Clinical and microbiological analysis of fungal keratitis in Toronto, Canada: A 20-year study.

Fungal keratitis is a devastating and difficult-to-treat ocular infection with high morbidity. Understanding geographic microbiological and clinical trends helps to guide rapid and effective treatment. We therefore report the characteristics and outcomes of fungal keratitis in Toronto,ON Canada, over a 20-year period. An electronic search of microbiology records at University Health Network, Toronto, ON, Canada identified all patients with positive corneal fungal culture over a 20-year period seen at our tertiary referral cornea practice. Review of corresponding patient charts identified demographic and microbiological details, clinical course, treatment regimen, and final outcomes associated with each episode of culture-positive fungal keratitis. A total of 46 patients with 51 discrete fungal keratitis episodes were included. Five patients experienced recurrent fungal keratitis. Candida species accounted for 60.8% of positive fungal cultures, followed by Filamentous species at 35.3%. Preferred initial anti-fungal treatment was topical amphotericin at 36.7% followed by topical voriconazole at 32.6%. Surgical intervention was required in 48.9% with therapeutic penetrating keratoplasty being the most common procedure (22.4%). Final visual acuity (VA) of <20/200 was attributed to 58% of patients in this study. Risk factors for poor outcomes included poor VA, topical steroid use at presentation, Candida involvement, history of ocular surface disease, organic ocular trauma, or prior corneal transplantation. Candida is the most frequent keratomycotic pathogen in Toronto. Risk factors for poor visual outcome include prior corneal transplantation, ocular surface disease/trauma, or pre-existing topical steroid use. Early suspicion, diagnosis and treatment are paramount for best clinical outcomes. LAY SUMMARY: Fungal keratitis can cause severe vision loss without effective treatment. In Toronto, Candida had been the most common species over a 20-year period. Poor clinical outcome was associated with low presenting visual acuity, previous corneal transplant, topical steroid use, trauma, and Candida involvement.

Ocular Sporotrichosis with Limbal Stem Cell Deficiency: An Impostor with Blinding Sequelae.

Sporotrichosis is a chronic granulomatous fungal infection caused by Sporothrix schenckii. Inoculation of the fungus through breached skin or mucosa typically results in nodular ulceration of the cutaneous and subcutaneous tissue as well as its draining lymphatic nodules. However, reports on ocular involvement have recently increased. We describe a severe case of diffuse granulomatous conjunctivitis involving bulbar and palpebral conjunctiva, resulting in inevitable damage to the limbal stem cells. Isolation of S. schenckii from a conjunctival swab confirmed the diagnosis of sporotrichosis. A 6-month course of oral antifungal therapy was given through which the patient fully recovered. However, extensive corneal conjunctivalization secondary to total limbal stem cell deficiency has caused almost complete blindness in the affected eye. Clinical suspicion of this zoonotic disease is essential for early diagnosis and prompt treatment to prevent ocular surface complication and blindness.

[Candida infiltrations in the iris and lens during iritis and situation after sepsis]. / Candida-Infiltrat in Iris und Linse bei Iritis und Zustand nach Sepsis.

Intraocular Candida infections are overall rather rare; nevertheless they are often found as endogenous infections after Candida sepsis and can be sight-threatening. The most common manifestations are either a sole chorioretinitis or an endophthalmitis. Here we report the case of a 35-year-old man developing Candida infiltrations in the lens capsule and behind the iris after corticosteroid treatment of a presumed HLA-B27-positive iritis. The patient suffered from a life-threatening intensive care stay with positive Candida blood cultures earlier after intestinal perforation. With systemic intracameral and topical voriconazole, the infection was successfully treated. In patients with positive blood samples for Candida, topical and systemic corticosteroids should be given with care even months after the last positive blood cultures.

Oculomicosis: una infección subestimada en Venezuela / Ocular mycosis: an underestimated infection in Venezuela

Venezuela, debido a su localización geográfica, clima y situación social, tiene el perfil para que las enfermedades oculares de origen fúngico se presenten. Aunque, en el país, la incidencia y prevalencia de las oculomicosis no ha sido suficientemente documentada, la mayoría de los oftalmólogos han tenido que atenderla en su consulta tanto pública como privada. La queratitis micótica es la forma más frecuente de presentación oftalmológica de las infecciones de origen fúngico que puede tener complicaciones irreversibles, incluso ceguera monocular, especialmente para aquellas personas que viven en comunidades agrícolas de países en vías de desarrollo. La enfermedad es fácilmente desapercibida, y los diagnósticos tardíos son comunes. Este hecho, hace que aumente las probabilidades de secuelas severas y la necesidad de intervenciones quirúrgicas. Los hongos filamentosos son los microorganismos causantes más frecuentemente asociados con traumatismos oculares o al uso de lentes de contacto. El propósito de este estudio, es presentar una revisión clínico-epidemiológica actualizada que incluye estrategias de tratamiento y diagnóstico de un problema subestimado en Venezuela e incentivar futuros estudios epidemiológicos con el objetivo de conocer los factores de riesgo asociados y medidas preventivas necesarias a ser implementadas en la región.

Due to its climate, geographical and social situation, Venezuela has the profile for fungal ocular diseases. Even though the incidence and prevalence of this ocular morbidity is undetermined in our country, most of the ophthalmologist have encountered the disease yearly in public or private practice. Fungal keratitis is the most frequent form of presentation of ocular mycosis, it can lead to irreversible complications and even monocular blindness, especially for people living in the agricultural communities of the developing world. The disease is easily overlooked or missed, and delayed diagnosis is common. This fact increases the likelihood of severe sequelae and surgical interventions. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with ocular trauma or contact lens wear. The purpose of this study is to present a clinical-epidemiological review-update, which includes diagnosis and treatment strategies of this underestimated disease in Venezuela, as well as to encourage future epidemiological studies to recognize risk factors and preventive treatment in our region.