Co-Infection of the Human Cornea with Stenotrophomonas Maltophilia and Candida Albicans - A Case Report

角膜同時感染嗜麥芽窄食單胞菌及白色念珠菌－個案報告

紀立中(Li-Chung Chi) ； 張丞賢(Cheng-Hsien Chang)

《中華民國眼科醫學會雜誌》 51卷2期 (2012/10) Pp. 185-191

https://doi.org/10.30048/ACTASOS.201210.0012

摘要

目的：報告一例角膜同時感染嗜麥芽窄食單胞菌及白色念珠菌。方法：病例報告。結果：一位身體狀況不佳的82歲女性因為右眼急性疼痛至本院眼科就診，診斷為角膜潰瘍。三個月前同一眼睛在接受白內障手術後患有眼內炎，感染得到控制後仍有些許角膜破損，在患得此次角膜潰瘍前病人的右眼前房無發炎反應接近六周之久，病人持續有在使用抗生素眼藥水及接受結膜下注射betamethasone。 此次角膜潰瘍的抹片培養顯示嗜麥芽窄食單胞菌感染，即使使用1% amikacin，10%piperacillin及0.5%levafloxacin抗生素治療， 角膜潰瘍也沒有明顯的改善，在出現了衛星病灶後我們懷疑到黴菌性角膜潰瘍的可能，而角膜抹片黴菌培養證實了白色念珠菌感染，在同時使用抗生素及抗徽菌眼藥水治療後感染最終得到了控制。結論：在一個身體狀況不佳的病人身上，長期使用抗生素及類固醇於角膜上時，角膜同時感染嗜麥芽窄食單胞菌及白色念珠菌是需要被考慮到的，如果在使用了適當的抗生素藥水後仍無明顯進步，而且有觀察到嚴重的前房發炎反應或是角膜上的衛星病灶等黴菌感染的表現，則需要懷疑角膜是否同時感染了細菌及徽菌。

並列摘要

Purpose: To report a case of co-infection of the human cornea by Stenotrophomonas maltophilia and Candida albicans.Method: A case report.Result: An 82-year-old female with poor health condition had suffered from an unhealed right eye corneal epithelial defect since previous endophthalmitis. This time she complained of sudden right eye pain for five days. Corneal ulcer was diagnosed. Three months ago, she had undergone a smooth cataract surgery. Unfortunately, endophthalmitis developed 3 days after the operation. After receiving topical and intravitreous injection of antibiotics, endophthalmitis was under control. The patient had been using topical antibiotics and receiving subconjunctival injection of betamethasone. The patient’s right eye anterior chamber was clear for almost 6 weeks until this new episode of corneal ulcer was noted. Cultures from corneal scrapings showed infection by Stenotrophomonas maltophilia. Despite topical 1% amikacin, 10% piperacillin and 0.5% levofloxacin use, corneal condition continued to deteriorate. Fungal infection was suspected when satellite lesions occurred. Infection by Candida albicans was confirmed by culture of corneal scraping. With antibacterial and anti-fungal agents use, eventually infection was under control.Conclusion: Infection by S. maltophilia and Candida albicans has common risk factors such as a compromised cornea, exposure to broad-spectrum antibiotics and topical immunosuppressants. If corneal infection cannot be controlled by appropriate antibiotics, and any finding of fungal infection is observed, the possibility of co-infection by bacteria and fungus must be considered.

並列關鍵字

Corneal ulcer ； Co-infection ； Stenotrophomonas maltophilia ； Candida albicans