Aureobasidium pullulans keratitis.
BACKGROUND: Corneal ulcer caused by Aureobasidium pullulans is considered to be a rare entity. So far very few reports have appeared in the world literature and the authors' hospital is the first to report from Nepal. Although A. pullulans is regarded as a contaminant, it should be considered as a pathogen if isolated from corneal ulcer specimen with clinical signs of infection and with growth of the organism on two or more culture media or growth in one medium with consistent direct microscopy findings or growth of the same organism on repeated corneal scrapings. In the present study, a series of proven cases of A. pullulans corneal ulcers at a tertiary eye care centre of Eastern Nepal is reported. METHODS: A retrospective analysis of stored data of microbiological and clinical cases of corneal ulcer was carried out. All consecutive patients (447 patients) with presumed microbial keratitis from 1 August 1998 to 31 July 2001 were evaluated with regards to clinical details, microbiological examination and management. RESULTS: Of 200 fungal organisms isolated from the cultures, 25 were identified as A. pullulans. These ulcers showed negligible improvement to topical natamycin and required either topical fluconazole or topical itraconazole in all along with systemic intravenous fluconazole in eight patients. Of 25 eyes, 22 responded well to antifungal therapy and 2 required therapeutic penetrating keratoplasty. One patient was lost to follow up for 3 months and revealed phthisis bulbi on subsequent examination. CONCLUSIONS: Aureobasidium pullulans corneal infection should be considered as a cause of keratomycosis.