{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:02:23Z","timestamp":1793397743038,"version":"4.5.0"},"reference-count":78,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Pythium insidiosum<\/jats:italic>\n                    is an oomycete and is also called \u201cparafungus\u201d as it closely mimics fungal keratitis. The last decade saw an unprecedented surge in Pythium keratitis cases, especially from Asia and India, probably due to growing research on the microorganism and improved diagnostic and treatment modalities. The clinical features such as subepithelial infiltrate, cotton wool-like fluffy stromal infiltrate, satellite lesions, corneal perforation, endoexudates, and anterior chamber hypopyon closely resemble fungus. The classical clinical features of Pythium that distinguish it from other microorganisms are reticular dots, tentacular projections, peripheral furrowing, and early limbal spread, which require a high index of clinical suspicion. Pythium also exhibits morphological and microbiological resemblance to fungus on routine smearing, revealing perpendicular or obtuse septate or aseptate branching hyphae. Culture on blood agar or any other nutritional agar is the gold standard for diagnosis. It grows as cream-colored white colonies with zoospores formation, further confirmed using the leaf incarnation method. Due to limited laboratory diagnostic modalities and delayed growth on culture, there was a recent shift toward various molecular diagnostic modalities such as polymerase chain reaction, confocal microscopy, ELISA, and immunodiffusion. As corneal scraping (10% KOH, Gram) reveals fungal hyphae, antifungals are started before the culture results are available. Recent\n                    <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                    molecular studies have suggested antibacterials as the first-line drugs in the form of 0.2% linezolid and 1% azithromycin. Early therapeutic keratoplasty is warranted in nonresolving cases. This review aims to describe the epidemiology, clinical features, laboratory and molecular diagnosis, and treatment of\n                    <jats:italic toggle=\"yes\">Pythium insidiosum<\/jats:italic>\n                    keratitis.\n                  <\/jats:p>","DOI":"10.4103\/ijo.ijo_1534_21","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T07:53:23Z","timestamp":1648454003000},"page":"1107-1120","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":39,"title":["Pythium insidiosum keratitis - A review"],"prefix":"10.4103","volume":"70","author":[{"given":"Bharat","family":"Gurnani","sequence":"first","affiliation":[{"name":"Cataract, Cornea, External Disease, Trauma and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirandeep","family":"Kaur","sequence":"additional","affiliation":[{"name":"Pediatric and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anitha","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Cornea, Ocular surface, Trauma and Refractive services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhupesh","family":"Bagga","sequence":"additional","affiliation":[{"name":"Cornea Clinic, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetha","family":"Iyer","sequence":"additional","affiliation":[{"name":"Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Christy","sequence":"additional","affiliation":[{"name":"Cataract, Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalitha","family":"Prajna","sequence":"additional","affiliation":[{"name":"Microbiology Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murugesan","family":"Vanathi","sequence":"additional","affiliation":[{"name":"Cornea and Ocular Surface, Cataract and Refractive Services, Dr R P Centre, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Garg","sequence":"additional","affiliation":[{"name":"Director and Kallam Anji Reddy Chair of Ophthalmology Paul Dubord Chair of Cornea, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivanand","family":"Narayana","sequence":"additional","affiliation":[{"name":"Cataract, Cornea, External Diseases, Trauma and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shweta","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikant","family":"Sahu","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment, Contact Lens, Cataract, Laser Refractive Surgery Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, Orissa, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,3,22]]},"reference":[{"key":"B1-20240828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.vetmic.2010.07.019","article-title":"Pythium insidiosum: An overview","volume":"146","author":"Gaastra","year":"2010","journal-title":"Vet 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