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Concept: Fungal keratitis

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In recent years, Aspergillus species are reported frequently as aetiological agents of fungal keratitis in tropical countries such as India. Our aim was to evaluate the epidemiological features of Aspergillus keratitis cases over a 3-year period in a tertiary eye care hospital and to determine the antifungal susceptibilities of the causative agents. This study included culture proven Aspergillus keratitis cases diagnosed between September 2005 and August 2008. Data including prevalence, predisposing factors and demography were recorded, the isolates were identified by morphological and molecular methods and the minimum inhibitory concentration values of antifungal agents towards the isolates were determined by the microdilution method. Two hundred Aspergillus isolates were identified among 1737 culture proven cases. Most of the aspergilli (75%) proved to be A. flavus, followed by A. fumigatus (11.5%). Sixteen (8%) isolates belonged to species that are recently identified causative agents of mycotic keratitis. Most of the infected patients (88%) were adults ranging from 21 to 70 years of age. Co-existing ocular disease was confirmed in 16.5% of the patients. Econazole, clotrimazole and ketoconazole were notably active against A. flavus. Aspergillus keratitis is a significant problem in patients with ocular lesions in South-Indian States, warranting early diagnosis and initiation of specific antifungal therapy to improve outcome.

Concepts: Epidemiology, Aspergillus flavus, Ophthalmology, Keratitis, Aspergillus, Aspergillus fumigatus, Ketoconazole, Fungal keratitis

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In previous studies of fungal keratitis (FK) from temperate countries, yeasts were the predominant isolates with ocular surface disease (OSD) being the leading risk factor. Since the 2005-6 outbreak of contact lens (CL) associated Fusarium keratitis, there may have been a rise in CL associated filamentary FK in the United Kingdom. This retrospective case series investigated the patterns of FK from 2007 to 2014. We compared these to 1994-2006 data from the same hospital.

Concepts: Epidemiology, Observational study, United Kingdom, Cornea, Ophthalmology, Contact lens, Keratitis, Fungal keratitis

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We aim to highlight the key factors for a good outcome of fungal keratitis. We describe a case of contact lens-related Fusarium keratitis in a young girl. After identification of Fusarium spp under direct microscopic examination and in culture, a prolonged treatment with topic natamycin 5% was started and administered for five months with restitutio ad integrum of the eye. Prompt microbiological diagnosis and a specific and prolonged treatment are essential for correct management of Fusarium keratitis.

Concepts: Biology, Fusarium, Cornea, Ophthalmology, Contact lens, Keratitis, Specific Identification, Fungal keratitis

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To evaluate the efficacy of combination therapy of a single intrastromal injection of amphotericin B and topical fluconazole in resistant cases of fungal keratitis, and also topical amphotericin B as monotherapy in terms of the duration of the recovery period and toxic drug effects.

Concepts: Pharmacology, Ophthalmology, Keratitis, Nephrotoxicity, Fungal keratitis

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Mycotic keratitis, with its diverse clinical presentation and difficulties in treatment, makes it a challenging task for clinicians and an important object of study. The aim of present study was to determine the frequency of occurrence and epidemiological association with identification of fungal isolates from mycotic keratitis cases.

Concepts: Keratitis, Fungal keratitis, Northwest

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This report describes the clinical presentation, diagnosis, and medical management of a 2-year-old spayed female dwarf rabbit (Oryctolagus cuniculus) suffering from an ulcerative keratitis and a stromal abscess with a rapid evolution. The diagnosis of fungal keratitis was based on fungal culture identifying the pathogen as Aspergillus fumigatus. Treatment by topical terbinafine was efficacious in resolving the keratomycosis within 8 weeks. To our knowledge, this is the first reported case of spontaneous keratomycosis in a rabbit and the first description of successful therapy by terbinafine.

Concepts: Medicine, Ophthalmology, Keratitis, Aspergillus, Aspergillus fumigatus, Rabbit, European Rabbit, Fungal keratitis

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Mycotic keratitis is an ocular infective process derived from any fungal species capable of corneal invasion. Despite its rarity in developed countries, its challenging and elusive diagnosis may result in keratoplasty or enucleation following failed medical management. Filamentous fungi such as Fusarium are often implicated in mycotic keratitis. Bearing greater morbidity than its bacterial counterpart, mycotic keratitis requires early clinical suspicion and initiation of antifungal therapy to prevent devastating consequences. We describe a case of multidrug-resistant mycotic keratitis in a 46-year-old man who continued to decline despite maximal therapy and therapeutic keratoplasty. Finally, enucleation was performed as a means of source control preventing dissemination of a likely untreatable fungal infection into the orbit. Multidrug-resistant Fusarium is rare, and may progress to endophthalmitis. We discuss potential management options which may enhance diagnosis and outcome in this condition.

Concepts: Medicine, Fungus, Therapy, Ophthalmology, Keratitis, Ascomycota, Medical error, Fungal keratitis

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Fungal keratitis is much less common in Europe than in Asia. Antifungal therapy can be applied topically as well as systemically and in advanced situations surgical intervention can become necessary.

Concepts: Medicine, Surgery, Europe, Ophthalmology, Keratitis, Fungal keratitis

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To determine the significance of Aspergillus and Fusarium spp., as identified by culture, on clinical outcome in equine keratomycosis.

Concepts: Culture, Ophthalmology, Keratitis, Ascomycota, Hinny, Fungal keratitis

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The purposes of this study were to determine whether the contact lens solution RevitaLens Ocutec (containing the antimicrobial agents alexidine and polyquaternium-1) would inhibit Fusarium organisms when heated in ReNu plastic bottles; whether alexidine would inhibit Fusarium organisms when heated in non-ReNu plastic bottles; and whether an alexidine-neutralizing compound leaches from heated ReNu bottles.

Concepts: Microbiology, Cornea, Recyclable materials, Contact lens, Keratitis, Corneal ulcer, Bausch & Lomb, Fungal keratitis