Outcomes And Treatment Paradigms In Recalcitrant Mixed Hsv With Fungal Keratitis

Published 2023 - 41st Congress of the ESCRS

Reference: PO0123 | Type: Case report | DOI: 10.82333/m0jc-cv50

Authors: Aravind Roy* ¹ , Joveeta Joseph ²

¹Shantilal Sanghvi Cornea Institute,KVC Campus, LV Prasad Eye Institute,Vijayawada,India, ²Jhaveri Microbiology Laboratory,LVPrasad Eye Institute,Hyderabad,India

Study the clinical outcomes of mixed infections of HSV and fungal keratitis

Retrospective case series of mixed HSV and fungal keratitis; HSV was detected by raised copy numbers of HSV 1 DNA with quantitative PCR and fungus with microbiologic demonstration of fungal filaments in smears or growth of fungal colonies in culture

We evaluated 3 eyes of 3 patients between 43-55 years, all were males with mixed infections of HSV and fungus. Two patients were diabetic, and one patient had prior treatment with topical corticosteroids. qPCR showed increased copy numbers of HSV1 DNA ranging from 438 to 1.02 million/cc. Significant growth of dematiaceous fungus was noted from one eye and fungal filaments in smears from the other two eyes. Combination of natamycin 1% hourly and oral acyclovir 400mg 5 times a day for 8 weeks led to resolution in two eyes and one patient required therapeutic PKP after 4 weeks of treatment. No recurrence was noted in any patients after 1 to 15 months of follow up.

Mixed infections of HSV and fungus are rare. Confirmatory diagnosis of HSV requires qPCR and demonstrable fungus in smears or culture. Diabetes and prior topical corticosteroids may worsen clinical picture. Prolonged antifungal and antiviral medications are required for treatment.