scholarly journals Electrocardiographic characteristics of patients with coronavirus disease 2019 (COVID-2019) related pneumonia at first presentation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
U Nguyen ◽  
M Strik ◽  
S Abu-Arib ◽  
A Bruekers ◽  
T Nguyen ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Negative Group ◽  
Male Mortality ◽  
Funding Sources ◽  
Atrial Enlargement ◽  
Study Population ◽  
Polymerase Chain ◽  
Repolarization Abnormalities ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Purpose To evaluate electrocardiographic (ECG) characteristics at first presentation in patients with possible coronavirus disease (COVID-19) pneumonia. Methods and results 356 patients presenting at the emergency room with possible COVID-19 pneumonia based on clinical presentation and computed tomography findings were included and subdivided into a COVID-19 positive group ([COVID-19-positive], n = 231, 65%) and a COVID-19 negative group ([COVID-19-negative], n = 125, 35%) based on polymerase chain reaction tests. The study population was predominantly middle aged-elderly (67 ± 14 year; n = 235, 66% male). Mortality rate was 24% after 1-month follow-up. There were no significant (NS) differences in sex, age, and mortality between the COVID-19-positive and COVID-19-negative group.  Atrial fibrillation (AF) was common (9%), though its prevalence was NS (regression analyses adjusted for age and sex) different in the COVID-19-positive vs. the COVID-19-negative group. ECG characteristics reflecting atrial enlargement and repolarization abnormalities were frequently present (<38% and 14% respectively). No significant differences were found between the COVID-19-positive vs. the COVID-19-negative group for the majority of morphological ECG characteristics (Figure 1 for more detailed data).  Conclusion AF and ECG characteristics reflecting atrial enlargement and repolarization abnormalities are commonly present in COVID-19 patients. The prevalence of these ECG characteristics however do NS differ from their COVID-19-negative counterparts. Abstract Figure.

Impact of air pollution on mortality due to cerebrovascular diseases

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
L Kuzma ◽  
EJ Dabrowski ◽  
A Kurasz ◽  
M Swieczkowski ◽  
H Bachorzewska-Gajewska ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cold Season ◽  
Cerebrovascular Diseases ◽  
Term Effect ◽  
Short Term ◽  
Short Term Effect ◽  
Funding Sources ◽  
Specific Mortality ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background The short-term effect of air pollution on cardiovascular mortality is well-documented but a scarce number of studies focus on cause-specific mortality in low-polluted areas. Purpose We decided to distinguish deaths due to cerebrovascular disease (CbVD) from a region widely known as the Green Lungs of Poland to assess the short-term effect of air pollution on CbVD mortality. Methods The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR) of air pollution. Results In the overall analysis of the studied region PM2.5 had an impact on increased CbVD mortality at LAG 0 (OR 1.046, 95% CI 1.013 – 1.080, P = 0.006), LAG 0-1 (1.048, 1.002-1.082, P = 0.040), and LAG 0-3 (1.052, 1.015-1.090, P = 0.006). The influence of PM10 was noted at LAG 0 (1.041, 1.002-1.082, P = 0.040). CbVD mortality in Bialystok was increased by exposure to PM10 at LAG 0 (1.05, 1.00-1.09, P = 0.048) and CO at LAG 1 (1.07, 1.00-1.14, P = 0.04). Additionally, an effect of CO was observed in cold season at LAG 1 (1.09, 1.02-1.17, P = 0.02), LAG 0-1 (1.08, 1.00-1.016, P = 0.04), and LAG 0-3 (1.09, 1.01-1.18, P = 0.04). In Suwalki, an impact of PM2.5 was also observed. Conclusions A short-term increase in air pollutants concentrations, especially in PM2.5 and CO, had an influence on CbVD mortality. Mortality rates were significantly increased in cold season. We also found heterogeneity in the influence of major contributors on mortality between analyzed cities.

Long term stability of the subcutaneous cardioverter defibrillator implanted by means of the intermuscular two incision technique

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
G Bisignani ◽  
A Bisignani ◽  
AL Cavaliere ◽  
M Lovecchio ◽  
S Valsecchi ◽  
...  
Keyword(s):  
Thoracic Wall ◽  
Fat Tissue ◽  
Cardioverter Defibrillator ◽  
Long Term Stability ◽  
Funding Sources ◽  
Incision Technique ◽  
Post Implantation ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background To ensure effective defibrillation with the subcutaneous implantable cardioverter defibrillator (S-ICD), both the lead and the generator must be adequately positioned extrathoracically. We assessed the long-term adequacy of the S-ICD system position and its stability in a group of patients who received the S-ICD by means of the two-incision intermuscular technique. Methods The PRAETORIAN score uses chest radiography to provide feedback on S-ICD positioning, and identifies patients with high defibrillation thresholds. We compared radiographs taken immediately after implantation and on 12-month follow-up examination. Results We analyzed data from 38 patients with the S-ICD generator positioned in an intermuscular pocket. The median PRAETORIAN score was 38 [25th to 75th percentile: 30 to 60]. Two (5%) patients had a score of 90 (intermediate risk of conversion failure). The thickness of the adipose tissue between the coil and the sternum was ≤1 coil width in 72% of patients, the generator was on, or posterior to, the midline in 94% of patients, and the amount of fat tissue between the generator and the thoracic wall was less than the generator width in 78% of patients. No generator or electrode dislodgments were detected on analyzing radiographs collected at the 12-month visit. In all patients, assessment of the PRAETORIAN score confirmed the values calculated on post-implantation analysis. During follow-up, no ineffective therapies, sudden cardiac or device-related deaths occurred. Conclusions The position of the S-ICD system implanted using the two-incision intermuscular technique was adequate at the time of implantation and remained stable after 12 months.

scholarly journals BCR-ABL Transcripts in Bone Marrow Aspirates of Philadelphia-Negative Essential Thrombocythemia Patients: Clinical Presentation

Blood ◽  
1997 ◽  
Vol 90 (7) ◽  
pp. 2768-2771 ◽  
Author(s):  
Dorit Blickstein ◽  
Adina Aviram ◽  
Jacob Luboshitz ◽  
Miron Prokocimer ◽  
Pinhas Stark ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Essential Thrombocythemia ◽  
Clinical Presentation ◽  
Molecular Level ◽  
Philadelphia Chromosome ◽  
Nested Polymerase Chain Reaction ◽  
History Of ◽  
Polymerase Chain ◽  
Positive Groups

Abstract One of the diagnostic criteria of essential thrombocythemia (ET) is the absence of the Philadelphia chromosome (Ph-neg). On the molecular level, Ph-neg ET patients may carry BCR-ABL transcript. The natural history of BCR-ABL positive Ph-neg ET patients is undetermined. We examined the BCR-ABL status by reverse transcriptase two-step nested polymerase chain reaction in bone marrow aspirates of 25 Ph-neg ET patients. We found 12 BCR-ABL positive and 13 BCR-ABL negative patients in the study group. The comparison showed that the two groups had similar clinical and laboratory characteristics, except for a significant increased patients' age and decreased polymorphonuclear cell count in the BCR-ABL positive group. During a median follow-up of 20 and 22.5 months for the BCR-ABL negative and positive groups, respectively, there was neither blastic transformation nor unrelated death in both groups. We conclude that it is important to look for BCR-ABL transcript in Ph-neg ET patients and to follow them closely to investigate the nature of this translocation in this group of patients.

scholarly journals Upregulation of the RNF8 gene can predict the presence of sperm in azoospermic individuals

2020 ◽  
Vol 47 (1) ◽  
pp. 61-67
Author(s):  
Majid Nazari ◽  
Emad Babakhanzadeh ◽  
S. Mohsen Aghaei Zarch ◽  
Mehrdad Talebi ◽  
Nima Narimani ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Testicular Biopsy ◽  
Negative Group ◽  
Nonobstructive Azoospermia ◽  
Entire Study ◽  
Biopsy Specimens ◽  
Study Population ◽  
Polymerase Chain

Objective: In this study, specimens from testicular biopsies of men with nonobstructive azoospermia (NOA) were used to investigate whether <i>RNF8</i> gene could serve as a biomarker to predict the presence of sperm in these patients.Methods: Testicular biopsy specimens from 47 patients were classified according to the presence of sperm (positive vs. negative groups) and investigated for the expression of <i>RNF8</i>. The level of <i>RNF8</i> gene expression in the testes was compared between these groups using reverse-transcription polymerase chain reaction.Results: The expression level of <i>RNF8</i> was significantly higher in testicular samples from the positive group than in those from the negative group. Moreover, the area under the curve of <i>RNF8</i> expression for the entire study population was 0.84, showing the discriminatory power of <i>RNF8</i> expression in differentiating between the positive and negative groups of men with NOA. A receiver operating characteristic curve analysis showed that <i>RNF8</i> expression had a sensitivity of 81% and a specificity of 84%, with a cutoff level of 1.76.Conclusion: This study points out a significant association between the expression of <i>RNF8</i> and the presence of sperm in NOA patients, which suggests that quantified <i>RNF8</i> expression in testicular biopsy samples may be a valuable biomarker for predicting the presence of spermatozoa in biopsy samples.

scholarly journals Routine follow-up of native valve disease: real life data from a physiologist-led valve clinic

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Hyams ◽  
K Balkhausen ◽  
C Townsend
Keyword(s):  
Real Life ◽  
Heart Association ◽  
Native Valve ◽  
Conservative Strategy ◽  
Funding Sources ◽  
Real Life Data ◽  
Number Of Patients ◽  
The Mean ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Purpose The 2014 American Heart Association (AHA) guidelines for the management of Valvular Heart Disease (VHD) suggest that patients with mild and moderate native VHD should be followed up with echocardiography at regular intervals. Following audits at our hospital in 2016, dedicated Physiologist Led Valve Clinics (PLVC) were initiated to improve guideline adherence. A conservative strategy for follow-up frequency based on AHA guidelines was chosen (3 years for mild VHD, and 1 year for moderate VHD). This audit aimed to ascertain adherence to this conservative follow-up strategy, and to assess the progression of VHD between echocardiographic assessments to inform a strategy for safe follow-up in our PLVC. Methods Our echocardiography database Cognos was searched for patients with isolated mild and moderate native VHD, seen in our PLVC between 2016-2018 and followed up between 2017-2019. Patients with severe, prosthetic, combined or significant mixed VHD were excluded. Echocardiography reports on McKesson were reviewed and the follow-up interval recorded for each patient. The severity of VHD at the index visit, and then at follow-up, was recorded to determine whether there had been a progression in VHD severity. For patients with progression, it was recorded whether they were symptomatic at follow-up or subsequently underwent valvular intervention. Results 466 index echocardiograms were reviewed; 134 patients were included (mean age 73.4) after removing those with exclusion criteria. The mean follow-up interval in mild VHD ranged between 587.6 ± 188.3 days, and 667.3 ± 174.6 days, well above the recommended 3 years (or 1095 days). The majority of patients with moderate VHD received follow-up well before the upper limit of AHA guidance (2 years, or 730 days). Mean follow-up ranged between 408.3 ± 80.8 days (in moderate aortic stenosis (AS)) and 504.0 ± 29.0 days (in moderate mitral stenosis (MS)). The number of patients followed up with mild VHD was very low. 1 patient in each group progressed to moderate VHD (out of 2, 3 and 5 respectively); none became symptomatic, and none progressed from mild to severe VHD. In moderate VHD, progression rates were highest in AS (34.8%). Patients with progressive disease were more frequently symptomatic (43%) or underwent valve intervention (25%). Fewer with mitral regurgitation (MR) (22%) progressed, 44.5% of whom were symptomatic, 11% undergoing intervention. Patients with moderate aortic regurgitation (AR) saw the lowest progression rates (11.4%), 50% of whom were symptomatic. There was no progression in moderate MS. Conclusions Patients with mild VHD can safely be followed up less conservatively in the PLVC setting, adhering to AHA guidance (3-5 years). Patients with moderate AS should be considered to remain under conservative follow-up (12-18 months). Follow-up for moderate AR, MR and MS can safely be adjusted towards the less conservative end of the AHA guidance (2 years). Abstract Figure.

scholarly journals Localization of ST-elevation on ECG is associated with regional myocardial fibrosis in acute myocarditis

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
M Karolyi ◽  
M Kolossvary ◽  
L Weber ◽  
I Matziris ◽  
J Sokolska ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Myocardial Fibrosis ◽  
Acute Myocarditis ◽  
Linear Regression Analysis ◽  
Poor Outcome ◽  
Funding Sources ◽  
Visual Presence ◽  
St Elevation ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Both ST elevation (STE) on ECG and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) are related to poor outcome in myocarditis. Purpose We evaluated if there is an association between regional STE and LGE pattern in patients with suspected myocarditis. Methods 51 patients (42 male, 32 ± 13 years old) underwent 12-lead ECG and CMR with LGE due to suspected myocarditis. &gt;1mm STE was assessed in the antero-septal (V1-V4, aVR), inferior (II, III, aVF) and lateral (I, aVL, V5-V6) localizations. LGE was quantified as visual presence score (VPS) (1-17) and visual transmurality score (VTS) (1-68) on CMR, according to the 17-segment AHA model. STE and LGE were correlated using linear regression analysis.  Results 31% of the patients had STE on admission ECG and a median VPS of 3 (IQR: 1-5) and VTS of 6 (IQR: 3-11) on CMR. STE showed an association with VPS and VTS in univariate and multivariate analysis (p &lt; 0.001 all). STE was most frequent in the lateral and inferior leads (48% and 31%) which correlated with regional VPS and VTS in univariate model (p &lt; 0.05 all), and remained significant in multivariate analysis for VPS (p &lt; 0.05 both). STE was less frequent in the antero-septal region (21%, where no association between LGE and STE could be revealed (p &gt; 0.05 all). Conclusions  Inferior and lateral STE in myocarditis is associated with regional LGE on CMR, which is an indicator of myocardial fibrosis and possible poor outcome. Our results need not be validated on larger cohorts with follow-up.

scholarly journals Slow VT treatment in a contemporary population of primary prevention ICD recipients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Angeletti ◽  
M Ziacchi ◽  
C Martignani ◽  
M Massaro ◽  
G Statuto ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Ventricular Rate ◽  
Antitachycardia Pacing ◽  
Funding Sources ◽  
Consensus Document ◽  
Independent Expert ◽  
Multiple Shocks ◽  
Expert Consensus Document ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter defibrillator (ICD) is an effective therapy for sudden cardiac death (SCD). 2015 HRS/EHRA/APHRS/SOLAECE expert consensus document suggests long VT detection, above 185 bpm, as optimal ICD programming to reduce unnecessary therapies in primary prevention (PP). Purpose The aim of our study is to evaluate incidence, safety and efficacy of ICD treatment for VT arrhythmias below 185 bpm, in a contemporary population of PP ICD recipients with long detection intervals (LDI), morphological discrimination algorithm and antitachycardia pacing therapies (ATP) before shock. Methods We conducted a single centre retrospective study enrolling 236 patients implanted with a primary-prevention indication from January 2013 to June 2019. Patients were implanted with single or dual chamber single-lead transvenous ICD. All patients had standard device setting with long (at least 20 s in VT and 7 s in VF) VT/VF detection above 150 bpm and therapies starting from 171 with up to 5 ATP and multiple shocks. PainFREE-like bursts and Schaumann-like ramps ATP were always set in VT zone. Of each patient we collected a detailed report of up to five appropriate events and three inappropriate events. Arrhythmia diagnosis was confirmed from 3 independent expert physicians.  Date of the event, cycle length, type of morphology (polymorphic or monomorphic), therapies with their effect were collected. Results During a mean follow-up of 42 months, 47 (20 %) and 18 (8%) patients had at least one appropriate and inappropriate activation, respectively. The detailed-events analysis shows that 16 (7%) patients had 38 (30%) appropriate events with rate &lt;188 bpm. At these rate ATP were 97% effective. 14 (38%) of inappropriate activations were caused by arrythmias with ventricular rate below 188 bpm and half of these received a shock; 30% of inappropriate shocks were due to arrhythmia with rate &lt;188 bpm. 73% of treated events, with rate &lt;188 bpm, were appropriate. Only 5.6% (n = 10) of ATP attempts cause arrhythmia acceleration. Conclusions One third of detected arrhythmias had a rate below 188 bpm and 73% were true VT. In this slow VT zone, ATP had a high success rate with low percentage of acceleration.

A STUDY OF CLINICAL PRESENTATION OF GALLSTONE DISEASE AND ITS MANAGEMENT AMONG ADMITTED PATIENTS IN BIHAR

2021 ◽  
pp. 47-49
Author(s):  
Ravindra Kumar Gupta ◽  
Debarshi jana
Keyword(s):  
Clinical Presentation ◽  
Gallstone Disease ◽  
Epidemiological Studies ◽  
Wall Thickening ◽  
Sociodemographic Characteristics ◽  
Pain Abdomen ◽  
Female Predominance ◽  
Study Population ◽  
Cbd Stone

INTRODUCTION: Diseases of the gallbladder commonly manifest as gallstones and gallbladder cancer. To identify risk factors in a given 1 population, epidemiological studies must rst dene the frequency of disease. Studies employing necropsy surveys or healthcare databases carry biases by their implicit nature: being postmortem or requiring biliary symptoms/complications, respectively. AIMS & OBJECTIVE:To assess the relevant sociodemographic characteristics, relevant history and clinical prole of the study population. METHODOLOGY: Study Area: The study was conducted DEPARTMENT OF GENERAL SURGERY, PARAS GLOBAL HOSPITAL, DARBHANGA. It is having a capacity of 252 indoor beds in the Department of Surgery and associated academic section, catering to people of several districts. The study shall be done in the Surgery Indoor of his hospital. Duration of Study:Twelve Months RESULTAND ANALYSIS:We found in our study 37(5.9%) patients had GB Wall thickness. 12(1.9%) patients had GB Commet tail appearencel, 8(1.3%) patients had GB Mass and 1(0.2%) patients had GB Mass fundus. 52(8.4%) patients had CBD stone. 1(0.2%) patient had Irregular wall thickening GB body and 407(65.3%) patients had MRCP. 52(8.4%) patients had CT. 1(0.2%) patient had GB Thickening and 1(0.2%) patient had EUS. 34(5.5%) patients had Conservative. 17(2.7%) patients had ERCPand 1(0.2%) patient had failed ESRCPon 14/3/18. SUMMARY AND CONCLUSION:We found that 22(3.5%) patients had post-operative jaundice. 8(1.3%) patients had post-operative pancreatitis. 622(100.0%) patients had no post-operative cases of retained stone. 13(2.1%) patients had post-operative signicant pain abdomen. It was found that 611(98.1%) patients had monthly. 10(1.6%) patients had lost follow-up. We concluded that symptomatic gallstone diseases were more common in > 35 Years with a female predominance.

P911High rate of cardiac amyloidosis in elderly patients with aortic stenosis: clinical presentation before and after aortic valve intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Zikry Deitch ◽  
D Haberman ◽  
S Lifshitz ◽  
S Tshori ◽  
Y Fabricant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Cardiac Amyloidosis ◽  
Clinical Presentation ◽  
Left Ventricular ◽  
Clinical Effects ◽  
Negative Group ◽  
Time Point

Abstract Background Aortic Stenosis (AS) is the most common valvular heart disease in the Western world. Wild-type transthyretin amyloid (wtATTR) affects the heart, causing restrictive cardiomyopathy. Deposits can be found in up to 25% of individuals >85 years of age at autopsy. Recently several reports showed a relatively high prevalence of transthyretin cardiac amyloidosis (TTR-CA) in patients with AS. Objectives The aim of this study was to examine the clinical effects of TTR-CA in patients who have undergone aortic valve replacement therapy and evaluate the outcome of the intervention. Methods We recruited patients who underwent surgical (AVR) or percutaneous (TAVI) aortic valve intervention between 2011 and 2018. The patients underwent a Tc99m-PYP scan using SPECT technology which has been shown to be valid for the diagnosis of TTR-CA. We reviewed patient files before (time point 1) and after intervention (time point 2) and at 2 years (time point 3) follow up, and collected data on hospitalizations, laboratory, and echocardiography. Results The study included 86 patients, mean age 78±6 years, 55% women. Twenty-nine (33%) participants were diagnosed as positive (VAS 2 and 3) for transthyretin cardiac amyloidosis.There were no differences in baseline characteristics between patients with and without TTR-CA in cardiovascular risk factors and co-morbidities, laboratory parameters and nutritional status. There were no differences in baseline echocardiographic parameters including valve gradients and left ventricular hypertrophy. However, the patients with TTR CA had more advanced diastolic dysfunction compared to patients without TTR CA (P=0.03) and higher pulmonary artery pressure (44±14.75mmhg vs 30.5±11.38mmhg, p=0.06). Before the intervention, patients with transthyretin cardiac amyloidosis had 3.26 times more hospitalizations due to heart failure as compared to patients in the negative group (p=0.01). After the intervention, diastolic function remained more severely affected in the positive group at all follow-up points compared to the negative group (p=0.05). Similar observations were seen in the measurements of pulmonary arterial pressure (p=0.019 at time 2 and p=0.015 at time 3). Consistent with the echocardiographic findings, patients with transthyretin cardiac amyloidosis had 2.84 times more hospitalizations after intervention for heart failure than patients in the negative group (p=0.02). Conclusions Co-existence of transthyretin cardiac amyloidosis and aortic stenosis in the older population is associated with a more severe clinical presentation and with more advanced clinical and echocardiographic signs of heart failure. Improvement after valvular intervention might be limited in terms of symptoms and hospitalizations in this subgroup. Acknowledgement/Funding None

scholarly journals Pythium keratitis: clinical course of an emerging scourge

2020 ◽  
Vol 17 (3) ◽  
pp. 318-323
Author(s):  
Radhika Natarajan ◽  
Ankit Anil Harwani ◽  
Ramya Ravindran
Keyword(s):  
Polymerase Chain Reaction ◽  
Confocal Microscopy ◽  
Penetrating Keratoplasty ◽  
Clinical Presentation ◽  
Corneal Ulcer ◽  
Clinical Course ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Therapeutic Penetrating Keratoplasty

We hereby report two cases of the emerging and devastating Pythium keratitis for their different presentations, prolonged clinical course, and suspicion of recurrence after therapeutic penetrating keratoplasty (TPK). The history, clinical presentation, investigations including smears, cultures, polymerase chain reaction (PCR) and confocal microscopy, the tumultuous course of the infection, and outcome of TPK have been discussed for two cases having this unusual and severe emerging infection. These two cases demonstrate that Pythium keratitis can present as a central reticular or peripheral guttering corneal ulcer with dense infiltration. PCR is a valuable tool for diagnosis. Pythium keratitis has a severe and prolonged clinical course. Response to antibiotics is modest and needs to be closely monitored. It can present with inflammation after TPK that mimics the dreaded recurrence of the infection. Pythium keratitis presents variably and can be suspected from typical clinical and microbiological findings. It needs protracted treatment with close follow-up. Although the infection is known torecur in the therapeutic graft, not all recurrences are what they seem.

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