Candida Keratitis

Sengupta, Jayangshu; Khetan, Archana; Saha, Suman; Banerjee, Debdulal; Gangopadhyay, Nibaran; Pal, Dipanjan

doi:10.1097/ico.0b013e31823f8a71

Cited by 25 publications

(8 citation statements)

References 20 publications

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“…Yeast keratitis is not known to respond favourably to natamycin and Chlorhexidine. 34 This particular patient was a previously undiagnosed HIV positive patient, he presented a few weeks later with another infiltrate in his only remaining eye which we successfully treated with topical amphotericin B 0.15%. 35 …”

Section: Discussionmentioning

confidence: 91%

Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

et al. 2021

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ObjectiveFungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis.MethodsThis study was nested within a large cohort study of people presenting with microbial keratitis in Uganda. We enrolled patients with recalcitrant fungal keratitis not improving with topical natamycin 5% and commenced chlorhexidine 0.2%. Follow-up was scheduled for 3 months and 1 year. The main outcome measures were healing, visual acuity and scar size at final follow-up.ResultsThirteen patients were followed in this substudy. The patients were aged 27–73 years (median 43 years). Filamentous fungi were identified by microscopy of corneal scrape samples in all cases. Isolated organisms included Aspergillus spp, Fusarium spp, Candida spp, Bipolaris spp and Acremoninum spp. At the final follow-up, nine patients (75%) had healed; three had vision of better than 6/18. Three patients lost their eyes due to infection. In the remaining nine cases, corneal scarring was variable ranging from 4.6 to 9.4 mm (median 6.6 mm, IQR 5.9–8.0 mm); of these five had dense scars, three had moderate scars and one had a mild scar. None of the patients demonstrated signs of chlorhexidine toxicity during the follow-up.ConclusionChlorhexidine 0.2% was found to be a useful sequential adjunctive topical antifungal in cases of fungal keratitis not responding to natamycin 5%, which warrants further evaluation.

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Section: Discussionmentioning

confidence: 91%

Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

et al. 2021

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“…It was not possible to enrol controls for 45 cases because of several reasons. These included: not at home at the agreed time of the home visit (11), wrong home address (4), died (1), uncooperative village members (20), case address too far (9). The cases without controls were dropped from the matched risk factor analysis.…”

Section: Resultsmentioning

confidence: 99%

“…[11][12][13] Diabetes Mellitus (DM) has been the most commonly reported systemic risk factor, especially following keratoplasty or corneal trauma. [19][20][21] In the few studies from SSA on the risk factors for MK, suggested factors include trauma and use of TEM. [22][23][24] The other risk factors reported in the literature are steroid use, severe staphylococcal eyelid infections and the HIV positive cases.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Microbial Keratitis in Uganda: A Case Control Study

Arunga

Kintoki

Gichuhi

et al. 2019

Ophthalmic Epidemiology

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Purpose: Microbial keratitis (MK), is a frequent cause of sight loss worldwide, particularly in low and middle-income countries. This study aimed to investigate the risk factors of MK in Uganda. Methods: Using a nested case control, we recruited healthy community controls for patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018. Controls were individually matched for age, gender and village of the cases on a 1:1 ratio. We collected information on demographics, occupation, HIV and Diabetes Mellitus status. In STATA version 14.1, multivariable conditional logistic regression was used to generate odds ratios for risk factors of MK and a likelihood ratio test used to assess statistical significance of associations. Results: Two hundred and fifteen case-control pairs were enrolled. The HIV positive patients among the cases was 9% versus 1% among the controls, p = .0003. Diabetes 7% among the cases versus 1.4% among the controls, p = .012. Eye trauma was 29% versus 0% among the cases and controls. In the multivariable model adjusted for age, sex and village, HIV (OR 83.5, 95%CI 2.01-3456, p = .020), Diabetes (OR 9.38, 95% CI 1.48-59.3, p = .017) and a farming occupation (OR 2.60, 95%CI 1.21-5.57, p = .014) were associated with MK. Compared to a low socioeconomic status, a middle status was less likely to be associated with MK (OR 0.29, 95%CI 0.09-0.89, p < .0001). Conclusion: MK was associated with HIV, Diabetes, being poor and farming as the main occupation. More studies are needed to explore how these factors predispose to MK.

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“…Fungal keratitis (FK) is a severe infectious corneal disease in developing countries [1][2][3]. In China, more than 50% of infectious keratitis cases are the result of a fungal infection [4].…”

Section: Introductionmentioning

confidence: 99%

Endothelial Plaques as Sign of Hyphae Infiltration of Descemet’s Membrane in Fungal Keratitis

Liu

et al. 2020

Journal of Ophthalmology

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Background. To evaluate the relationship between corneal endothelial plaques and fungal hyphae infiltration in fungal keratitis. Methods. Retrospective cross-sectional study of 60 fungal keratitis patients who underwent keratoplasty between January 2013 and March 2017. The endothelial plaques were graded as follows: grade 1, 1–3 endothelial plaques; grade 2, 4–8 endothelial plaques; and grade 3, more than 8 endothelial plaques or dense, merging endothelial plaques. The fungal pathogen culture and histopathology of diseased Descemet’s membrane were evaluated. Results. According to endothelial plaque grading, 3 patients were grade 1, 29 patients were grade 2, and 28 patients were grade 3. The PK surgery was performed in 57 patients with endothelial plaques of grade 2 and grade 3 and DALK surgery in 3 patients of grade 1. The predominating fungal pathogens were Aspergillus species (63.2%). All 57 patients with grade 2 and grade 3 had fungal hyphae in Descemet’s membrane based on calcofluor white staining or PAS staining. In patients with grade 3, more hyphae and inflammatory cells were found in Descemet’s membrane. The immunohistochemical staining of endothelial plaques revealed that CD15 and CD68 were positive in most cells. During the follow-up, 2 out of 3 patients who underwent DALK had recurrent fungal keratitis. Conclusions. Endothelial plaques are considered as a sign of hyphae infiltrating Descemet’s membrane. PK should be performed once plaques are detected in endothelium during the surgery.

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Candida Keratitis

Abstract: Candida is a new concern in developing countries like India. We are concerned about the poorer outcome, probably resulting from our unpreparedness and failure of medical therapy leading to more complication and requiring surgical intervention in higher numbers.

Cited by 25 publications

References 20 publications

Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

Risk Factors of Microbial Keratitis in Uganda: A Case Control Study

Endothelial Plaques as Sign of Hyphae Infiltration of Descemet’s Membrane in Fungal Keratitis

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