Keratitis due to a coelomycetous fungus: Case reports and review of the literature

Purpose: To describe a series of 7 patients with ulcerative keratitis caused by species of Colletotrichum, which are coelomycetous fungal pathogens. Methods: The patients presented with keratitis of varying degrees of severity. Multiple scrapes from the corneal lesions of 6 of the 7 patients were used for microbiological investigations by a standard protocol. in the seventh patient, scraping was not performed due to the presence of deep infiltration and a descemetocele at presentation. All 7 patients were hospitalized and treatment was initiated with topical applications of natamycin (5%) and ciprofloxacin (0.3%) every hour and cyclopentolate (1%) drops 3 times daily. An emergency therapeutic penetrating keratoplasty was performed after 48 hours in the patient who had presented with a descemetocele and for another patient whose keratitis did not respond to 10 days of medical therapy. Results: The corneal samples of all 7 patients yielded significant growth of filamentous fungi in culture. On the basis of macroscopic and microscopic characteristics, the fungal isolates were identified as Colletotrichum spp. Corneal lesions completely resolved with medical therapy alone in 5 patients. In the 2 patients who had undergone therapeutic penetrating keratoplasty, the infection was eradicated and the corneal graft remained clear even after several months of follow-up. Conclusion: Colletotrichum spp may be more frequent causes of keratitis than previously thought. Keratitis due to Colletotrichum spp frequently responds to medical therapy alone, although surgery may be indicated in a small proportion of patients.