A 5-Year Retrospective Analysis of the Risk Factors, Treatment, and Prognosis of Patients With Fungal Keratitis in Heilongjiang, China

Jin, Xin; Feng, Jiaoyang; Sun, Naiyu; Jin, Hao; Wang, Jingrao; Song, Zhen; Zhang, Nan; Liu, Ying; Zhang, Hong

doi:10.1016/j.ajo.2022.07.023

Cited by 10 publications

(9 citation statements)

References 31 publications

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“…The common pathogenic species included Aspergillus , Fusarium , Candida , Curvularia, and Penicillium , with Fusarium (37–62%) and Aspergillus (24–30%) being the most common ones [ 11 , 28 , 29 ]. Aspergillus , Fusarium , and Curvularia species are found mainly in tropical regions, while yeast is common in temperate areas of the world [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our research, Hubei, a major agricultural province in central China, has a subtropical climate and an extraordinarily higher positive rate of Aspergillus species than other regions of China. The proportion of Aspergillus species ranges from 7.3% [ 29 ] to 21.7% [ 10 ] in northern China, while this figure was 15.2% [ 32 ]) to 30.7% [ 10 ] in southern China. This indicates that the proportion of Aspergillus species increases with regional latitude.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of In Vitro Culture and In Vivo Confocal Microscopy in Patients with Fungal Keratitis in a Tertiary Referral Hospital in Central China

Wang

Deng

et al. 2023

Microorganisms

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Purpose: To investigate the characteristics of in vitro culture and in vivo confocal microscopy (IVCM) in patients with fungal keratitis (FK) presented in a tertiary referral hospital in central China. Methods: In this noncomparative retrospective study, patients with the diagnosis of FK between October 2021 and November 2022 were reviewed. An IVCM and fungal culture (corneal scraping specimens) were performed, and the characteristics were analyzed. Results: During October 2021 and November 2022, 85 patients were diagnosed with FK. From 63 culture-positive cases, 8 species of fungus were identified. The proportions of isolated fungal species were Fusarium and Aspergillus equally accounting for 33.3% (21 of 63), Alternaria 9.5% (6 of 63), Curvularia 6.3% (4 of 63), Scedosporium apiospermum 6.3% (4 of 63), Paecilomyces lilacinus 3.2% (2 of 63), Exserohilum 3.2% (2 of 63), and Candida 4.8% (3 of 63), respectively. In positive culture cases, IVCM was found to be positive for hyphae or spores in 61 of 63 patients (96.8%). Different fungal species had a variety of cultural characteristics and IVCM manifestations. Conclusions: In a tertiary referral hospital in central China, Fusarium species, Aspergillus species, and Alternaria species were the 3 most common isolated fungal pathogens, and the proportion of Aspergillus species was significantly higher than that in other regions of China. Careful lesion depth examination by IVCM and OCT should be taken before lamellar keratoplasty to avoid postoperative recurrence. Identifying the IVCM image and culture characteristics will facilitate rapid diagnosis and proper treatment, but IVCM cannot yet replace fungal cultures to distinguish between different fungal species.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics of In Vitro Culture and In Vivo Confocal Microscopy in Patients with Fungal Keratitis in a Tertiary Referral Hospital in Central China

Wang

Deng

et al. 2023

Microorganisms

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“…Moreover, alterations in the tear components, commensals and the enzyme activities in a long-term hyperglycaemic ocular microenvironment facilitate fungal adherence, proliferation and deep-layer penetration [14]. Xin et al [15] observed that delayed medical attention-seeking by farmers, especially during harvest season, resulted in a poorer response to antifungal drugs and higher rates of surgery.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the diagnosis and management of atypical fungal keratitis during the COVID-19 pandemic: a case series

Ali,

Vijayan,

Shenoy

et al. 2023

Access Microbiology

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Fungal keratitis is a time-sensitive ocular infection that often requires a high index of suspicion followed by intensive medical/surgical interventions to achieve a successful clinical outcome. COVID-19 pandemic-related restrictions, necessitated the modification of conventional protocols and guidelines associated with the treatment of keratomycosis. We report four cases of atypical fungal keratitis with poorly differentiated clinical characteristics. The challenges faced during their management were (1) the dilemma of clinically differentiating fungal (Scedosporium and Purpureocillium lilacinum) and bacterial keratitis; (2) treatment of Scedosporium and Trichosporon keratitis with natamycin monotherapy; (3) mixed infection of Candida albicans and Aureobasidium pullulans and continuing medications before rescraping the corneal ulcer against the recommended treatment guidelines; (4) phenotypic identification and differentiation among morphologically resembling fungi; and (5) decision making arising out of disparities between KOH and fungal culture results. Three patients responded well to conservative treatments. The fourth patient underwent therapeutic keratoplasty but was lost to follow-up due to travel-related pandemic restrictions. This case series seeks to broaden the clinician’s knowledge of rare and emerging moulds as presumptive aetiologies of keratomycosis. It also intends to emphasize the significance of early microbiological investigations, (direct microscopy and culture), in resource-limited settings, for initiating empirical treatment for a better visual prognosis.

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“…Timely diagnosis of MK and early prescribing of appropriate antimicrobials are imperative to increase the likelihood of a good patient outcome . However, bacterial and fungal MK cannot be distinguished by clinical presentation alone, and the current diagnostic strategy has several limitations .…”

Section: Introductionmentioning

confidence: 99%

“…2,[4][5][6][7] Timely diagnosis of MK and early prescribing of appropriate antimicrobials are imperative to increase the likelihood of a good patient outcome. 6,[8][9][10][11] However, bacterial and fungal MK cannot be distinguished by clinical presentation alone, 12 and the current diagnostic strategy has several limitations. 13,14 One limitation is the paucity of diagnostic tests suitable for use within community or primary health care settings.…”

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confidence: 99%

Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis

Gunasekaran,

Chandrasekaran,

Rajarathinam

et al. 2023

JAMA Ophthalmol

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ImportanceMicrobial keratitis (MK) is a common cause of unilateral visual impairment, blindness, and eye loss in low-income and middle-income countries. There is an urgent need to develop and implement rapid and simple point-of-care diagnostics for MK to increase the likelihood of good outcomes.ObjectiveTo evaluate the diagnostic performance of the Aspergillus-specific lateral-flow device (AspLFD) to identify Aspergillus species causing MK in corneal scrape and corneal swab samples of patients presenting with microbial keratitis.Design, Setting, and ParticipantsThis diagnostic study was conducted between May 2022 and January 2023 at the corneal clinic of Aravind Eye Hospital in Madurai, Tamil Nadu, India. All study participants were recruited during their first presentation to the clinic. Patients aged 15 years or older met the eligibility criteria if they were attending their first appointment, had a corneal ulcer that was suggestive of a bacterial or fungal infection, and were about to undergo diagnostic scrape and culture.Main Outcomes and MeasuresSensitivity and specificity of the AspLFD with corneal samples collected from patients with MK. During routine diagnostic scraping, a minimally invasive corneal swab and an additional corneal scrape were collected and transferred to aliquots of sample buffer and analyzed by lateral-flow device (LFD) if the patient met the inclusion criteria. Photographs of devices were taken with a smartphone and analyzed using a ratiometric approach, which was developed for this study. The AspLFD results were compared with culture reports.ResultsThe 198 participants who met the inclusion criteria had a mean (range) age of 51 (15-85) years and included 126 males (63.6%). Overall, 35 of 198 participants with corneal scrape (17.7%) and 17 of 40 participants with swab samples (42.5%) had positive culture results for Aspergillus species. Ratiometric analysis results for the scrape samples found that the AspLFD achieved high sensitivity (0.89; 95% CI, 0.74-0.95), high negative predictive value (0.97; 95% CI, 0.94-0.99), low negative likelihood ratio (0.12; 95% CI, 0.05-0.30), and an accuracy of 0.94 (95% CI, 0.90-0.97). Ratiometric analysis results for the swab samples showed that the AspLFD had high sensitivity (0.94; 95% CI, 0.73-1.00), high negative predictive value (0.95; 95% CI, 0.76-1.00), low negative likelihood ratio (0.07; 95% CI, 0.01-0.48), and an accuracy of 0.88 (95% CI, 0.73-0.96).Conclusions and RelevanceResults of this diagnostic study suggest that AspLFD along with the ratiometric analysis of LFDs developed for this study has high diagnostic accuracy in identifying Aspergillus species from corneal scrapes and swabs. This technology is an important step toward the provision of point-of-care diagnostics for MK and could inform the clinical management strategy.

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A 5-Year Retrospective Analysis of the Risk Factors, Treatment, and Prognosis of Patients With Fungal Keratitis in Heilongjiang, China

Cited by 10 publications

References 31 publications

Characteristics of In Vitro Culture and In Vivo Confocal Microscopy in Patients with Fungal Keratitis in a Tertiary Referral Hospital in Central China

Characteristics of In Vitro Culture and In Vivo Confocal Microscopy in Patients with Fungal Keratitis in a Tertiary Referral Hospital in Central China

Challenges in the diagnosis and management of atypical fungal keratitis during the COVID-19 pandemic: a case series

Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis

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