Case Study

Cylindrocarpon lichenicola keratomycosis in Nigeria: the challenge of limited access to effective antimicrobials

Emmanuel O. Irek, Temitope O. Obadare, Patrick A. Udonwa, Olajumoke Laoye, Oyekola V. Abiri, Adenike O. Adeoye, Aaron O. Aboderin
African Journal of Laboratory Medicine | Vol 6, No 1 | a612 | DOI: https://doi.org/10.4102/ajlm.v6i1.612 | © 2017 Emmanuel O. Irek, Temitope O. Obadare, Patrick A. Udonwa, Olajumoke Laoye, Oyekola V. Abiri, Adenike O. Adeoye, Aaron O. Aboderin | This work is licensed under CC Attribution 4.0
Submitted: 06 February 2017 | Published: 11 July 2017

About the author(s)

Emmanuel O. Irek, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria
Temitope O. Obadare, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria
Patrick A. Udonwa, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun stat, Nigeria
Olajumoke Laoye, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun stat, Nigeria
Oyekola V. Abiri, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria
Adenike O. Adeoye, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria
Aaron O. Aboderin, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria


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Abstract

Introduction: We report a rare cause of keratitis, due to Cylindrocarpon lichenicola, in a farmer with keratomycosis. Despite the acknowledged virulence of this fungus, a suitable antifungal for its management was not accessible.

Case presentation: A 67-year-old farmer presented with a two-week history of pain, mucopurulent discharge, redness and a corneal ulcer with a visual acuity of hand movement in the right eye. With a working diagnosis of infective keratitis, corneal scrapings were taken under a slit lamp biomicroscope for microbiological testing. Direct lactophenol cotton blue mounts revealed septate fungal hyphae, while fungal culture on Sabouraud dextrose agar at room temperature grew woolly mould phenotypically consistent with C. lichenicola.

Management and outcome: The patient was started on hourly topical natamycin (5%), ciprofloxacin (0.3%), two-hourly instillation of tobramycin (0.3%) and atropine (1%) twice daily for three months following the isolation of the fungus. The eye healed with a corneal scar and no improvements in visual acuity.

Discussion: This infection was difficult to manage due to the inaccessibility of a suitable antifungal, namely, voriconazole in our setting. Hence, there is a need for prompt identification and early institution of suitable antifungals in any patient with suspected keratomycosis.

 


Keywords

Cylindrocarpon; Nigeria; antimicrobials; keratitis

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