from clinical specimens. The main parameters assessed included predisposing (risk) factors, clinical characteristics, treatment modality used, and visual sequel of individual patients. Time to healing was stated as the time interval from beginning of clinical symptoms to the follow up visit when antifungals were stopped (absolute scarring of infiltrate).

Outcome measures: Of included eight cases, Scedosporium apiospermum was identified in five cases (including teleomorph state Pseudallescheria boydii and Graphium form) and Lomentospora prolificans was identified in three cases. The mean time to presentation at our hospital from the commencement of clinical disease was 19.2 days (range 1-30 day). History of trauma was present in five (83.3%) of six patients. Different clinical presentations predominantly included keratitis followed by endophthalmitis. Two cases (culture positive Lomentospora prolificans) with provisional diagnosis of fungal keratitis presented with complete corneal melt. Medical management alone with natamycin was successful in two cases, while other patients required surgical intervention in addition to medical management. Scleral involvement and vitreous involvement were associated with poor prognosis. The average time to healing in noted in our series was ~ 90 days. Thus, prompt diagnosis is critical for commencing targeted antifungal therapy as these fungi are resistant to many antifungal agents. Oral and topical antifungals along with surgical management (therapeutic penetrating keratoplasty) were successful for the treatment of S. apiospermum/L. prolificans oculomycosis involving the posterior segment of the eye.