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Purpose: To evaluate the efficacy of liposomal amphotericin B (L?AMB) for the treatment of fungal keratitis. Methods: Patients with fungal keratitis confirmed by potassium hydroxide (KOH) smear and/ or confocal microscopy were administered topical L?AMB and randomized into three groups treated with three different formulations. The medication was administered two hourly till clinical improvement was achieved, followed by six hourly till complete resolution. The outcome measures were time to clinical improvement, resolution of epithelial defect, stromal infiltrate, hypopyon, extent and density of corneal opacity, neovascularization, and best corrected visual acuity (BCVA) at 3 months. Results: Mean age of the patients was 46.6 ± 14.8 years, and trauma with vegetative matter was the most common predisposing factor. Aspergillus flavus (36%) was the most common fungus cultured, followed by Fusarium (23%). Mean time to clinical improvement, time to resolution of epithelial defect, mean time to resolution of infiltrate, and time to resolution of hypopyon were 3.45 ± 1.38, 25.35 ± 8.46, 37.97 ± 9.94, and 13.33 ± 4.90 days, respectively, and they were comparable among the three groups. There was a significant difference between treatment failure and success cases in terms of days of presentation (P < 0.01), size of the epithelial defect (P?value 0.04), and infiltrate size at presentation (P?value 0.04). At 3 months follow?up, no statistically significant difference was noted in BCVA and mean scar size among groups. Conclusion: L?AMB in a gel form is an effective antifungal agent that promotes the healing of fungal ulcers with notably least vascularization and better tolerance.
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Objective:To prepare water-soluble graphene-based itraconazole antifungal eye drops and evaluate its antifungal activity against Fusarium solani. Methods:By oxidative modification of graphene and modification of polymer materials, water-soluble graphene oxide-modified polyethylene glycol (GO-PEG) composites were prepared.The composites were characterized by scanning electron microscopy, zeta potential, and Raman spectroscopy.The antifungal drug itraconazole was loaded onto the GO-PEG vector by solvent evaporation method, and itraconazole eye drops were obtained.The drug loading of itraconazole eye drops was measured using a UV and visible spectrophotometer.The antifungal effect in vitro was assessed by the microdilution method and light microscopy. Results:Scanning electron microscopy showed that GO-PEG had a two-dimensional nanosheet structure and many wrinkles.The zeta potential of GO-PEG was -42.40 mV.Raman spectroscopy showed that the ID/ IG of GO-PEG was 1.003.Using the water-soluble GO-PEG vector, a maximum itraconazole concentration of 10 mg/ml was achieved with a 10 000-fold increase in apparent solubility (10 mg/ml vs 0.001 mg/ml). The antifungal results showed that the minimum inhibitory concentration of itraconazole eye drops against Fusarium solani was approximately 1.88 μg/ml, but the GO-PEG vector has no significant antifungal activity against Fusarium solani. Conclusions:GO-PEG achieves effective loading and solubilization of itraconazole, demonstrating an in vitro inhibitory effect on Fusarium solani.
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Purpose: To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North Indian population. Methods: Prospective study of the antifungal sensitivity testing (natamycin, amphotericin B, voriconazole, itraconazole, fluconazole, posaconazole, caspofungin, micafungin) of fungal isolates from 50 cases of culture positive fungal keratitis by using E test method. Details noted included demographic data, visual acuity, clinical details, grade of keratitis, healing time, and success in medical management. Results: Of 50 patients with fungal keratitis (mean age: 40.28 ± 16.77 years), 12 eyes healed within 3 weeks, 14 had a delayed healing response, and 24 had chronic keratitis. Among the 15 cases of Fusarium isolates, 93.3% were sensitive to natamycin, while 40% to amphotericin B; 66.6% to voriconazole, 13.4% to itraconazole and fluconazole each. 80% of Fusarium cases (n = 12) showed susceptibility to posaconazole. Among Aspergillus flavus isolates, 53.4% (n = 8) were sensitive to natamycin, with only 40% (n = 7) showing sensitivity to amphotericin B and good susceptibility to azoles. MIC against susceptible Fusarium spp. for natamycin was 3–16 ?g/mL, amphotericin B: 1–8 ?g/mL, voriconazole: 0.5–1.5 ?g/ mL, itraconazole: 0.5–12 ?g/mL, posaconazole: 0.094–1.5 ?g/mL. MIC against Aspergillus flavus was natamycin: 8–32 ?g/mL, amphotericin B: 0.5–16 ?g/mL, voriconazole: 0.025–4 ?g/mL, itraconazole: 0.125–8 ?g/mL, posaconazole: 0.047–0.25 ?g/mL; against Aspergillus niger isolates, to natamycin was 6 ?g/mL (n=1), amphotericin B 8–12 ?g/mL (n = 3), voriconazole: 0.125–0.19 ?g/mL (n = 3), itraconazole: 0.38–0.75 ?g/mL, posaconazole: 0.064–0.19 ?g/mL and against Aspergillus fumigatus (n = 1), was natamycin4 ?g/ mL, amphotericin B ? 8 ?g/mL, voriconazole 0.25 ?g/mL, itraconazole 1 ?g/mL, and posaconazole 0.19 ?g/mL. MIC against susceptible Acremonium spp. for natamycin was 1.5–16 ?g/mL, amphotericin B: 0.5–8 ?g/mL, voriconazole: 0.19–3 ?g/mL, itraconazole: 0.125 ?g/mL, posaconazole: 0.125–0.5 ?g/mL and against susceptible Curvularia was natamycin 0.75–4 ?g/mL, amphotericin B 0.5–1 ?g/mL, voriconazole 0.125–0.19 ?g/mL, itraconazole 0.047–0.094 ?g/mL, posaconazole 0.047–0.094 ?g/mL. MIC against Mucor spp.+ Rhizopus spp. (n = 1) was natamycin: 8 ?g/mL, amphotericin B: 0.75 ?g/mL, posaconazole: 1.5 ?g/ mL. MIC against of Alternaria (n = 1) was voriconazole: 0.19 ?g/mL, posaconazole: 0.094 ?g/mL. MIC against Penicillium (n=1) was natamycin: 8 ?g/mL, voriconazole: 0.25 ?g/mL, itraconazole: 0.5 ?g/mL, and Posaconazole: 0.125 ?g/mL. Conclusion: Our observations highlight the variations in susceptibility to antifungal agents. Posaconazole seems to be effective with low MIC against common corneal pathogenic fungal isolates
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Purpose: To differentiate Pythium keratitis from fungal keratitis using clinical signs, to explore usefulness of various signs as diagnostic prognosticators, and develop a clinical scoring system. Methods: A retrospective review of medical records and archived clinical photographs of patients with culture?positive Pythium keratitis and hyaline filamentous fungal keratitis was conducted at a tertiary eye institute to explore characteristics of ulcers that may aid diagnosis. Results: Full?thickness corneal stromal keratitis (P = 0.055), a dry ulcer surface (P = 0.010), tentacles (P < 0.0001), intrastromal dots (P < 0.0001), ring infiltrates (P = 0.024), reticular patterns (P < 0.0001), and peripheral furrows (P < 0.0001) were clinical signs associated with Pythium keratitis. Multiple regression analysis identified tentacles (odds ratio: 24.1, 95% confidence interval (CI): 3.8–158.1, P = 0.001) and peripheral furrows (odds ratio: 60.6, 95% CI: 5.1–712.3, P = 0.001) as independent diagnostic prognosticators for Pythium keratitis. The positive and negative likelihood ratios of a dry ulcer surface, tentacles, intrastromal dots, ring infiltrates, reticular patterns, and peripheral furrows predicting Pythium keratitis were 1.6, 13.6, 17.9, 4.3, 30.7, 15.3 and 0.4, 0.4, 0.7, 0.9, 0.6 and 0.8, respectively. The presence of two or more of these clinical signs (excluding a dry ulcer surface) had a sensitivity of 55.6% and a false positive rate of 1.4%. Conclusion: Tentacles, intrastromal dots, ring infiltrates, reticular patterns, and peripheral furrows are clinical signs to be considered for the diagnosis of Pythium keratitis and the presence of two or more signs has a very low false positive rate
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Purpose: To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary?care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations. Methods: All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts. Results: Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions. Conclusion: The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region?specific clinico?epidemiological profile.
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Purpose: To report a new entity called “toxic non?inflammatory fungal keratitis.” Methods: Eyes manifesting infective keratitis with a history of prior administration of topical steroids were included in the study. The details pertaining to the type of injury, duration of injury, and primary treatment for corneal trauma were meticulously documented. The corneal tissues were scraped from the patients and were analyzed for fungal filaments by using a 10% KOH mount under a compound microscope. Moreover, these scraped materials were plated on blood agar and Sabouraud dextrose agar plates. Results: The corneal ulcers displayed a disproportionately reduced intensity of pain and improved visual acuity. Further, 10% KOH revealed profuse fungal filaments with few inflammatory cells in all the patients. The anterior chamber cells and flare were either reduced or entirely absent. There was no evidence of lid edema and surrounding corneal edema in any of the patients. The mean healing period was 28.8 days (standard deviation (SD): 10.05). The KOH mount revealed the presence of confluent fungal hyphae with a few inflammatory cell infiltrates. The Aspergillus species and Fusarium species were found in 47% and 40% of the cases, respectively. Conclusion: Toxic non?inflammatory fungal keratitis following steroid therapy needs to be considered in fungal ulcers with disproportionately less pain and good visual acuity. The fungal ulcers with altered clinical signs of classical inflammation need to be assessed for topical steroid misuse.
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Purpose: To assess Photo Activated Chromophore for Infective Keratitis?Cross Linking (PACK?CXL) and its efficacy as a treatment modality in managing microbial keratitis. Methods: Single Centre prospective interventional study in infectious keratitis. A total of eleven patients were taken who had corneal thickness (CT) more than 400?m. PACK?CXL was performed according to Dresden’s protocol. The response was assessed by slit lamp examination, BCVA and AS?OCT at the time of complete healing. Results: The mean visual acuity at presentation was 1.207logMAR (0.3?3) which improved to mean value of 0.53logMAR (0.3?1). Mean time taken for complete epithelization was 17.45 days (14? 30 days) and that for complete healing was 33.72 days (21? 60 days). Mean CT at the baseline was 650.5± 108?m which reduced on consecutive follow up visits. There was reduction in the symptoms in nine patients except in two. One case reported increase in symptoms with worsening increase in endoexudates and hypopyon, and the other developed drug toxicity due to topical medications. Conclusion: Patients who underwent PACK?CXL showed good and early healing, good remodelling of cornea and improved visual acuity. The recalcitrant cases became responders to the same medications after PACK?CXL. Thus, PACK?CXL works well for both fungal and bacterial keratitis
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Purpose: To compare the costs associated with medications and travel of patients with smear?proven bacterial keratitis and fungal keratitis in a tertiary care center in India. Methods: Retrospective analysis of case records of a cohort of patients who presented between April 2017 and March 2018 to a tertiary care center in India, with infectious keratitis who were smear?positive for bacteria or fungi, and whose costs of treatment and travel were supported by a philanthropic program. Results: In total, 672 case records of 177 smear?positive bacterial keratitis (BK) and 495 smear?positive fungal keratitis (FK) were included in the study. Further, 62% of BK and 75% of FK received more than one antimicrobial drug (P < 0.001). The mean total medication cost (INR) was significantly more in FK (959.1 � 675.2) compared to BK (674.9 � 463.7) (P < 0.0001). The mean medication cost (INR) per visit was also more for FK (201.1 � 109.4) compared to BK (155.2 � 84.1) (P < 0.0001). The mean total medication cost was significantly more for FK for both patients who healed with medical treatment (611.6 � 395.6 for BK, 801.5 � 599.9 for FK, P = 0.0005) and for patients who required TPK (953.7 � 653.1 for BK, 1374.6 � 701.5 for FK, P = 0.0023) compared to their respective counterparts in BK. Conclusion: Patients with fungal keratitis incurred significantly more on medications compared to patients with bacterial keratitis irrespective of whether they had healed with successful medical treatment or required therapeutic keratoplasty. Prolonged duration of treatment and the high costs of antifungal medications account for the significant economic burden of fungal keratitis.
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Background: Objectives: Fungi are commonly found in the environment and most of them are either commensals or nonpathogenic. Eye infections are caused by bacteria, viruses and less commonly by fungi, therefore not given much attention by the practitioners and also by ophthalmolog ists. In the last one - decade incidence of fungal eye infections has increased due to increase in the number of patients with poor immunity. Common conditions which impair the immunity are prolonged use of steroids and antibacterial broad - spectrum antibioti cs, use of immunosuppressive drugs in cancer patients, in patients with organ transplant and some infections like AIDS. Candida, Fusarium and Aspergillus are the fungi frequently found to be associated with fungal eye infections. Trauma is the most signifi cant predisposing factor particularly when accompanied by contamination with vegetable matter. Methods: Samples such as corneal scrapings, Conjunctival swab, Vitreous & Aqueous aspirates were collected aseptically and sent to microbiology laboratory for KO H wet mount examination and fungal culture. KOH preparation was examined directly under microscope and culture were done on SDA, incubated at 25° c for three weeks. Results: Males were more commonly infected (66.5%) as compared to females (33.5%) The overall positivity in direct microscopy ( KOH preparation) was 32% while positivity in culture was 51%.The most frequently isolated fungus was Fusarium (16) followed by A. flavus ( 07), A. fumigatus (06), Candida sp.(06) and Curvalaria (03) Conclusion: If medical therapy fails to control the infection, surgery should be considered to save the eye visual function before the progression of disease.
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Purpose: To assess the sensitivity of potassium hydroxide and calcofluor white (KOH+CFW) mount in the diagnosis of Pythium keratitis and concordance among microbiologists. Methods: Three microbiologists evaluated the microscopic images of KOH + CFW mounts of confirmed cases of Pythium and fungal keratitis seen between January 2019 and February 2021. The filaments were compared using specific differentiating features. The sensitivity and specificity of KOH + CFW in diagnosing Pythium infection were evaluated along with concordance among the microbiologists. Results: Sixty consecutive cases with confirmed growth of fungus or Pythium insidiosum (n = 29) were evaluated. The sensitivity of KOH + CFW in the correct identification of Pythium filaments ranged from 79.3% to 96.5% among three microbiologists. There was good interobserver (k = 0.76–0.90) and intraobserver (k = 0.70–0.97) agreements among three microbiologists. The differentiating findings (P < 0.0001) suggestive of Pythium filaments were the absence of septae in 23 (79.3%) and collapsed walls in 22 (75.9%) cases. Conclusion: KOH + CFW has good sensitivity and specificity in the diagnosis of Pythium keratitis with good interobserver and intraobserver concordance.
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Objetivo: Investigar a etiologia e o perfil epidemiológico da ceratite fúngica (CF) em um centro de referência no estado de Minas Gerais. Design: Estudo retrospectivo longitudinal Métodos: Foram revisados os prontuários de pacientes com ceratite fúngica comprovada laboratorialmente no Hospital São Geraldo/HC-UFMG de janeiro de 2015 a dezembro de 2020. Resultados: Foram incluídos 114 pacientes. Destes, 81,6% eram do sexo masculino, com idade média de 47,3 anos e 79,2% oriundos de zonas rurais. Em 60% dos casos, a admissão no serviço foi entre os meses de maio a setembro. O principal fator predisponente encontrado foi o trauma ocular, registrado em 59,1% dos pacientes, sendo que, em 41,3% destes, o trauma se deu com material vegetal. Além disso, 40,1% tinham doenças sistêmicas, 15% dos pacientes tinham doenças oculares prévias, 13,2% tinham história de cirurgias oculares anteriores e 2,7 % eram usuários de lente de contato. Ao exame inicial, 56,4% dos pacientes apresentavam acuidade visual (AV) > 2,0 (LogMAR), 37,2% hipópio, 34,6% infiltrado estromal maior que 5 mm e 15% perfuração ocular. Os fungos filamentosos foram os mais prevalentes (103/114 casos; 90,3%), sendo que o Fusarium foi o gênero mais frequente entre os filamentosos (72/103; 70%), seguido de Aspergillus (20/103; 19,4%). Dos fungos leveduriformes, tivemos 11 casos de Candida sp. (9,6%), sendo sete casos de Candida albicans (63,7%), um de Candida parapsilosis (9,1%) e três casos sem identificação da espécie (27,3%). Dos 114 pacientes, 102 (89,5%) receberam tratamento com antifúngico tópico; em 96 (94,1%) olhos foi utilizada pimaricina e, em 50 olhos (49%), anfotericina B. Antifúngico sistêmico foi utilizado por 88/113 pacientes (77,9%). Transplante de córnea terapêutico foi necessário em 54/113 pacientes (47,8%). Houve recidiva no enxerto transplantado em 12 olhos (22,2%), em média 13 dias após o transplante. Complicações oculares da CF foram observadas em 56/111 pacientes (50,5%). O tempo de cicatrização foi em média de 40 dias (mediana: 36,5 dias). Logo após a cura, a AV ficou > 2,0 (LogMAR) em 58 pacientes (61,1%). À análise de regressão logística multivariada, os fatores de risco significativos (p<0,05) para ocorrência de perfuração e/ou necessidade de transplante de córnea terapêutico foram o tamanho do infiltrado corneano > 5 mm na maior extensão e AV inicial (LogMAR) > 2,0. Conclusões: Este é o estudo com o maior número de casos abordando o perfil etiológico e epidemiológico da ceratite fúngica no estado de Minas Gerais, Brasil. A CF foi predominante em homens adultos jovens oriundos de zonas rurais, nos meses de maio a setembro, coincidente com a época de maior atividade agrícola do estado. O principal fator de risco foi o trauma ocular. Fusarium sp. seguido de Aspergillus sp. foram os patógenos predominantes das CF na região estudada. Palavras chave: Ceratite fúngica. Infecção corneana. Epidemiologia. Etiologia. Transplante de córnea.
Objective: To investigate the etiology and epidemiological profile of fungal keratitis (FK) in a referral center in the state of Minas Gerais. Design: Longitudinal retrospective study Methods: We reviewed the medical records of patients with laboratory-proven fungal keratitis at Hospital São Geraldo/HC-UFMG from January 2015 to December 2020. Results: 114 patients were included. Of these, 81.6% were male, with a mean age of 47.3 years and 79.2% came from rural areas. In 60% of the cases, admission was between the months of May and September. The main predisposing factor was ocular trauma, recorded in 59.1% of the patients, and in 41.3% of these, trauma occurred with vegetable matter. In addition, 40.1% had systemic diseases, 15% had other eye diseases, 13.2% had a history of previous ocular surgeries, and 2.7% were contact lens wearers. At presentation, 56.4% of the patients had visual acuity (VA) > 2.0 (LogMAR), 37.2% had hypopyon, 34.6% displayed stromal infiltrate greater than 5 mm and 15% had ocular perforation. Filamentous fungi were the most prevalent (103/114 cases; 90.3%), with Fusarium being the most frequent genus among filamentous fungi (72/103; 70%), followed by Aspergillus (20/103; 19, 4%). Of the yeast-like fungi, we had 11 cases of Candida sp. (9.6%), being seven cases of Candida albicans (63.7%), one of Candida parapsilosis (9.1%) and three cases without identification of the species (27.3%). Of the 114 patients, 102 (89.5%) received topical antifungal treatment; pimaricin was used in 96 (94.1%) eyes and amphotericin B in 50 eyes (49%). Systemic antifungal was used by 88/113 patients (77.9%). Therapeutic corneal transplantation was required in 54/113 patients (47.8%). There was recurrence of fungal infection in the transplanted graft in 12 eyes (22.2%), at an average of 13 days after transplantation. Ocular complications of CF were observed in 56/111 patients (50.5%). Healing time averaged 40 days (median: 36.5 days). Immediately after healing, VA was > 2.0 (LogMAR) in 58 patients (61.1%). On multivariate logistic regression analysis, significant risk factors (p<0.05) for occurrence of perforation and/or need for therapeutic corneal transplantation were corneal infiltrate size > 5 mm at greatest extent and initial AV (LogMAR) > 2.0. Conclusions: This is largest investigation on the etiological and epidemiological profiles of fungal keratitis in the state of Minas Gerais, Brazil. FK was predominant in young adult men from rural areas, most frequently during period of high agricultural activity in the state, with the main risk factor being ocular trauma with vegetable matter. Fusarium sp. followed by Aspergillus sp. were the predominant pathogens implicated in FK in the region studied. Keywords: Fungal keratitis. Corneal infection. Epidemiology. Etiology. Corneal transplant.
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Humans , Male , Female , Epidemiology , Corneal Transplantation , Invasive Fungal Infections , KeratitisABSTRACT
AIM: To analyze the infection characteristics and clinical treatment outcome of patients with fungal keratitis(FK)in Jingzhou area, so as to provide basis for clinical diagnosis and treatment of FK. METHODS: The data of 176 patients with FK diagnosed by etiology in Jingzhou Central Hospital from January 2015 to July 2020 were collected, and the epidemiological characteristics, identification results of fungal strains, drug sensitivity and clinical treatment outcome of the patients were analyzed. RESULTS:Among the 176 patients with FK, 118 were male and 58 were female, and the ratio of male to female is 2.03:1. The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The peak seasons of onset were April to June and October to December. Risk factors include trauma and possible history of trauma, ocular surface diseases, post ophthalmic surgery, wearing corneal contact lenses and long-term local drug use. The main pathogens were Fusarium(39.8%), aspergillus(30.7%), alternaria(15.9%)and candida(5.1%). The results of drug sensitivity showed that voriconazole and amphotericin B were sensitive, while the drug resistance rate of fluconazole was very high. There were 125 eyes improved or cured after conservative treatment, 12 eyes were injected into corneal stroma, 15 eyes were covered with conjunctival flap or amniotic membrane transplantation, and 21 eyes were treated with corneal transplantation. Enucleation of ocular contents was performed in 8 eyes, including 5 eyes with severe endophthalmitis after conjunctival flap covering. CONCLUSION:The incidence of FK in Jingzhou area is mostly middle-aged and elderly men, mostly caused by corneal trauma in the process of agricultural labor. The main pathogens were fusarium and aspergillus. It is very important to select reasonable antifungal drugs and treatment methods according to the drug sensitivity results.
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@#AIM: To construct and evaluate a diagnostic model based on transfer learning and data augmentation as a non-invasive tool for fusarium identification of fungal keratitis. <p>METHODS: A retrospective study. In this study, 2 157 images of fungal keratitis patients who underwent <i>in vivo</i> confocal microscopy examination in the Department of Ophthalmology of the people's Hospital of Guangxi Zhuang Autonomous Region from March 2017 to January 2020 were included as the dataset, which was classified according to the results of microbial culture. The dataset was subsequently randomly divided into training set(1 380 images), validation set(345 images)and test set(432 images). We used the transfer learning Inception-ResNet V2 network to construct a diagnostic model, and to compare the performance of the model trained on different datasets. The performance of the diagnostic model evaluated with specificity, sensitivity, accuracy, and area under the receiver operating characteristics curve(AUC).<p>RESULTS: The model trained with the original training set had a specificity rate of 71.6%, a sensitivity rate of 72.0%, an accuracy rate of 71.8% and AUC of 0.785(95%<i>CI</i>: 0.742-0.828, <i>P</i><0.0001). And the model trained with the augmented training set had a specificity rate of 76.6%, a sensitivity rate of 83.1%, an accuracy rate of 79.9% and AUC of 0.876(95%<i>CI</i>: 0.843-0.909, <i>P</i><0.0001), which made the model's prediction performance boost.<p>CONCLUSION: In this study, we constructed an intelligent diagnosis system for fungal keratitis fusarium through transfer learning, which has higher accuracy, and realized the intelligent diagnosis of fungal keratitis pathogen fusarium. Furthermore, we verified that the data augmentation strategy can improve the performance of the intelligent diagnosis system when the original dataset is limited, and this method can be used for intelligent diagnosis and identification of fungal keratitis pathogen fusarium.
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Purpose: To evaluate the efficacy of intrastromal voriconazole for the management of fungal keratitis not responding to conventional therapy. Methods: Patients having microbiologically proven fungal keratitis with poor response to 2 weeks of conventional topical therapy were included in the study. After obtaining informed consent, an intrastromal injection of voriconazole was administered around the ulcer. Response to treatment in the form reduction in the size of the ulcer and infiltration was recorded on regular follow-ups. Results: Out of a total of 20 patients, 14 responded to intrastromal treatment and resolved, whereas six patients progressed to perforation. Mean resolution time was 35.5 � 9.2 days. The most common organism isolated was Fusarium in six patients while Aspergillus and Mucor were isolated in two each. The causative organism could not be isolated in eight patients. The size of the ulcer at presentation and height of hypopyon were found to be significant risk factors associated with treatment outcomes. Conclusion: Intrastromal voriconazole as an adjuvant therapy appeared to be effective in treatment of fungal keratomycosis not responding to conventional therapy, thus, reducing the need for therapeutic or tectonic keratoplasty.
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Purpose: This study was aimed at identifying differentially expressed genes (DEGs) in bacterial and fungal keratitis. The candidate genes can be selected and quantified to distinguish between causative agents of infectious keratitis to improve therapeutic outcomes. Methods: The expression profile of bacterial or fungal infection, and normal corneal tissues were downloaded from the Gene Expression Omnibus. The limma package in R was used to screen DEGs in bacterial and fungal keratitis. The Co-Express tool was used to calculate correlation coefficients of co-expressed genes. The "Advanced network merge" function of Cytoscape tool was applied to obtain a fusional co-expression network based on bacterial and fungal keratitis DEGs. Finally, functional enrichment analysis by DAVID software and KEGG analysis by KOBAS of DEGs in fusion network were performed. Results: In total, 451 DEGs in bacterial keratitis and 353 DEGs in fungal keratitis were screened, among which 148 DEGs were found only in bacterial keratitis and 50 DEGs only in fungal keratitis. Besides, 117 co-expressed gene pairs were identified among bacterial keratitis DEGs and 87 pairs among fungal keratitis DEGs. In total, nine biological pathways and seven KEGG pathways were screened by analyzing DEGs in the fusional co-expression network. Conclusion: TLR4 is the representative DEG specific to bacterial keratitis, and SOD2 is the representative DEG specific to fungal keratitis, both of which are promising candidate genes to distinguish between bacterial and fungal keratitis.
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@#AIM:To investigate the<i> in vitro</i> interaction between antifungals and tacrolimus acting alone or in combination against Fusarium solani.<p>METHODS: According to Clinical and Laboratory Standards Institute(CLSI)M27-Ed4 and M38-A3, 22 strains of Fusarium solani were used to perform drug sensitivity tests with chessboard microdilution method by cyclosporin A combined with 4 kinds of antifungal drugs <i>in vitro</i>.<p>RESULTS: The MIC ranges of natamycin, voriconazole, amphotericin B and fluconazole against 22 strains of Fusarium solani were 2-8, 1-8, 1-8 and 8-512μg/mL respectively. When combined with tacrolimus <i>in vitro</i>, the synergistic effects of fluconazole and Amphotericin B were observed in 64% and 41% strains respectively. There were no antagonistic effects observed in all combined drug tests. With the combination, the sensitivity of Fusarium to amphotericin B was significantly increased from 4.5% to 68.2%(<i>P</i><0.001).<p>CONCLUSION: Fusarium solani is sensitive to natamycin <i>in vitro</i> and is partially sensitive to voriconazole. When combined with cyclosporine A, it can produce synergistic effects with fluconazole and amphotericin B, and significantly increase the sensitivity of Fusarium solani to amphotericin B drugs.
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Purpose: To study the outcomes of therapeutic penetrating keratoplasty in fungal keratitis. Methods: This retrospective, observational, interventional case series involved an audit of 198 consecutive eyes that underwent therapeutic penetrating keratoplasty (ThPK) for fungal keratitis at L V Prasad Eye Institute between January 2008 and December 2010 was performed. The data on demographics, clinical characteristics, intraoperative, and late postoperative complications were noted. The primary outcome measure was eradication of infection and postoperative anatomical success. Secondary outcome measures were graft survival, risk factors, clinical features, and management of recurrent fungal keratitis post ThPK. Results: Mean follow-up after ThPK was 24 ± 17 months. A total of 178 (89.9%) eyes had complete eradication of fungal infection, whereas 20 (10.1%) eyes developed recurrence. Anatomical restoration was achieved in majority of cases (192 eyes; 97%). Larger infiltrate size was associated with a higher risk of recurrence of infection. The median graft survival rate was 5.9 months. The graft survival was better for grafts <8 mm versus those with >8 mm (P = 0.026) and not found significantly related to the species of fungus. Twenty-seven eyes underwent re-grafting: penetrating keratoplasty in 14 eyes, and Descemet's stripping endothelial keratoplasty in 13 eyes. Conclusion: As larger infiltrate prior to therapeutic keratoplasty had much higher risk of recurrences; timely surgical intervention should be considered in cases not responding to medical therapy. Alternative strategies of management of postoperative inflammation need to be considered to prevent graft failures.
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Fungal keratitis is a dreaded occurrence in the cornea and anterior segment given the difficulty in treating the disease. Hereby reporting 5 cases of fungal keratitis causes by virulent organisms such as Aspergillus versicolor, Aspergillus fumigatus, Phialophora sp, and Fusarium sp. A retrospective interventional case series of 5 fungal keratitis which were successfully treated by intrastromal antifungal injection performed by a single surgeon from March 2017 till April 2018. The fungal keratitis stromal abscess sizes range from largest of 3mm x 2mm to smallest of 1mmx 1mm, mostly located paracentral and one case was noted to have hypopyon measuring about 1mm. On the first week of treatment, patients noted to exhibit poor response to topical antifungal. Hence, intrastromal amphotericin B injection 5mcg/0.1ml about 0.1ml administered into the affected eye ranging from once to 3 times in all patients except for one patient; who is post-operative 1 year penetrating keratoplasty infected with Phialophora keratitis is given intrastromal amphotericin B injection 5mcg/0.1ml about 0.1ml for 3 times and intrastromal voriconazole injection 50mcg/0.1ml about 0.1ml for 3 times. Within next four weeks, all the 5 cases of fungal keratitis became completely quiet with healed epithelial defect and corneal scarring. In summary, the intrastromal antifungal injection can constitute a good modality for the treatment of recalcitrant cases of fungal keratitis, revealing highly potent antifungal effects as the medication is administrated directly to the site of keratitis, promises shorter recovery period, and early intrastromal antifungal injection also leads to quicker healing with good vision prognosis.
ABSTRACT
A 55-year-old lady developed a corneal ring infiltrate following trauma with a wooden stick. 10% KOH mount of corneal scrapings revealed septate hyaline fungal filaments. White feathery colonies with shiny black dots grew on potato dextrose agar. Characteristic features of Pestalotiopsis spores were seen on Lactophenol cotton blue mount. DNA sequencing showed 99% similarity with Pseudopestalotiopsis theae. Complete resolution was noted with topical and oral antifungals. To the best of our knowledge, this is the first report of Pseudopestalotiopsis keratitis following trauma with vegetative matter highlighting the role of DNA sequencing in identification of rare fungi.
ABSTRACT
@#AIM:To assess the clinical application of confocal microscopy combined with corneal scraping in the diagnosis and treatment of fungal keratitis.<p>METHODS: Totally 56 eyes of 56 patients with fungal keratitis from our hospital were included. All patients underwent confocal microscopy and cornea scraping for smear microscopy and fungal culture. The diagnostic yield was analyzed.<p>RESULTS: The positive diagnostic rates of confocal microscopy and cornea scraping were 91% and 54% respectively,whereas in combination the positive diagnostic rate increased to 95%. 44 eyes(79%)were clinically cured with drugs alone while 12 eyes(21%)also required surgery. <p>CONCLUSION: Confocal microscopy examination is non-invasive, with rapid detection and strong repeatability. When combined with corneal scraping it can be used to improve diagnostic yield and guide clinical therapy.