Update on Management of Fungal Keratitis

Anutarapongpan, Orapin

doi:10.4172/2327-5073.1000168

Cited by 8 publications

(5 citation statements)

References 95 publications

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“…The study was halted due to the comparatively higher rates of corneal perforations in the oral voriconazole arm [177]. Filamentous fungi have been most frequently reported in our review, supporting current antifungal treatment recommendations [2, 178,179] (Table 4).…”

Section: Fungal Keratitissupporting

confidence: 75%

The Spectrum of Microbial Keratitis: An Updated Review

Bartimote¹,

Foster²,

Watson³

2019

TOOPHTJ

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Background: In microbial keratitis, infection of the cornea can threaten vision through permanent corneal scarring and even perforation resulting in the loss of the eye. A literature review was conducted by Karsten, Watson and Foster (2012) to determine the spectrum of microbial keratitis. Since this publication, there have been over 2600 articles published investigating the causative pathogens of microbial keratitis. Objective: To determine the current spectrum of possible pathogens implicated in microbial keratitis relative to the 2012 study. Methods: An exhaustive literature review was conducted of all the peer-reviewed articles reporting on microbial pathogens implicated in keratitis. Databases including MEDLINE, EMBASE, Scopus and Web of Science were searched utilising their entire year limits (1950-2019). Results: Six-hundred and eighty-eight species representing 271 genera from 145 families were implicated in microbial keratitis. Fungal pathogens, though less frequent than bacteria, demonstrated the greatest diversity with 393 species from 169 genera that were found to cause microbial keratitis. There were 254 species of bacteria from 82 genera, 27 species of amoeba from 11 genera, and 14 species of virus from 9 genera, which were also identified as pathogens of microbial keratitis. Conclusion: The spectrum of pathogens implicated in microbial keratitis is extremely diverse. Bacteria were most commonly encountered and in comparison, to the review published in 2012, further 456 pathogens have been identified as causative pathogens of microbial keratitis. Therefore, the current review provides an important update on the potential spectrum of microbes, to assist clinicians in the diagnosis and treatment of microbial keratitis.

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Section: Fungal Keratitissupporting

confidence: 75%

The Spectrum of Microbial Keratitis: An Updated Review

Bartimote¹,

Foster²,

Watson³

2019

TOOPHTJ

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“…As yet, no standard therapeutic strategy has been established for mycotic keratitis. However, some therapeutic options are available, which include solutions of natamycin, amphotericin B, voriconazole and fluconazole for topical treatment, and voriconazole and posaconazole for systemic application . Due to the severity of infection and its progression in our case, therapy was guided by in vitro antifungal susceptibility testing.…”

Section: Discussionmentioning

confidence: 99%

Tintelnotia, a new genus in Phaeosphaeriaceae harbouring agents of cornea and nail infections in humans

Ahmed

Hofmüller

Seibold

et al. 2016

Mycoses

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Phaeosphaeriaceae is a family in the order Pleosporales containing numerous plant pathogens, endophytes, lichenised fungi, and environmental saprobes. A novel genus, Tintelnotia is introduced containing two species, one of which caused an eye infection and several nail infections in humans. All species of Tintelnotia produce conidia in soft pycnidia with a wide ostiole. The generic type species is T. opuntiae causing necrotic spots on cactus plants. The isolates of the human opportunist T. destructans showed variable susceptibility pattern to a panel of common antifungal agents. The MICs of amphotericin B, voriconazole, posaconazole and itraconazole were 1 μg/mL, complemented by an in vitro MEC of 16 μg/mL against caspofungin; the MIC of terbinafine was 0.125 μg/mL. The latter compound contributed to the successful therapy in the ocular mycosis refractory to standard antifungal therapy, the benefit of terbinafine should be highlighted as a therapeutic option especially in difficult-to-treat fungal keratitis.

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“… 34 If not diagnosed and treated effectively it will frequently result in corneal melting, visual impairment, and devastating ocular damage. 22 , 35 Recurrence, worsened visual acuity, and corneal ulcer are common and serious ocular diseases caused by viral infection. 36 Even though no more study conducted on viral keratitis in Ethiopia previous study conducted in this country showed herpetic keratitis as the common risk factor for bacterial keratitis.…”

Section: Introductionmentioning

confidence: 99%

Medical History, Clinical Features, Treatment Outcome and Its Predictors Among Infectious Keratitis Patients in Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study

Regasa¹,

Woldemichael²,

Daba³

2021

OPTH

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Background: Infectious keratitis is a major global cause of visual impairment and irreversible blindness among the corneal diseases. Its diagnosis and management remain getting challenge. The clinical and visual outcome remains poor in developing countries. The aim of this study was to determine treatment outcome and its predictors among patients with infectious keratitis. Methods: Prospective observational study was conducted among adult patients diagnosed with infectious keratitis at the Ophthalmology Department in Jimma University Medical Center from April 1 to September 30, 2019. The primary outcome indicator was response of the ulcer to empirical treatment. Ulcers that did not heal and required surgery had a poor outcome. Variables with a p-value of <0.25 were entered into a multivariate logistic regression model to determine the independent predictors of poor treatment outcome and variables with a p-value of <0.05 were considered statistically significant. Results: The research involved 131 adult patients. Eighty-seven (66.4%) were males. The mean age was 39.38 (±18.9) years. Eighty-three (63.4%) patients had poor treatment outcome. Mean length of hospital stay was 17.38 (±12.563) days. Poor visual outcome was observed among 71 (54.2%) participants. Evisceration was done for seven (5.3%) patients. Independent predictors of poor treatment outcome include perforation at admission (AOR=6.1, 95%CI: 1.5-25.1), presence of comorbidity (AOR=7.7, 95%CI: 2.16-27.3), poor adherence (AOR=5.3, 95%CI: 1.8-25.9), traditional medicine use (AOR=6.7, 95%CI: 1.8-25.4), ulcer depth >1/3 (AOR=7.6, 95%CI: 2.48-48.23) and farm workers (AOR=3.59, 95%CI: 1.09-11.77). Major complications occurred after admissions were perforation (14.5%), followed by endophthalmitis (7.63%) and corneal opacity (6.87%). Conclusion and Recommendation: Our study found high poor treatment outcomes and high poor visual outcomes. Presence of comorbidity, perforation at admission, traditional medicine use, working on a farm, poor adherence, and ulcer depth were the predictors of poor treatment outcome. This high poor outcome requires a nationwide interventional study and urgent intervention that may reach rural communities.

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Update on Management of Fungal Keratitis

Cited by 8 publications

References 95 publications

The Spectrum of Microbial Keratitis: An Updated Review

The Spectrum of Microbial Keratitis: An Updated Review

Tintelnotia, a new genus in Phaeosphaeriaceae harbouring agents of cornea and nail infections in humans

Medical History, Clinical Features, Treatment Outcome and Its Predictors Among Infectious Keratitis Patients in Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study

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