Mycotic keratitis: epidemiology, diagnosis and management

doi:10.1111/1469-0691.12126

Home
/
Papers
/
Mycotic keratitis: epidemiology, diagnosis and management

Journal Article•DOI•

Mycotic keratitis: epidemiology, diagnosis and management

01 Mar 2013-Clinical Microbiology and Infection (Elsevier)-Vol. 19, Iss: 3, pp 210-220

TL;DR: The PCR has gained prominence as a diagnostic aid for mycotic keratitis, being used to complement microbiological methods; more importantly, this molecular method permits rapid specific identification of the aetiological agent.

read less

About: This article is published in Clinical Microbiology and Infection.The article was published on 2013-03-01 and is currently open access. It has received 342 citations till now. The article focuses on the topics: Fungal keratitis & Keratitis.

...read moreread less

Citations

PDF

Open Access

More filters

Journal Article•DOI•

Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America

[...]

Thomas F. Patterson¹, George Richard Thompson², David W. Denning³, Jay A. Fishman⁴, Susan Hadley⁵, Raoul Herbrecht⁶, Dimitrios P. Kontoyiannis⁷, Kieren A. Marr⁸, Vicki A. Morrison⁹, M. Hong Nguyen¹⁰, Brahm H. Segal¹¹, William J. Steinbach¹², David A. Stevens, Thomas J. Walsh¹³, John R. Wingard¹⁴, Jo Anne H. Young⁹, John E. Bennett¹⁵ - Show less +13 more•Institutions (15)

University of Texas Health Science Center at San Antonio¹, University of California, Davis², University Hospital of South Manchester NHS Foundation Trust³, Harvard University⁴, Tufts University⁵, University of Strasbourg⁶, University of Texas MD Anderson Cancer Center⁷, Johns Hopkins University⁸, University of Minnesota⁹, University of Pittsburgh¹⁰, Roswell Park Cancer Institute¹¹, Duke University¹², Cornell University¹³, University of Florida¹⁴, National Institutes of Health¹⁵

15 Aug 2016-Clinical Infectious Diseases

TL;DR: IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

...read moreread less

Abstract: It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

...read moreread less

1,745 citations

Cites background from "Mycotic keratitis: epidemiology, di..."

...Diagnosis should be confirmed by smear and culture of corneal scrapings [505]....
[...]
...Confocal microscopy and anterior segment coherence tomography are useful to monitor therapeutic response [505]....
[...]

Journal Article•DOI•

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi

[...]

Anuradha Chowdhary¹, Jacques F. Meis², Josep Guarro, G.S. de Hoog, Shallu Kathuria¹, Maiken Cavling Arendrup³, S. Arikan-Akdagli, Murat Akova⁴, Teun Boekhout⁵, Morena Caira⁶, Jesús Guinea⁷, Jesús Guinea⁸, Arunaloke Chakrabarti⁹, Eric Dannaoui¹⁰, A.D. van Diepeningen, Tomáš Freiberger¹¹, Andreas H. Groll, William W. Hope¹², Elizabeth M. Johnson¹³, Michaela Lackner¹⁴, Katrien Lagrou¹⁵, Fanny Lanternier¹⁶, Fanny Lanternier¹⁷, Cornelia Lass-Flörl¹⁴, O. Lortholary¹⁶, O. Lortholary¹⁷, Joseph Meletiadis, Patricia Muñoz⁸, Patricia Muñoz⁷, Livio Pagano⁶, George Petrikkos¹⁸, Malcolm Richardson¹⁹, Emmanuel Roilides, Anna Skiada¹⁸, Anna Maria Tortorano²⁰, Andrew J. Ullmann, Paul E. Verweij², Oliver A. Cornely²¹, Manuel Cuenca-Estrella²² - Show less +35 more•Institutions (22)

University of Delhi¹, Radboud University Nijmegen², Statens Serum Institut³, Hacettepe University⁴, University Medical Center Utrecht⁵, The Catholic University of America⁶, Hospital General Universitario Gregorio Marañón⁷, Complutense University of Madrid⁸, Post Graduate Institute of Medical Education and Research⁹, Paris Descartes University¹⁰, Central European Institute of Technology¹¹, University of Liverpool¹², Public Health England¹³, Innsbruck Medical University¹⁴, Katholieke Universiteit Leuven¹⁵, Pasteur Institute¹⁶, Necker-Enfants Malades Hospital¹⁷, National and Kapodistrian University of Athens¹⁸, Manchester Academic Health Science Centre¹⁹, University of Milan²⁰, University of Cologne²¹, Carlos III Health Institute²²

01 Apr 2014-Clinical Microbiology and Infection

TL;DR: Oral itraconazole has been considered the drug of choice, given the extensive clinical experience with this drug, but voriconazole may presumably be superior for central nervous system infections because of its ability to achieve good levels in the cerebrospinal fluid.

...read moreread less

260 citations

Cites background from "Mycotic keratitis: epidemiology, di..."

...Severe and refractory cases require administration of oral azoles and usually surgery including penetrating and lamellar keratoplasty (recommendation BIII) [89,91–93]....
[...]
...Keratitis due to dematiaceous fungi is mainly reported from India where trauma accounts for up to 20% of cases [89–91]....
[...]

Journal Article•DOI•

Current Thoughts in Fungal Keratitis: Diagnosis and Treatment

[...]

Zubair Ansari¹, Zubair Ansari², Zubair Ansari³, Darlene Miller², Anat Galor³, Anat Galor² - Show less +2 more•Institutions (3)

Marshall University¹, University of Miami², United States Department of Veterans Affairs³

01 Sep 2013-Current Fungal Infection Reports

TL;DR: This review will discuss current diagnostic modalities of fungal keratitis and will particularly focus on treatment regimens, and explore future therapeutic models and critique the potential benefit of each.

...read moreread less

Abstract: Fungal keratitis remains a challenging and often elusive diagnosis in geographic regions where it is endemic. Marred by delays in diagnosis, the sequelae of corneal fungal infections, though preventable, can be irreversible. Recent studies and advances in the arena have broadened the approach and treatment to mycotic keratitis. This review will discuss current diagnostic modalities of fungal keratitis and will particularly focus on treatment regimens. It will also explore future therapeutic models and critique the potential benefit of each.

...read moreread less

214 citations

Cites background from "Mycotic keratitis: epidemiology, di..."

...Many other species have also been robustly reported, ranging from Curvularia and other phaeohyphomycetes, Scedosporium apiospermum and Paecilomyces [8]....
[...]

Journal Article•DOI•

An Ocular Commensal Protects against Corneal Infection by Driving an Interleukin-17 Response from Mucosal γδ T Cells

[...]

Anthony J. St. Leger¹, Jigar V. Desai¹, Rebecca A. Drummond¹, Abirami Kugadas², Fatimah Almaghrabi¹, Phyllis B. Silver¹, Kumarkrishna Raychaudhuri¹, Mihaela Gadjeva², Yoichiro Iwakura³, Michail S. Lionakis¹, Rachel R. Caspi¹ - Show less +7 more•Institutions (3)

National Institutes of Health¹, Brigham and Women's Hospital², Tokyo University of Science³

18 Jul 2017-Immunity

TL;DR: A mouse model of ocular surface disease is used to reveal that commensals were present in the ocular mucosa and had functional immunological consequences, providing direct evidence that a resident commensal microbiome exists on the Ocular surface and identify the cellular mechanisms underlying its effects on ocular immune homeostasis and host defense.

...read moreread less

195 citations

Cites background from "Mycotic keratitis: epidemiology, di..."

..., are more closely linked to temperate climates and pre-existing conditions like insufficient tear quality, defective eyelid function, diabetes mellitus, or immunosuppression (Lakhundi et al., 2017; Nivenius and Montan, 2015; Oude Lashof et al., 2011; Romano et al., 1976; Thomas and Kaliamurthy, 2013)....
[...]
...…more closely linked to temperate climates and pre-existing conditions like insufficient tear quality, defective eyelid function, diabetes mellitus, or immunosuppression (Lakhundi et al., 2017; Nivenius and Montan, 2015; Oude Lashof et al., 2011; Romano et al., 1976; Thomas and Kaliamurthy, 2013)....
[...]

Journal Article•DOI•

Scedosporium and Lomentospora: an updated overview of underrated opportunists.

[...]

Andoni Ramirez-Garcia¹, Aize Pellon¹, Aitor Rementeria¹, Idoia Buldain¹, Eliana Barreto-Bergter², Rodrigo Rollin-Pinheiro², Jardel Vieira de Meirelles², Mariana Ingrid Dutra da Silva Xisto², Stéphane Ranque, Vladimír Havlíček³, Patrick Vandeputte⁴, Yohann Le Govic⁴, Jean-Philippe Bouchara⁴, Sandrine Giraud⁴, Sharon C.-A. Chen⁵, Johannes Rainer⁶, Ana Alastruey-Izquierdo⁷, María Teresa Martín-Gómez, Leyre M. López-Soria, Javier Pemán⁸, Carsten Schwarz⁹, Anne Bernhardt¹⁰, Kathrin Tintelnot¹⁰, Javier Capilla, Adela Martin-Vicente¹¹, José F. Cano-Lira, Markus Nagl¹², Michaela Lackner¹², Laszlo Irinyi⁵, Wieland Meyer⁵, Sybren de Hoog¹³, Fernando L. Hernando¹ - Show less +28 more•Institutions (13)

University of the Basque Country¹, Federal University of Rio de Janeiro², Academy of Sciences of the Czech Republic³, University of Angers⁴, University of Sydney⁵, University of Innsbruck⁶, Carlos III Health Institute⁷, Instituto Politécnico Nacional⁸, Charité⁹, Robert Koch Institute¹⁰, University of Tennessee Health Science Center¹¹, Innsbruck Medical University¹², Utrecht University¹³

01 Apr 2018-Medical Mycology

TL;DR: The current review presents recent findings and summarizes the most relevant points, including the Scedosporium/Lomentospora taxonomy, environmental distribution, epidemiology, pathology, virulence factors, immunology, diagnostic methods, and therapeutic strategies.

...read moreread less

Abstract: Species of Scedosporium and Lomentospora are considered as emerging opportunists, affecting immunosuppressed and otherwise debilitated patients, although classically they are known from causing trauma-associated infections in healthy individuals. Clinical manifestations range from local infection to pulmonary colonization and severe invasive disease, in which mortality rates may be over 80%. These unacceptably high rates are due to the clinical status of patients, diagnostic difficulties, and to intrinsic antifungal resistance of these fungi. In consequence, several consortia have been founded to increase research efforts on these orphan fungi. The current review presents recent findings and summarizes the most relevant points, including the Scedosporium/Lomentospora taxonomy, environmental distribution, epidemiology, pathology, virulence factors, immunology, diagnostic methods, and therapeutic strategies.

...read moreread less

149 citations

1
2
3
4
…
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69

Collapse

References

PDF

Open Access

More filters

Patent•

Eye contact lens

[...]

Bojko Ehrnest Vital Evich, Sukhonos Jurij Anatol Evich, Rejtuzov Vladimir Alekseevich

20 Jul 2011

TL;DR: In this paper, the end surface of an eye contact lens, having an outer front and rear surfaces, there are two patches lying in parallel on opposite sides of the lens, and on its front surface there is a film made from a selenium solution on which a protective coating made from methoxyethyl mercuric acetate is deposited.

...read moreread less

Abstract: FIELD: physics. ^ SUBSTANCE: on the end surface of an eye contact lens, having an outer front and rear surfaces, there are two patches lying in parallel on opposite sides of the end surface of the lens, and on its front surface there is a film made from a selenium solution on which a protective coating made from a solution of methoxyethyl mercuric acetate is deposited. On top of these coatings and the lens, there are two annular concentric cuts 11, 12, lying coaxial to the centre of the lens, filled with black dye. ^ EFFECT: easy placement and removal, alignment and placing on the eye cornea, reduced injuries, high efficiency when used in different atmospheric conditions. ^ 2 dwg

...read moreread less

629 citations

Journal Article•DOI•

Taxonomy, biology, and clinical aspects of Fusarium species.

[...]

P E Nelson¹, M C Dignani¹, Elias Anaissie¹•Institutions (1)

Pennsylvania State University¹

01 Oct 1994-Clinical Microbiology Reviews

TL;DR: Foreign-body-associated fusarial infection such as keratitis in contact lens wearers, onychomycosis, skin infections, and disseminated multiorgan infections are discussed and the implications for the association of the carcinogens, fumonisins, produced by Fusarium moniliforme and other FUSarium species with human diseases are discussed.

...read moreread less

Abstract: There are several taxonomic systems available for identifying Fusarium species. The philosophy used in each taxonomic system is discussed as well as problems encountered in working with Fusarium species in culture. Fusarium species are toxigenic, and the mycotoxins produced by these organisms are often associated with animal and human diseases. The implications for the association of the carcinogens, fumonisins, produced by Fusarium moniliforme and other Fusarium species with human diseases are discussed. Foreign-body-associated fusarial infection such as keratitis in contact lens wearers, onychomycosis, skin infections, and disseminated multiorgan infections are discussed. Disseminated fusarial hyalohyphomycosis has emerged as a significant, usually fatal infection in the immunocompromised host. Successful outcome is determined by the degree of immunosuppression, the extent of the infection, and the presence of a removable focus such as an indwelling central venous catheter. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy, probably with one of the newer antifungal agents. Perhaps the use of such agents or the use of colony-stimulating factors may improve the outcome of this devastating infection. However, until new approaches for treatment develop, effective preventive measures are urgently needed.

...read moreread less

624 citations

"Mycotic keratitis: epidemiology, di..." refers background in this paper

...Although Fusarium species have been cultured from soft contact lenses during use [23], it was still a surprise when, from mid-2005 to around July 2006, a multi-country outbreak of contact lens-associated keratitis due to Fusarium species...
[...]

Journal Article•DOI•

Current Perspectives on Ophthalmic Mycoses

[...]

Philip A. Thomas

01 Oct 2003-Clinical Microbiology Reviews

TL;DR: 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.

...read moreread less

Abstract: 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.

...read moreread less

416 citations

"Mycotic keratitis: epidemiology, di..." refers background or methods in this paper

...Conventional microbiological methods used for diagnosis of mycotic keratitis suffer from inherent drawbacks [38,39]....
[...]
...Wherever possible, microbiological investigations should be performed in patients presenting with suspected microbial keratitis [14,38]....
[...]
...Two agar media that should be used are blood agar (incubated at 37°C) and Sabouraud glucose–neopeptone agar (incubated at 22–25°C); additional media can be used if warranted [14,38]....
[...]
...This led one investigator to review the therapy of keratitis caused by frequently encountered hyaline filamentous fungi, phaeohyphomycetes and yeast-like fungi based on reports in the published literature [38]....
[...]
...2); only growth on the ‘C’-streaks is deemed significant [38]....
[...]

Journal Article•DOI•

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

[...]

A K Leck¹, Philip A. Thomas, M Hagan, J. Kaliamurthy, E Ackuaku, M John, Mercy J. Newman, F S Codjoe, Japheth A. Opintan, C.M. Kalavathy, V Essuman, C A N Jesudasan, G J Johnson - Show less +9 more•Institutions (1)

University of London¹

01 Nov 2002-British Journal of Ophthalmology

TL;DR: 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 and microscopy is an essential tool in the diagnosis of these infections.

...read moreread less

Abstract: 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.

...read moreread less

412 citations

"Mycotic keratitis: epidemiology, di..." refers background or methods in this paper

...Wherever possible, microbiological investigations should be performed in patients presenting with suspected microbial keratitis [14,38]....
[...]
...Two agar media that should be used are blood agar (incubated at 37°C) and Sabouraud glucose–neopeptone agar (incubated at 22–25°C); additional media can be used if warranted [14,38]....
[...]
...In addition to the solid media, it may be useful to use a liquid medium, such as brain–heart infusion broth, containing an antibacterial drug to suppress bacterial growth; however, not all investigators agree on this point [14,39]....
[...]
...Environmental factors (humidity, rainfall, wind) appear to have a bearing on the occurrence of filamentous fungal keratitis and may also determine seasonal variations in the frequency of isolation of fungi and the fungal species isolated [14]....
[...]
...Growth in culture is deemed significant if the same growth is obtained (i) on more than one occasion, (ii) on the ‘C’ streaks on more than one culture medium, or (iii) on one solid or in one liquid medium with direct microscopy of corneal material revealing the presence of fungal hyphae or yeast cells [14]....
[...]

Journal Article•DOI•

The Changing Spectrum of Fungal Keratitis in South Florida

[...]

Robert H. Rosa¹, Darlene Miller¹, Eduardo C. Alfonso¹•Institutions (1)

Bascom Palmer Eye Institute¹

01 Jun 1994-Ophthalmology

TL;DR: Trauma, including contact lens wear, is the most commonly associated risk factor, and the mainstay of therapy is topical natamycin with the increasing use of imidazoles.

...read moreread less

355 citations