Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India

Abstract

Purpose: The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India. Methods: Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered. Results: Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. ( n = 55/83; 66.3%), Alternaria sp. ( n = 12/83; 14.5%), Ulocladium sp. ( n = 5/83; 6%), Bipolaris sp. ( n = 5/83; 6.1%), Scedosporium sp. ( n = 3/83; 3.6%), Acremonium sp. ( n = 2/83; 2.4%), and Epicoccum sp. ( n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm 2 . The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 ( n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 ( n = 27/65; 41.5%) eyes. Conclusion: Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.

Clinical manifestations and treatment outcomes of rare genera fungal keratitis in China

“…As such, Curvularia crescentulum keratitis seems to respond well to antifungal drug. Exserohilum, Bipolaris, and Colletotrichum are also dematiaceous fungi where foreign bodies or plant trauma are predisposing factors [17]. Human infections mainly invade the skin and respiratory tract, rarely infecting the cornea [18][19][20][21][22].…”

Response to comments on: Causative fungi and treatment outcome of Dematiaceous fungal keratitis in North India

“…We thank Sodhi et al . [ 1 ] for their interest and comments on our article “Causative fungi and treatment outcome of Dematiaceous fungal keratitis in North India.“[ 2 ] To answer the queries raised: the mean delay in patient presentation was 13.5 ± 14.5 days (95% confidence interval: 10.3–16.7 days; range: 1–90 days). Final visual acuity of patients with central location of ulcer was 0.96 ± 0.76 logMAR and of patients with paracentral/peripheral (combined as other group) ulcers was 0.51 ± 0.7 logMAR ( P = 0.04; Independent sample t -test).…”

Comments on: Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India

“…We would like to congratulate the authors for elaborately reporting dematiaceous fungal keratitis,[ 1 ] a lesser documented form in literature. This is one of the largest case series from North India which has reported it.…”

“…Also, the treatment protocol mentioned by the authors describes the use of topical natamycin suspension and voriconazole for larger and deeper ulcers. [ 1 ] We would like to know if any systemic medication/intra-stromal injections were given for deep seated infections as has been reported by other studies. [ 2 3 4 ]…”