Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2023 Feb;71(2):510-514.
doi: 10.4103/ijo.IJO_913_22.

Clinical differentiation of keratitis due to fungus and Pythium: A photographic survey

Rakhi P D'cruz  1 , Ashik Mohamed  2 , Sujata Das  1
Affiliations
Comment

Clinical differentiation of keratitis due to fungus and Pythium: A photographic survey

Rakhi P D'cruz et al. Indian J Ophthalmol. 2023 Feb.

Abstract

Purpose: To evaluate the knowledge and skills of clinicians in differentiating cases of Pythium from fungal keratitis based on their clinical appearance.

Methods: Thirty slit-lamp photographs from culture-proven cases of Pythium and fungal keratitis were selected for conducting a prospective online-based photographic survey. The participants were asked to identify the causative organism and enlist the specific clinical features which helped in reaching the diagnosis. Both cornea specialists and clinical fellows/trainees participated in the survey. Sensitivity, specificity, and predictive values were estimated, and the factors associated with these, including the identification rates of clinical signs, were evaluated using bivariate and multivariate linear regression analyses. The identification rates between the consultants and fellows were compared.

Results: A total of 42 cornea specialists (28 consultants and 14 clinical fellows) participated in the survey. Clinicians were able to differentiate Pythium from fungal etiology in only 56% of cases. The differentiating ability between the consultants and fellows was statistically insignificant. Average sensitivity, specificity, and positive and negative predictive values for differentiating Pythium from fungus were 56%, 65%, 56%, and 66%, respectively. The specific clinical features enlisted by the participants to differentiate Pythium from fungus were the presence of tentacles, peripheral guttering, dot-like infiltrates, and elevated plaques.

Conclusion: Clinical knowledge regarding the signs and symptoms and the microbiological identification of features for Pythium are still lacking among clinicians. As the treatment protocols are distinctly different for both, it is imperative to enhance the knowledge and diagnosing ability to tackle this emerging microorganism which causes high morbidity.

Keywords: Fungus; Pythium; keratitis; survey.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Slit-lamp photographs of Pythium keratitis (a and b) and fungal keratitis (c and d) in diffuse illumination
See this image and copyright information in PMC

Comment in

Comment on

References

    1. Mendoza L, Vilela R. The mammalian pathogenic oomycetes. Curr Fungal Infect Rep. 2013;7:198–208.
    1. Chakrabarti A, Singh R. The emerging epidemiology of mould infections in developing countries. Curr Opin Infect Dis. 2011;24:521–6. - PubMed
    1. Thanathanee O, Enkvetchakul O, Rangsin R, Waraasawapati S, Samerpitak K, Suwan-apichon O. Outbreak of Pythium keratitis during rainy season:A case series. Cornea. 2013;32:199–204. - PubMed
    1. Lekhanont K, Chuckpaiwong V, Chongtrakool P, Aroonroch R, Vongthongsri A. Pythium insidiosum keratitis in contact lens wear:A case report. Cornea. 2009;28:1173–7. - PubMed
    1. Badenoch PR, Mills RA, Chang JH, Sadlon TA, Klebe S, Coster DJ. Pythium insidiosum keratitis in an Australian child. Clin Exp Ophthalmol. 2009;37:806–9. - PubMed