Candida parapsilosis keratitis: A case series

Purpose

to describe the diagnosis and management of Candida parapsilosis keratitis

Design

a retrospective, observational case series.

Methods

this study was carried out in a single-centre tertiary referral eye hospital and includes 20 eyes of 19 patients. Electronic case notes and in vivo confocal microscopy (IVCM) records were searched for the keyword ‘parapsilosis’, with inclusion if there was keratitis with either a corresponding positive polymerase chain reaction (PCR) or microbial culture result for Candida parapsilosis. Individual case notes were reviewed to obtain information regarding diagnosis, treatment, and final visual outcomes. Cases were excluded if a patient was lost to follow-up before the end of antifungal treatment.

Results

the risk factors for C. parapsilosis keratitis were: ocular surface disease, concurrent topical steroid use, previous corneal surgery and long-term contact lens wear. The mean presenting corrected distance visual acuity (CDVA) was LogMAR 1.49 (range 0.2 – 2.3), with a final CDVA of LogMAR 1.11 (-0.2 – 2.3). Where used, microbiological culture was positive in 19 out of 20 cases, PCR in 6 out of 11 cases, and IVCM in 8 out of 13 cases. Two-thirds of cases were managed with either topical voriconazole or amphotericin B, with four cases surgically managed by therapeutic keratoplasty and two cases requiring evisceration.

Conclusions

Patients presenting with microbial keratitis with risk factors for C. parapsilosis keratitis should be managed with a high degree of clinical suspicion. Post-infection visual outcomes are poor but reflect pre-existing ocular comorbidities. Delays in diagnosis can be reduced by through the use of ICVM and PCR.