The global incidence and diagnosis of fungal keratitis

Brown, Lottie; Leck, Astrid; Gichangi, Michael; Burton, Matthew J.; Denning, David W.

doi:10.1016/s1473-3099(20)30448-5

Cited by 239 publications

(278 citation statements)

References 44 publications

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“…It is one of the leading causes of microbial keratitis (MK) or corneal ulcer. The latest conservative estimates predict that there are close to 1.5 million new infections every year [ 3 ], which correlate with estimates published more than 20 years ago [ 4 , 5 ]. The burden of FK is greatest in tropical and subtropical countries, accounting for between 20 and 60% of MK cases presenting in tropical regions [ 6 ], likely a result of climate (higher temperatures and relative humidity) and frequent agriculture-related ocular trauma [ 7 ].…”

Section: Introductionsupporting

confidence: 61%

“…Until recently, the annual global incidence of fungal keratitis had never been estimated. In 2020, Brown et al estimated the incidence of fungal keratitis to be 1,051,787 cases per annum, within a range of between 736,251 and 1,367,323 cases per annum [ 3 ]. The incidence may in fact be higher at 1,480,916 cases per annum (range 1,036,641–1,925,191) if it is assumed that all unconfirmed culture negative cases of microbial keratitis were in fact fungal in aetiology.…”

Section: Epidemiology Of Fungal Keratitismentioning

confidence: 99%

“…There have also been reports of an increase in Fusarium -related keratitis in contact lens wearers in temperate, industrialised regions [ 9 , 10 , 11 ]. Interestingly, even within developed countries fungal keratitis is a disease of poverty: infections are associated with contact lens wearers from deprived or low socioeconomic backgrounds [ 3 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Hoffman

Burton

Leck

2021

JoF

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Mycotic or fungal keratitis (FK) is a sight-threatening disease, caused by infection of the cornea by filamentous fungi or yeasts. In tropical, low and middle-income countries, it accounts for the majority of cases of microbial keratitis (MK). Filamentous fungi, in particular Fusarium spp., the aspergilli and dematiaceous fungi, are responsible for the greatest burden of disease. The predominant risk factor for filamentous fungal keratitis is trauma, typically with organic, plant-based material. In developed countries, contact lens wear and related products are frequently implicated as risk factors, and have been linked to global outbreaks of Fusarium keratitis in the recent past. In 2020, the incidence of FK was estimated to be over 1 million cases per year, and there is significant geographical variation; accounting for less than 1% of cases of MK in some European countries to over 80% in parts of south and south-east Asia. The proportion of MK cases is inversely correlated to distance from the equator and there is emerging evidence that the incidence of FK may be increasing. Diagnosing FK is challenging; accurate diagnosis relies on reliable microscopy and culture, aided by adjunctive tools such as in vivo confocal microscopy or PCR. Unfortunately, these facilities are infrequently available in areas most in need. Current topical antifungals are not very effective; infections can progress despite prompt treatment. Antifungal drops are often unavailable. When available, natamycin is usually first-line treatment. However, infections may progress to perforation in ~25% of cases. Future work needs to be directed at addressing these challenges and unmet needs. This review discusses the epidemiology, clinical features, diagnosis, management and aetiology of FK.

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Section: Introductionsupporting

confidence: 61%

Section: Epidemiology Of Fungal Keratitismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Hoffman

Burton

Leck

2021

JoF

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“…From an epidemiological point of view, the cultured species in these cases and within the Netherlands Fusarium species are the most prevalent fungal species that cause fungal keratitis. This is in conjunction with the global species distribution described by Brown et al, who reported Fusarium as the most common causative agent followed by Aspergillus and Candida [ 24 ]. However, it is worth noting that there are regional differences to keep in mind.…”

Section: Discussionsupporting

confidence: 66%

Chlorhexidine for the Treatment of Fusarium Keratitis: A Case Series and Mini Review

Santos

Hanemaaijer

et al. 2021

JoF

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Fungal keratitis is difficult to treat, especially Fusarium keratitis. In vitro studies show that chlorhexidine could be an interesting option as monotherapy. We describe a case series of four patients (four eyes) with Fusarium keratitis at Radboud University Medical Center (Nijmegen, the Netherlands). The patients were treated with chlorhexidine 0.02% eye drops. The in vitro activity of eight antifungals and chlorhexidine was determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth microdilution method. We also reviewed the literature on the use of chlorhexidine in the treatment of fungal keratitis. Topical chlorhexidine was well tolerated, and all patients showed complete resolution of the keratitis upon treatment with chlorhexidine. A PubMed search of the available literature was conducted (last search 8 March 2020) and yielded two randomized clinical trials (natamycin versus chlorhexidine) and one case report addressing the treatment of fungal keratitis with chlorhexidine. Chlorhexidine was found to be safe with regard to toxicity and to be superior to natamycin in the clinical trials. Chlorhexidine showed in vitro fungicidal activity against Fusarium and clinical effectiveness in our cases, supporting further clinical evaluation. Advantages of chlorhexidine are its topical application, its general availability, its low costs, its broad-spectrum activity, and its fungicidal mechanism of action at low concentrations.

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“…Infectious keratitis represents a serious concern for ophthalmologists, with a progressively growing incidence in the last few years ( 3 ), A recent article published in The Lancet estimates an annual number of 1.4 million cases ( 4 ). All of these concerns force us to elaborate on new techniques for better management of these infections Other medical specialties are using alternate treatments for infections management, for example a recent study proves the efficiency of boric acid in vaginal candidosis ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Accelerated vs. conventional collagen cross‑linking for infectious keratitis

et al. 2021

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Infectious keratitis represents a serious concern for ophthalmologists, with a progressively growing incidence in the last few years. In this prospective comparative study, we evaluated two groups of patients with infectious keratitis or corneal ulcer resistant to antimicrobial and antifungal therapy, treated respectively with conventional and accelerated photoactivated chromophore collagen cross-linking. Eight patients were assigned to each group and they were monitored for 12 months. We investigated the differences between groups, comparing on one side the mean of the quantitative variables using the t-test and on the other side the frequencies of qualitative variables using the Fisher exact test. The time to healing for the group treated with conventional cross-linking was 2 days longer than for the group undergoing accelerated cross-linking (34.9±11.4 vs. 32.9±9.4 days), a difference that did not reach statistical significance (P=0.708). We conclude that the accelerated protocol is as safe and efficient as the classic procedure. The accelerated protocol has an important advantage, both for the doctor and the patient, of being time sparing (the time for accelerated cross-linking is 3 times shorter than in the case of the conventional protocol).

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The global incidence and diagnosis of fungal keratitis

Cited by 239 publications

References 44 publications

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Chlorhexidine for the Treatment of Fusarium Keratitis: A Case Series and Mini Review

Accelerated vs. conventional collagen cross‑linking for infectious keratitis

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