Rapid molecular diagnosis of posttraumatic keratitis and endophthalmitis caused by Alternaria infectoria

Abstract

The first case of Alternaria infectoria ocular infection is reported. Keratitis and endophthalmitis developed after eye-perforating trauma from a lemon tree branch. Two months after surgery and empirical steroid and antibiotic treatment, diagnosis by molecular methods was performed. PCR amplification was positive for a fungus after 4 h. Antifungal treatment with amphotericin B and fluconazole was initiated immediately. DNA sequence analysis showed Alternaria infectoria to be the causal agent. After topical and systemic administration of antifungal treatment, ocular inflammation disappeared and visual acuity improved. DNA typing was found to be a useful tool to achieve early identification of the causal agent.

FIG. 1.

(Upper panel) Right eye showing opacification of the cornea due to abscess, with inferior descemetocele, deep stromal infiltrates, and hypopyon; (lower panel) right eye showing the leukomatous cornea with complete resolution of the abscess and descemetocele (6 months after treatment).

FIG. 2.

Light photomicrographs showing typical conidia of A. infectoria. (Upper left panel) Free pigmented conidium showing transverse and longitudinal septa (magnification, ×400); (upper right panel) free pigmented conidium with a typical beak end (magnification, ×200); (lower panels) conidia in chains showing very close transverse septa and typical beaks (magnification, ×400).