The atlas compiled by these editors is a commendable effort and welcome addition to the mycology textbook sector. Up until now, the publication of medical mycology textbooks has been sparse and those that have been published are either too detailed for a resident in training or practicing physician or do not provide sufficient photographs or illustrations of the main features of the mycotic organisms. As a lecturer in mycology for the dermatology residents at my local teaching hospital and program, there are 3 key objectives of my mycology lectures: (1) to provide some type of organizational approach to mycotic organisms, (2) to provide a concise clinical history, and (3) to provide as many photographs and illustrations of mycotic organisms as possible. This atlas provides an exemplary addition to my book collection on medical mycology textbooks and sources for illustrations of mycotic organisms. The electron photomicrographs, photoplates, and line drawings of

Atlas of Clinical Fungi

Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors.

/pdf/current-perspectives-on-ophthalmic-mycoses-4mk8f0p693.pdf

Current Perspectives on Ophthalmic Mycoses

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)60126-9/pdf

Mycotic keratitis: epidemiology, diagnosis and management

Human fusariosis

Purpose: To determine the influence of risk factors, climate, and geographical variation on the microbial keratitis in South India. Methods: A retrospective analysis of all clinically diagnosed infective keratitis presenting between September 1999 and August 2002 was performed. A standardised form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Corneal scrapes were collected and subjected to culture and microscopy. Results: A total of 3,183 consecutive patients with infective keratitis were evaluated, of which 1,043 (32.77%) were found to be of bacterial aetiology, 1,095 (34.4%) were fungal, 33 (1.04%) were Acanthamoeba, 76 (2.39%) were both fungal and bacterial, and the remaining 936 (29.41%) were found to be culture negative. The predominant bacterial and fungal pathogens isolated were Streptococcus pneumoniae (35.95%) and Fusarium spp. (41.92%), respectively. Most of the patients (66.84%) with fungal keratitis were between 21 and 50 yea...

Microbial Keratitis in South India: Influence of Risk Factors, Climate, and Geographical Variation

Background: A multicentre study was carried out in Ghana and southern India to determine the aetiology of suppurative keratitis in two regions located at similar tropical latitudes. Studies of fungal keratitis from the literature were reviewed.

Methods: Patients presenting at rural and urban eye units with suspected microbial keratitis were recruited to the study. Corneal ulceration was defined as loss of corneal epithelium with clinical evidence of infection with or without hypopyon. Microscopy and culture were performed on all corneal specimens obtained.

Results: 1090 patients were recruited with suspected microbial keratitis between June 1999 and May 2001. Overall the principal causative micro-organisms in both regions were filamentous fungi (42%): Fusarium species and Aspergillus species were the commonest fungal isolates. Pseudomonas species were most frequently isolated from cases of bacterial keratitis in Ghana but in India the commonest bacterial isolates were streptococci.

Conclusion: Infections of the cornea due to filamentous fungi are a frequent cause of corneal damage in developing countries in the tropics and are difficult to treat. Microscopy is an essential tool in the diagnosis of these infections. A knowledge of the “local” aetiology within a region is of value in the management of suppurative keratitis in the event that microscopy cannot be performed.

https://bjo.bmj.com/content/bjophthalmol/86/11/1211.full.pdf

J. Kaliamurthy

Papers

Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis.

Keratitis due to Cylindrocarpon lichenicola.