• 1.

    Puangsricharern V, Chotikkakamthorn P, Tulvatana W, Kittipibul T, Chantaren P, Reinprayoon U, Kasetsuwan N, Satitpitakul V, Worasilchai N, Chindamporn A, 2021. Clinical characteristics, histopathology, and treatment outcomes of Pythium keratitis: a retrospective cohort study. Clin Ophthalmol Auckl NZ 15: 1691701.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Vishwakarma P, Mohanty A, Kaur A, Das S, Priyadarshini SR, Mitra S, Mittal R, Sahu KS, 2021. Pythium keratitis: clinical profile, laboratory diagnosis, treatment, and histopathology features post-treatment at a tertiary eye care center in Eastern India. Indian J Ophthalmol 69: 15441552.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Gurnani B, Christy J, Narayana S, Rajkumar P, Kaur K, Gubert J, 2021. Retrospective multifactorial analysis of Pythium keratitis and review of literature. Indian J Ophthalmol 69: 10951101.

    • Search Google Scholar
    • Export Citation
  • 4.

    Worasilchai N, Permpalung N, Chongsathidkiet P, Leelahavanichkul A, Mendoza AL, Palaga T, Reantragoon R, Finkelman M, Sutcharitchan P, Chindamporn A, 2018. Monitoring anti-Pythium insidiosum IgG antibodies and (1→3)-β-d-Glucan in vascular pythiosis. J Clin Microbiol 56: e00610e00618.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Mendoza L, Newton JC, 2005. Immunology and immunotherapy of the infections caused by Pythium insidiosum. Med Mycol 43: 477486.

  • 6.

    Thitithanyanont A, Mendoza L, Chuansumrit A, Pracharktam R, Laothamatas J, Sathapatayavongs B, Lolekha S, Ajello L, 1998. Use of an immunotherapeutic vaccine to treat a life-threatening human arteritic infection caused by Pythium insidiosum. Clin Infect Dis Off Publ Infect Dis Soc Am 27: 13941400.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Wanachiwanawin W, Mendoza L, Visuthisakchai S, Mutsikapan P, Sathapatayavongs B, Chaiprasert A, Suwanagool P, Manuskiatti W, Ruangsetakit C, Ajello L, 2004. Efficacy of immunotherapy using antigens of Pythium insidiosum in the treatment of vascular pythiosis in humans. Vaccine 22: 36133621.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Thanathanee O, Enkvetchakul O, Rangsin R, Waraasawapati S, Samerpitak K, Suwan-apichon O, 2013. Outbreak of Pythium keratitis during rainy season: a case series. Cornea 32: 199204.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Agarwal S et al., 2019. Clinical profile, risk factors and outcome of medical, surgical and adjunct interventions in patients with Pythium insidiosum keratitis. Br J Ophthalmol 103: 296300.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Hasika R, Lalitha P, Radhakrishnan N, Rameshkumar G, Prajna NV, Srinivasan M, 2019. Pythium keratitis in South India: incidence, clinical profile, management, and treatment recommendation. Indian J Ophthalmol 67: 4247.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Sane SS, Madduri B, Mohan N, Mittal R, Raghava JV, Fernandes M, 2021. Improved outcome of Pythium keratitis with a combined triple drug regimen of linezolid and azithromycin. Cornea 40: 888893.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Ahirwar LK, Kalra P, Sharma S, Mohamed A, Mittal R, Das S, Bagga B, 2021. Linezolid shows high safety and efficacy in the treatment of Pythium insidiosum keratitis in a rabbit model. Exp Eye Res 202: 108345.

    • Search Google Scholar
    • Export Citation
  • 13.

    Gurnani B, Kaur K, 2021. Pythium Keratitis. Available at: http://www.ncbi.nlm.nih.gov/books/NBK573072/. Accessed October 4, 2021.

    • Crossref
    • Export Citation
  • 14.

    Gurnani B, Narayana S, Christy J, Rajkumar P, Kaur K, Gubert J, 2021. Successful management of pediatric pythium insidiosum keratitis with cyanoacrylate glue, linezolid, and azithromycin: rare case report. Eur J Ophthalmol 28: 11206721211006564.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Maeno S, Oie Y, Sunada A, Tanibuchi H, Hagiwara S, Makimura K, Nishida K, 2019. Successful medical management of Pythium insidiosum keratitis using a combination of minocycline, linezolid, and chloramphenicol. Am J Ophthalmol Case Rep 15: 100498.

    • Search Google Scholar
    • Export Citation
  • 16.

    Chitasombat MN, Jongkhajornpong P, Lekhanont K, Krajaejun T, 2020. Recent update in diagnosis and treatment of human pythiosis. PeerJ 8: e8555.

  • 17.

    Xu L-J, Song X-S, Zhao J, Sun S-Y, Xie L-X, 2012. Hypopyon in patients with fungal keratitis. Chin Med J (Engl) 125: 470475.

  • 18.

    Permpalung N, Worasilchai N, Manothummetha K, Torvorapanit P, Ratanawongphaibul K, Chuleerarux N, Plongla P, Chindamporn A, 2019. Clinical outcomes in ocular pythiosis patients treated with a combination therapy protocol in Thailand: a prospective study. Med Mycol 57: 923928.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 671 671 390
Full Text Views 12 12 10
PDF Downloads 18 18 16
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Role of Immunotherapy in Pythium insidiosum Keratitis

View More View Less
  • 1 Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;
  • | 2 Division of Mycology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Restricted access

ABSTRACT.

Pythium keratitis is a potentially devastating ocular condition. Incidence of Pythium keratitis has been reported in tropical and subtropical areas. In previous reports, there were no effective or standard treatments, and combinations of medication, immunotherapy, and surgery were proposed. Pythium insidiosum antigen immunotherapy (PIAI) showed an acceptable safety profile, but its efficacy is questionable in Pythium keratitis. This retrospective review included 10 eyes from 10 patients. All cases were confirmed diagnosis of P. insidiosum keratitis by culture and/or polymerase chain reaction. Three doses of PIAI were injected at 2-week intervals in all patients. The infiltration diameter ranged from 5.2 mm to total corneal involvement, and eight cases (80%) had hypopyon. Therapeutic penetrating keratoplasty (TPK) or scleral graft were undertaken in nine cases. Enucleation was done in one case on the first visit. A second TPK was undertaken in three cases, and two globes were saved. Two cases in the globe salvage group received voriconazole via eyedrops and intracameral injection. No case received either linezolid or azithromycin. Three of nine eye globes (33.33%) were saved. PIAI did not show efficacy in the treatment of Pythium keratitis. Radical surgery including resurgery in recurrence is an approved effective treatment. The recently reported medications may offer supportive management.

Author Notes

Address correspondence to Onsiri Thanathanee, Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand. E-mail: onsirit@yahoo.com

Financial support: This study was funded by a grant from Research Affairs, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University.

Authors’ addresses: Onsiri Thanathanee, Chavakij Bhoomibunchoo, Orapin Anutarapongpan, Olan Suwan-apichon, and Korawin Charoensuk, Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, E-mails: onsirit@yahoo.com, chavbh@gmail.com, orapin_159@yahoo.com, osuwanapichon@hotmail.com, and korawin.wn@gmail.com. Ariya Chindamporn, Division of Mycology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mail: drariya@gmail.com.

Save