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A Case of Beauveria Bassiana Keratitis Confirmed by Gene Sequencing. Sung-Dong Chang, M.D., Jong-Hwa Jun, M.D. Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea . INTRODUCTION.
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Sung-Dong Chang, M.D., Jong-Hwa Jun, M.D.
Department of Ophthalmology, School of Medicine,
Dongsan Medical Center,
Keimyung University, Daegu, Korea
Beauveria genus is composed by the insect pathogens, soil fungus, and Beauveria bassiana is distributes worldwide. 8 cases of human infection, and 4 cases of ocular infection have been reported. Ocular infection induces very severe keratitis, and surgical removal such as deep lamellar dissection or penetrating keratoplasty of infected tissues is required. As the diagnosis, in most cases, early diagnosis is difficult resulting in the administration of antifungal agents under the condition that keratomycosis is progressed substantially, and thus early appropriate treatment is delayed and poor prognosis is shown. Among cases reported until now, none of cases was definitely diagnosed by gene sequencing for more early diagnosis, and it is considered that for cases suspicious to be fungal keratomycosis, by performing gene sequencing, it could be definitely diagnosed early and aggressive treatments could be administered, hence, the prognosis of patient could be improved
Recently, the incidence of keratomycosis shows a trend to be increased continuously due to the expanded use of antibiotics, steroid, and immunosuppressant, and consequently, interests on it are on the rise. Among them, regarding Beuaveria bassiana, prior to the infection in the cornea in 1985 by Sachs et al. for the first time, it has been known to be a fungus with weak pathogenicity that could not induce keratomycosis. After the report in 1985 by Sachs et al. infection cases such as keratomycosis, deep tissue infection, fungal empyema, disseminated infection, etc. have been reported, and particularly, it has been reported that upon the development of keratomycosis, it is detected to be negative in fungus culture by corneal scraping in many cases, and early appropriate fungus treatment is delayed in many cases, hence, even in cases definitely diagnosed to be fungus keratomycosis, surgical treatments such as penetrating keratoplasty are required in most cases
In keratomycosis cases, 4 cases have been reported, and for 3 cases required surgical treatments, penetrating keratoplasty was performed in 2 cases, and 1 case was treated by deep lamellar dissection, and regarding cases treated with medical management, Kisla et al. have reported 1 case, and thus for cases developed keratomycosis, surgical treatments were required in most cases. In our case, in the second corneal scraping test, several hyphae were detected, and thus medical agents were switched to natamycin eye drop, and afterward, it showed a pattern to be improved, nonetheless, because of the progressive destruction of the stroma, permanent amniotic membrane transplantation was required. Afterward, amphotericin B eye drops were administered additionally, and the epithelial defect and cell infiltration findings in the vicinity were improved rapidly, and without penetrating keratoplasty, his ocular intergrity could be maintained.
Different from previously reported 8 cases of human infection, in our case, by fungal culture, Beauveria spp. was suspected, and thus for its definite diagnosis, gene sequencing was performed, and it could be ultimately diagnosed as Beauveria bassiana, and with the aggressive use of antifungal agents, the rapid improvement pattern of keratitis could be observed. In our case also, the initial diagnosis by corneal scraping and culture failed, the disease course was prolonged, the level of corneal destruction was severe, and amnion membrane transplantation was required, and it is considered that from now, for cases suspected to be fungal keratomycosis, by the application of aggressive diagnosis methods such as gene sequencing, and by the administration of of appropriate antifungal agents, conservation of the eye could be achieved.