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Erdem E, Köktaş Z, İnan Harbiyeli I, Atalay E, Kibar F, Durmaz G, Arslan YK, Seydaoğlu G, Yıldırım N, Yağmur M. The effect of climatic and seasonal factors on the microbial keratitis profile. J Fr Ophtalmol 2024; 47:104018. [PMID: 37932171 DOI: 10.1016/j.jfo.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/31/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. STUDY DESIGN Retrospective cohort. METHODS This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. RESULTS This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. CONCLUSION The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.
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Affiliation(s)
- E Erdem
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey.
| | - Z Köktaş
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - I İnan Harbiyeli
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey
| | - E Atalay
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - F Kibar
- Microbiology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - G Durmaz
- Microbiology Department of Eskişehir Osmangazi, University Faculty of Medicine, Eskişehir, Turkey
| | - Y K Arslan
- Statistic Department of Cukurova University, Faculty of Medicine, Adana, Turkey
| | - G Seydaoğlu
- Statistic Department of Cukurova University, Faculty of Medicine, Adana, Turkey
| | - N Yıldırım
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - M Yağmur
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey
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Moramarco A, Grendele A, Iannetta D, Ottoboni S, Gregori G, di Geronimo N, Ortalli M, Lazzarotto T, Fontana L. Efficacy of the Combined Intrastromal Injection of Voriconazole and Amphotericin B in Recalcitrant Fungal Keratitis. Microorganisms 2024; 12:922. [PMID: 38792749 PMCID: PMC11124487 DOI: 10.3390/microorganisms12050922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/28/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
This study aims to report the efficacy of a combined intrastromal injection in optimizing the outcome of severe mycotic keratitis. Herein, we report a case series of 20 consecutive patients with positive fungal cultures not responding to topical antifungal treatment. Patients received cycles of intrastromal injections of voriconazole (50 µg/0.1 mL) and amphotericin B (2.5 µg/0.1 mL); all patients continued their topical antifungal therapy. The organisms isolated were Fusarium (n = 5), Aspergillus (n = 4), Candida (n = 4), Rhodotorula (n = 2), Penicillium (n = 2), Alternaria (n = 1), Bipolaris (n = 1), and Curvularia (n = 1). The size of the infiltrate varied from 6.5 to 1.5 mm. At presentation, the best corrected visual acuity (BCVA, namely, the best visual acuity achieved with glasses, if needed) was less than 20/400 in all patients, improving to better than 20/400 in eleven patients. Seven patients required surgical intervention; four of them underwent penetrating keratoplasty (PK) à chaud one month after the first intrastromal injection. Patients who underwent surgery achieved a BCVA of 20/40 or better. Combined intrastromal injections before therapeutic penetrating keratoplasty (TPK) effectively reduced ulcer size and graft diameter, preventing infection recurrence. Our results highlight the efficacy of combined intrastromal injections in optimizing outcomes for severe mycotic keratitis undergoing TPK.
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Affiliation(s)
- Antonio Moramarco
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.G.); (S.O.); (N.d.G.); (L.F.)
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Arianna Grendele
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.G.); (S.O.); (N.d.G.); (L.F.)
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Danilo Iannetta
- Department of Organs of Sense, University of Rome La Sapienza, 00185 Rome, Italy;
| | - Simone Ottoboni
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.G.); (S.O.); (N.d.G.); (L.F.)
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Giulia Gregori
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy;
| | - Natalie di Geronimo
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.G.); (S.O.); (N.d.G.); (L.F.)
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Margherita Ortalli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (M.O.); (T.L.)
- Microbiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (M.O.); (T.L.)
- Microbiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Luigi Fontana
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.G.); (S.O.); (N.d.G.); (L.F.)
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
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Somerville TF, Mdala S, Zungu T, Gandiwa M, Herbert R, Everett D, Corless CE, Beare NAV, Neal T, Horsburgh MJ, Darby A, Kaye SB, Kayange PC. Microbial keratitis in Southern Malawi: a microbiological pilot study. BMJ Open Ophthalmol 2024; 9:e001682. [PMID: 38653537 PMCID: PMC11043707 DOI: 10.1136/bmjophth-2024-001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Microbial keratitis (MK) is a significant cause of blindness in sub-Saharan Africa. We investigated the feasibility of using a novel corneal impression membrane (CIM) for obtaining and processing samples by culture, PCR and whole-genome sequencing (WGS) in patients presenting with suspected MK in Malawi. METHODS AND ANALYSIS Samples were collected from patients presenting with suspected MK using a 12 mm diameter polytetrafluoroethylene CIM disc. Samples were processed using culture and PCR for Acanthamoeba, herpes simplex virus type 1 (HSV-1) and the bacterial 16S rRNA gene. Minimum inhibitory concentrations of isolates to eight antimicrobials were measured using susceptibility strips. WGS was used to characterise Staphylococcus aureus isolates. RESULTS 71 eyes of 71 patients were included. The overall CIM isolation rate was 81.7% (58 positive samples from 71 participants). 69 (81.2%) of isolates were Gram-positive cocci. Coagulase-negative Staphylococcus 31.8% and Streptococcus species 14.1% were the most isolated bacteria. Seven (9.9%) participants were positive for HSV-1. Fungi and Acanthamoeba were not detected. Moxifloxacin and chloramphenicol offered the best coverage for both Gram-positive and Gram-negative isolates when susceptibility was determined using known antimicrobial first quartile concentrations and European Committee on Antimicrobial Susceptibility Testing breakpoints, respectively. WGS identified known virulence genes associated with S. aureus keratitis. CONCLUSIONS In a resource-poor setting, a CIM can be used to safely sample the cornea in patients presenting with suspected MK, enabling identification of causative microorganisms by culture and PCR. Although the microbiological spectrum found was limited to the dry season, these preliminary results could be used to guide empirical treatment.
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Affiliation(s)
- Tobi F Somerville
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
| | - Shaffi Mdala
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
- Ophthalmology Unit, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Thokozani Zungu
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
- Ophthalmology Unit, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Moira Gandiwa
- Ophthalmology Unit, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
- Kamuzu Central Hospital, Lilongwe, Central Region, Malawi
| | - Rose Herbert
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
| | - Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- College of Medicine and Health Sciences, Infection Research Unit, Khalifa University, Abu Dhabi, UAE
| | - Caroline E Corless
- Medical Microbiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Timothy Neal
- Department of Infection and Immunity, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Malcolm J Horsburgh
- Department of Infection Biology and Microbiomes, University of Liverpool, Liverpool, UK
| | - Alistair Darby
- Department of Infection Biology and Microbiomes, University of Liverpool, Liverpool, UK
| | - Stephen B Kaye
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
| | - Petros C Kayange
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
- Ophthalmology Unit, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
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Shareef O, Shareef S, Saeed HN. New Frontiers in Acanthamoeba Keratitis Diagnosis and Management. BIOLOGY 2023; 12:1489. [PMID: 38132315 PMCID: PMC10740828 DOI: 10.3390/biology12121489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Acanthamoeba Keratitis (AK) is a severe corneal infection caused by the Acanthamoeba species of protozoa, potentially leading to permanent vision loss. AK requires prompt diagnosis and treatment to mitigate vision impairment. Diagnosing AK is challenging due to overlapping symptoms with other corneal infections, and treatment is made complicated by the organism's dual forms and increasing virulence, and delayed diagnosis. In this review, new approaches in AK diagnostics and treatment within the last 5 years are discussed. The English-language literature on PubMed was reviewed using the search terms "Acanthamoeba keratitis" and "diagnosis" or "treatment" and focused on studies published between 2018 and 2023. Two hundred sixty-five publications were initially identified, of which eighty-seven met inclusion and exclusion criteria. This review highlights the findings of these studies. Notably, advances in PCR-based diagnostics may be clinically implemented in the near future, while antibody-based and machine-learning approaches hold promise for the future. Single-drug topical therapy (0.08% PHMB) may improve drug access and efficacy, while oral medication (i.e., miltefosine) may offer a treatment option for patients with recalcitrant disease.
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Affiliation(s)
- Omar Shareef
- School of Engineering and Applied Sciences, Harvard College, Cambridge, MA 02138, USA;
| | - Sana Shareef
- Department of Bioethics, Columbia University, New York, NY 10027, USA
| | - Hajirah N. Saeed
- Department of Ophthalmology, University of Illinois Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
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Byanju R, Kandel RP, Poudyal B, Bhandari S, Ligal A, Pradhan S, Gautam M, Shrestha P, Sah RK, Gonzales JA, Porco TC, Whitcher JP, Srinivasan M, Upadhyay MP, Lietman TM, Keenan JD, O'Brien KS. Risk factors for corneal ulcers: a population-based matched case-control study in Nepal. Br J Ophthalmol 2023; 107:1771-1775. [PMID: 36202599 PMCID: PMC10076439 DOI: 10.1136/bjo-2022-322141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We aimed to examine risk factors for corneal ulcer in a rural and peri-urban setting in Nepal. METHODS This population-based matched case-control study was nested in a cluster randomised trial in 24 village development committees in Nepal. Incidence density sampling was used to match incident corneal opacity cases to controls, matching on time of opacity, age, sex and location. Cases and controls were invited to participate in a survey of risk factors for corneal ulcer. Risk factors were evaluated using conditional logistic regression to account for matching. RESULTS Of the 540 participants with incident opacities identified in the trial, 433 were willing to participate in this substudy and matched to a control. Compared with controls, cases had lower odds of having any education vs no education (adjusted OR, aOR 0.60, 95% CI 0.39 to 0.94), working in non-manual labour occupations vs manual labour occupations (aOR 0.64, 95% CI 0.42 to 0.95) and preferring medical shops for ocular trauma versus eye care system centres (aOR 0.58, 95% CI 0.37 to 0.92). Cases had higher odds of protective goggle use versus no protection (aOR 3.8, 95% CI 1.3 to 11.0) and having an ocular injury vs none (aOR 7.7, 95% CI 4.3 to 13.6) compared with controls. CONCLUSION We found ocular injury, manual labour and lower education to be strongly associated with the development of corneal ulcer. Given the persistent burden of corneal blindness in this area, prevention efforts could target efforts to increase access to care in areas where these factors are common.
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Affiliation(s)
| | - Ram Prasad Kandel
- Bharatpur Eye Hospital, Bharatpur, Nepal
- Seva Foundation, Berkeley, California, USA
| | | | | | - Anju Ligal
- Bharatpur Eye Hospital, Bharatpur, Nepal
| | | | | | | | | | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John P Whitcher
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Jeremy David Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
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Moon CW, Cho CH, Lee SB. Clinical comparative analysis of bacterial keratitis according to contact lens use: a retrospective study in a tertiary referral center of South Korea. Int Ophthalmol 2023; 43:3509-3521. [PMID: 37493928 DOI: 10.1007/s10792-023-02756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/21/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To compare the clinical aspects and treatment outcomes of contact lens-related bacterial keratitis (CLBK) and non-CLBK patients. METHODS Altogether 217 patients of bacterial keratitis (CLBK; 62, non-CLBK; 155) hospitalized between January 2012 and December 2020 were retrospectively analyzed for epidemiology, microbiological profiles, predisposing factors, clinical characteristics, and treatment outcomes. Poor treatment outcomes (PTO) were defined as a final BCVA < 0.3 (Snellen), a decreased visual acuity after treatment, complications, or surgical intervention. Relative importance of the initial clinical features leading to PTO was assessed using the random forest model and two-proportion Z-test. RESULTS The most common predisposing factors were sleeping with wearing CL (51.6%) in the CLBK group and trauma (55.5%) in the non-CLBK group. There were significant differences between the two groups in mean age (35.1:55.1 years, p < 0.001), female sex (56.5:34.8%, p = 0.003), symptom duration (6.2:6.9 days, p = 0.019), gram-negative organisms (83.3:48.3%, p = 0.008), epithelial healing time (8.5:14.1 days, p = 0.004), final BCVA (0.15:0.46 logMAR, p = 0.015), and PTO (9.7:21.9%, p = 0.035). For the entire group, the initial BCVA < 0.1 (27.9%), symptom duration ≥ 5 days (19.4%), age ≥ 60 years (16.4%), and hypopyon (14.0%) were important initial clinical features leading to PTO in the random forest model. In CLBK group, the type of CL or CL-related history was not significantly related to PTO. CONCLUSION CLBK patients had a higher proportion of females, younger age, gram-negative bacteria, and better treatment outcomes than those of non-CLBK patients. There were no significant risk factors leading to PTO in either the type of CL or CL-related history.
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Affiliation(s)
- Cheol-Won Moon
- Department of Ophthalmology, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944, South Korea
| | - Chan-Ho Cho
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 48108, South Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyunchung-ro, Nam-gu, Daegu, 42415, South Korea.
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Al Hadlaq AM, Al Harbi MM. The Epidemiological Profile and Predisposing Factors of Microbial Keratitis Over a 10-Year Period at a Tertiary Hospital in Central Saudi Arabia. Cureus 2023; 15:e45433. [PMID: 37727843 PMCID: PMC10506373 DOI: 10.7759/cureus.45433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE To evaluate the demographic and predisposing factors and clinical presentation of microbial keratitis (MK) patients over 10 years at a tertiary hospital in central Saudi Arabia. METHOD In 2020, a retrospective review of data from clinical and pathology departments from 2010 to 2019 was conducted. Demography includes age, gender, residence, and the risk factor of microbial keratitis, clinical features, and organism profile as number and percentage. RESULT We reviewed 181 eyes of 179 patients with microbial keratitis. The mean age was 40.1 years. Contact lens usage (55; 30%), ocular trauma (30; 16.5%), and ocular surface diseases (42; 23.2%) were the main predisposing factors. Hypopyon was noted in 60 (33%) eyes, impaired vision at presentation was observed in 78 (43%) eyes, and endophthalmitis with microbial keratitis was noted in eight (4.4%) eyes at presentation. Ninety-eight (54,1%) cases were culture positive, while gram-positive organisms were seen in 50 (27.6%) eyes, gram-negative organisms in 35 (19.3%) patients, and fungi in 13 (7.2%) patients. Microbial keratitis was central in 67 (37%), paracentral in 94 (52%), and peripheral in 20 (11.3%) patients. All instances of fungal keratitis occurred in the eyes of men who work in the agriculture field. CONCLUSION Standard operating procedures to manage microbial keratitis at primary and secondary eye care levels are recommended. Health promotion to prevent trauma, appropriate use of contact lens, and early treatment could prevent the incidence of microbial keratitis.
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Zaccaron BA, Araújo MEXDS, de Paula AIC, Costa BDM, Papalini EPDP, Pinto RASR. Bacterial keratitis in a tertiary hospital in São Paulo: a 21-year review of the epidemiological, laboratory, and clinical data. Braz J Infect Dis 2023; 27:102809. [PMID: 37806317 PMCID: PMC10597823 DOI: 10.1016/j.bjid.2023.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Infectious keratitis is a sight-threatening condition that is usually an ocular emergency. The visual outcome depends on prompt and accurate clinical management as well as geographic and epidemiological awareness. We conducted a retrospective observational study to define the epidemiological and laboratory profile, as well as the clinical course of bacterial keratitis in a tertiary hospital in São Paulo over 21 years. Information about age, sex, predisposing factors, topical and surgical treatment, visual acuity, ulcers' classification, bacterioscopy, culture, and antibiotic sensitivity tests were collected. This study included 160 patients. The mean age was 65.1 ± 18.4 years and risk factors were identified in 83.1 % of the patients. Empirical topical fortified cephalosporin with an aminoglycoside or fourth-generation fluoroquinolone was curative for 66.2 % of the cases. The mean treatment duration was 22.5 ± 9 days. The mean variation of visual acuity was -0.25 logMAR, p < 0.001. Culture revealed 64 % of Gram-positive bacteria. All Gram-positive bacteria were sensitive to cephalothin, vancomycin, and quinolones. All Gram-negative bacteria were sensitive to gentamicin, tobramycin, amikacin, and ciprofloxacin. These findings reinforce the importance of prompt empirical treatment of severe corneal ulcers with a fortified cephalosporin and aminoglycoside or a fourth-generation fluoroquinolone as there are equally effective. Collected data was insufficient to evaluate resistance of ocular infections over time in this population.
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Affiliation(s)
- Beatriz Avila Zaccaron
- Hospital do Servidor Público Estadual de São Paulo, Ciências da Saúde, São Paulo, SP, Brazil; Hospital dos Olhos de São Paulo, São Paulo, SP, Brazil.
| | - Maria Emilia Xavier Dos Santos Araújo
- Hospital do Servidor Público Estadual de São Paulo, Departamento de Córnea e Doenças Oculares Externas, São Paulo, SP, Brazil; Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Moledina M, Roberts HW, Mukherjee A, Spokes D, Pimenides D, Stephenson C, Bassily R, Rajan MS, Myerscough J. Analysis of microbial keratitis incidence, isolates and in-vitro antimicrobial susceptibility in the East of England: a 6-year study. Eye (Lond) 2023; 37:2716-2722. [PMID: 36709219 PMCID: PMC9883814 DOI: 10.1038/s41433-023-02404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/30/2022] [Accepted: 01/16/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/OBJECTIVES To report the incidence, microbiological profile and in-vitro antimicrobial susceptibilities of microbial keratitis (MK) in the East of England (EoE) over a 6-year period. SUBJECTS/METHODS A retrospective study of patients diagnosed with MK who underwent corneal scraping at participating trusts, within the EoE, between 01/01/2015-01/07/2020. Analysis was performed on MK isolate profiles, in-vitro anti-microbial sensitivities and trends over time. RESULTS The mean incidence of IK, in the EoE, was estimated at 6.96 per 100 000 population/year. 1071 corneal scrapes were analysed, 460 were culture positive (42.95%) of which 87.2% were bacteria (50.3% gram-positive and 49.7% gram-negative), 2.4% polymicrobial, 9.3% fungi and 1.1% acanthamoeba. The most common organisms were pseudomonas spp (29.57%). There was a non-statistically significant trend (NST) in increasing incidence of pseudomonas spp, staph aureus and serratia (p = 0.719, p = 0.615, and p = 0.099 respectively) and a declining NST in Fungi (p = 0.058). Susceptibilities in-vitro to, penicillin classes, fluoroquinolone and aminoglycosides were 76.7% and 89.4%, 79.2% and 97.2% and 95.4 and 96.1% to gram-positive and gram-negative bacteria respectively. Gram-negative organisms were increasingly resistant to cephalosporins with a 19.2% reduction in sensitivity over time. (p = 0.011). Ceftriaxone showed the greatest decrease in sensitivity of 41.67% (p = 0.006). CONCLUSION In the EoE, MK is relatively prevalent though likely underestimated. Profiles are similar to other UK regions with the exception of a higher fungal and lower acanthamoeba incidence. Common first and second-line antimicrobial selection provides, on the whole, good coverage. Nevertheless, anti-microbial resistance, to cephalosporins, was observed so selection should be carefully considered when treating MK empirically.
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Affiliation(s)
- Malik Moledina
- Department of Ophthalmology, Southend University Hospital, Southend, UK
| | - Harry W Roberts
- West of England Eye Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Achyut Mukherjee
- Department of Ophthalmology, Colchester General Hospital, Colchester, UK
| | - David Spokes
- Department of Ophthalmology Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Ramy Bassily
- Department of Ophthalmology, Ipswich Hospital, Ipswich, UK
| | - Madhavan S Rajan
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend, UK.
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
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Almulhim A, Alkhalifah MI, Kalantan H, Alsarhani WK. Bacterial Keratitis: Clinical Features, Causative Organisms, and Outcome During a 13-year Study Period. Cornea 2023; 42:702-707. [PMID: 36730384 DOI: 10.1097/ico.0000000000003179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to review clinical features, causative organisms, complications, and outcome of bacterial keratitis cases at a tertiary eye hospital. METHODS A retrospective study was conducted on clinically diagnosed bacterial keratitis cases from 2007 to 2019. Poor outcome was flagged if any of the following was identified: final visual acuity (VA) worse than 20/200, decrease in VA (1 line or worse compared with presenting VA), corneal perforation, endophthalmitis, failed graft, or cases requiring enucleation or evisceration. RESULTS The study included 263 cases of bacterial keratitis with 169 cases (64.3%) of culture-positive bacterial keratitis. Gram-positive bacteria were found to be the causative organism in 106 cases (62.8%). The most common types were coagulase-negative staphylococci (23.1%) and Pseudomonas (23.1%). Culture-positive bacterial keratitis was associated with the development of anterior chamber reaction (≥1+) on multivariate analysis [adjusted odds ratio (OR): 3.03, confidence interval (CI): 1.23-7.45, P = 0.016]. The complications that occurred in the current cohort included visually significant scar (64.7%), perforation (10.8%), cataract (8.8%), nonhealing epithelial defects (8.0%), corneal neovascularization (4.9%), endophthalmitis (4.6%), and hypotony (1.5%). On multivariate analysis, diabetes mellitus (adjusted OR: 3.51, CI: 1.59-7.76, P = 0.002), poor presenting best-corrected VA (adjusted OR: 3.95, CI 1.96-7.96, P < 0.001), and positive cultures (adjusted OR: 2.36, CI: 1.11-5.00, P = 0.025) were associated with poor outcome. CONCLUSIONS Culture-negative keratitis had less severe infection and better outcomes when compared to culture-positive bacterial keratitis. Factors associated with poor outcome included diabetes, poor presenting VA, and positive cultures.
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Affiliation(s)
- Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Muhannad I Alkhalifah
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hatem Kalantan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; and
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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11
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Tuft S, Evans J, Gordon I, Leck A, Stone N, Neal T, Macleod D, Kaye S, Burton MJ. Antimicrobial resistance in topical treatments for microbial keratitis: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e069338. [PMID: 36882242 PMCID: PMC10008341 DOI: 10.1136/bmjopen-2022-069338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION There is evidence for increased resistance against the antimicrobials used to treat keratitis. This review aims to provide global and regional prevalence estimates of antimicrobial resistance in corneal isolates and the range of minimum inhibitory concentrations (MIC) with their associated resistance breakpoints. METHODS AND ANALYSIS We report this protocol following Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. We will conduct an electronic bibliographic search in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Eligible studies will report in any language data for the resistance or MIC for antimicrobials against bacterial, fungal or amoebic organisms isolated from suspected microbial keratitis. Studies that only report on viral keratitis will not be included. There will be no time restrictions on the date of publication. Screening for eligible studies, assessment of risk of bias and data extraction will be conducted by two reviewers independently, using predefined inclusion criteria and prepiloted data extraction forms. We will resolve disagreements between the reviewers by discussion and, if required, a third (senior) reviewer will arbitrate. We will assess the risk of bias using a tool validated in prevalence studies. The certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. Pooled proportion estimates will be calculated using a random-effects model. Heterogeneity will be assessed using the I2 statistic. We will explore differences between Global Burden of Disease regions and temporal trends. ETHICS APPROVAL AND DISSEMINATION Ethics approval is not required as this is a protocol for a systematic review of published data. The findings of this review will be published in an open-access, peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023331126.
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Affiliation(s)
- Stephen Tuft
- Cornea and External Disease Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Jennifer Evans
- Faculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Iris Gordon
- Department of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Astrid Leck
- Department of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Neil Stone
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy Neal
- Department of Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - David Macleod
- Department of Medical Statistics, LSHTM, London, London, UK
| | - Stephen Kaye
- Department of Eye and Vision Science, University of Liverpool, Liverpool, Merseyside, UK
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12
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Wespiser S, Koestel E, Fabacher T, Sauer A, Bourcier T. Practice patterns in the management of bacterial keratitis: a five-continent survey. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-06003-6. [PMID: 36820985 DOI: 10.1007/s00417-023-06003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE To assess the current diagnostic and therapeutic practice patterns in early management of bacterial keratitis over five continents. METHODS Between March and August 2019, we distributed an online survey including two clinical scenarios of bacterial keratitis, namely, a mild case and severe case, to 2936 ophthalmologists from 144 countries around the world. The survey consisted of 29 questions. We performed descriptive statistics and a comparative analysis of the answers according to the participants' continent of practice, practice setting, seniority, and subspecialty. RESULTS We received 237 surveys from 54 countries (8% response rate). The proportion of respondents performing microbiological investigations was higher in North America, Asia, Europe, and Oceania than Africa and South America (p < 0.05). This ratio was also higher among ocular surface specialists than for other ophthalmologists (p < 0.001). For mild cases, fluoroquinolone monotherapy and a combination of two or more antibiotics were prescribed by 46% and 41% respondents, respectively. For severe cases, fluoroquinolone monotherapy and a combination of antibiotics were prescribed by 20% and 78% respondents, respectively. Fluoroquinolone monotherapy was the most commonly prescribed treatment in South America, Africa, and Oceania. A combination of two antibiotics was preferentially prescribed in the rest of the world. Topical steroids were prescribed in both circumstances, respectively, in 72% and 75% of cases. CONCLUSION Our results highlight essential geographical disparities in the current management of bacterial keratitis over five continents.
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Affiliation(s)
- Simon Wespiser
- Ophthalmology Department, NHC, Strasbourg University Hospital, FMTS, BP426, 67091, Strasbourg, France
| | - Emilia Koestel
- Ophthalmology Department, NHC, Strasbourg University Hospital, FMTS, BP426, 67091, Strasbourg, France.
| | - Thibaut Fabacher
- Public Health Department, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Arnaud Sauer
- Ophthalmology Department, NHC, Strasbourg University Hospital, FMTS, BP426, 67091, Strasbourg, France
| | | | - Tristan Bourcier
- Ophthalmology Department, NHC, Strasbourg University Hospital, FMTS, BP426, 67091, Strasbourg, France.,Gepromed, Strasbourg, France
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13
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Ting DSJ, Henein C, Bunce C, Qureshi R. Topical antibiotics for treating bacterial keratitis: a network meta‐analysis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9725178 DOI: 10.1002/14651858.cd015350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To compare the effectiveness and safety of topical antibiotics for treating BK and to rank different interventions through a systematic review and NMA.
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Affiliation(s)
| | - Darren SJ Ting
- Academic OphthalmologySchool of Medicine, University of NottinghamNottingham, NG7 2RDUK,Department of OphthalmologyQueen's Medical CentreNottinghamUK
| | - Christin Henein
- National Institute for Health Research Biomedical Research Centre for OphthalmologyMoorfields Eye Hospital and University College London Institute of OphthalmologyLondonUK
| | - Catey Bunce
- The Royal Marsden National Health Service Foundation TrustLondonUK
| | - Riaz Qureshi
- Department of OphthalmologyUniversity of Colorado Anschutz Medical CampusDenverColoradoUSA
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Gross AW, Fan JZ, Pfeiffer ML, Chuang AZ, Richani K, Crowell EL. Non-traumatic open globe injuries: presenting characteristics and visual outcomes. Eye (Lond) 2022; 36:2323-2327. [PMID: 34857923 PMCID: PMC9674630 DOI: 10.1038/s41433-021-01869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe clinical characteristics and visual outcomes of non-traumatic open globe injuries. SETTING A level 1 trauma centre in a large urban medical centre. DESIGN Retrospective study. METHODS Charts of non-traumatic open globe patients admitted to MHH-TMC from 1/2010 to 3/2015 were reviewed for demographics, cause, clinical characteristics, visual acuity (VA) and enucleation. RESULTS Thirty eyes were included: 15 (50%) were males with a mean age of 47 (±28) years. All presented with zone 1 injury. Twenty-five (83%) had a perforated corneal ulcer. Presenting VA was count fingers (n = 3, 10%) to NLP (n = 6, 20%). Twenty-four (80%) involved infection, 5 (17%) congenital, 3 (10%) chemical burn and 2 (7%) neurotrophic. Conjunctival injection (n = 22, 77%), corneal opacification (n = 20, 71%) and relative afferent pupillary defect (n = 9, 44%) were common. After treatment, 23 (88%) were worse than 6/60 (20/200), 9 (35%) were NLP and 8 (27%) required enucleation. CONCLUSIONS Often non-traumatic open globe injuries are zone 1 and due to perforated infectious ulcers. Compared to previously reported traumatic injuries, these have higher rates of enucleation (27% vs 8%) and poorer final VA (88% vs 68% worse than 6/60 20/200).
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Affiliation(s)
- Andrew W Gross
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - James Z Fan
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Margaret L Pfeiffer
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
| | - Alice Z Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Karina Richani
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
| | - Eric L Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Memorial Hermann-Texas Medical Center, Houston, TX, USA.
- Robert Cizik Eye Clinic, Houston, TX, USA.
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15
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Michaels L, Richardson J, Walkden A, Carley F. Impact of the COVID-19 Pandemic on the Incidence and Characteristics of Culture-Positive Microbial Keratitis at a Tertiary Eye Hospital in the UK. Clin Ophthalmol 2022; 16:2513-2519. [PMID: 35974905 PMCID: PMC9375992 DOI: 10.2147/opth.s373758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The COVID-19 pandemic has led to drastic changes to the daily lives of those living in the United Kingdom. We hypothesized that the effect of the imposed lockdown on both behaviour and social interaction has the potential to influence the characteristics of microbial keratitis presenting locally to Manchester Royal Eye Hospital — a major tertiary eye centre in the UK. Methods We conducted a retrospective case-note review of all positive corneal scrape cultures identified by our local microbiology laboratory during the year since the announcement of lockdown measures in the UK (23 March 2020 to 23 March 2021). Culture results were compared with previously collated, published “baseline” data from prior to the onset of the COVID-19 pandemic (2004–2019). Statistical analysis was undertaken, predominantly looking at the incidence of microbial keratitis and the variety of cultured pathogens. Results A total of 6243 corneal scrape results were reviewed. Comparison of data between the COVID-19 pandemic and subsequent lockdown did not show a significant change in the incidence of culture-positive microbial keratitis: mean annual positive samples during 2004–2019 were 128 (35%) vs 91 (29%) during lockdown (P=0.096). No statistically significant shifts in the incidence of organism subtypes — fungi, acanthamoeba, Gram-positive bacteria, or Gram negative bacteria — were identified (P=0.196, 1, 0.366, and 0.087, respectively). Conclusion Contrary to our hypothesis, our results suggest that the COVID-19 pandemic did not alter the incidence or characteristics of microbial keratitis presenting to Manchester Royal Eye Hospital in the year following the implementation of lockdown measures in the UK.
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Affiliation(s)
| | | | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester, UK
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Correspondence: Andrew Walkden, Manchester Royal Eye Hospital, Oxford Road, Manchester, Greater Manchester, M13 9WL, UK, Tel +44 161-276-1234, Email
| | - Fiona Carley
- Manchester Royal Eye Hospital, Manchester, UK
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Ferguson TJ, Downes RA, Isada CM, Goshe JM. High-Dose Oral Posaconazole for the Treatment of Recalcitrant Fungal Keratitis. Cornea 2022; 41:852-856. [PMID: 34469337 DOI: 10.1097/ico.0000000000002832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole. METHODS This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments. RESULTS All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces . The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist. CONCLUSIONS In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.
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Affiliation(s)
| | | | - Carlos M Isada
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH
| | - Jeff M Goshe
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH; and
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17
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Lorente Pascua J, García Bernal A, Garcia Sanchez E, Almeida González CV. Microorganisms and Antibiotic Resistance of Bacterial Keratitis at a Rural County Hospital in Seville. Eye Contact Lens 2022; 48:267-271. [PMID: 35333821 DOI: 10.1097/icl.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the incidence, resistance patterns, and management of bacterial keratitis during the past 4 years. METHODS We retrospectively reviewed the clinical records of microbiological isolates from patients with a clinical diagnosis of bacterial keratitis. RESULTS A total of 159 patients were analyzed, and 102 microorganisms were isolated from 129 cultures. In these cultures, 23.7% of the microorganisms were gram positive, 60.8% were gram negative, and 15.5% were fungi. Pseudomonas aeruginosa was the most common bacteria (9.2%), followed by Serratia marcescens (4.4%) and Staphylococcus aureus (4%). Resistance to fluoroquinolones and aminoglycosides was found to be 23.1% and 53.1% in gram-positive and 2.8% and 13.9% in gram-negative bacteria, respectively. Resistance to ceftazidime against gram-negative bacteria was 13.9%. No resistance to vancomycin was observed. CONCLUSIONS A high resistance rate to aminoglycosides and fluoroquinolones was observed in gram-positive bacteria. We concluded that fluoroquinolones or aminoglycosides may not be suitable for initial monotherapy in patients with severe bacterial keratitis.
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Affiliation(s)
- José Lorente Pascua
- Unidad de Gestión Clínica de Oftalmología Hospital Universitario Nuestra señora de Valme (J.L.B., A.G.B.), Seville, Spain; Unidad de Gestión Clínica de Microbiología Hospital Universitario Nuestra señora de Valme (E.G.S.), Seville, Spain; and Fundación Pública Andaluza para la Gestión de la Investigación en Salud en Sevilla (C.V.A.G.), Sede Hospital Universitario Nuestra señora de Valme, Seville, Spain
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18
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Pei Y, Chen X, Tan Y, Liu X, Duan F, Wu K. Microbiological Profiles of Ocular Fungal Infection at an Ophthalmic Referral Hospital in Southern China: A Ten-Year Retrospective Study. Infect Drug Resist 2022; 15:3267-3276. [PMID: 35769550 PMCID: PMC9234316 DOI: 10.2147/idr.s367083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Yinhui Pei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Xiaoling Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Yiwei Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Xiuping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Fang Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
- Fang Duan, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yan-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China, Email
| | - Kaili Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
- Correspondence: Kaili Wu, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yan-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China, Email
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Youssef AAA, Dudhipala N, Majumdar S. Dual Drug Loaded Lipid Nanocarrier Formulations for Topical Ocular Applications. Int J Nanomedicine 2022; 17:2283-2299. [PMID: 35611213 PMCID: PMC9124492 DOI: 10.2147/ijn.s360740] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/29/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction Untreated ocular infections can damage the unique fine structures of the eye with possible visual impairments and blindness. Ciprofloxacin (CIP) ophthalmic solution is prescribed as first-line therapy in ocular bacterial infections. Natamycin (NT) ophthalmic suspension is one of the progenitors in ocular antifungal therapy. Nanostructured lipid carriers (NLCs) have been widely examined for ocular penetration enhancement and distribution to deeper ocular tissues. The objective of the current study was to prepare NLCs loaded with a combination of CIP and NT (CIP-NT-NLCs) and embed them in an in-situ gelling system (CIP-NT-NLCs-IG). This novel formulation will target the co-delivery of CIP and NT for the treatment of mixed ocular infections or as empirical treatment in case of limited access to healthcare diagnostic services. Methods CIP-NT-NLC and CIP-NT-NLC-IG formulations were evaluated based on physicochemical characteristics, in vitro release, and ex vivo transcorneal permeation studies and compared against commercial CIP and NT ophthalmic eye drops. Results and Discussion NLCs formulation (0.1% CIP and 0.3% NT) showed particle size, polydispersity index, and zeta potential of 196.2 ± 1.2 nm, 0.43 ± 0.06, and −28.1 ± 1.4 mV, respectively. Moreover, CIP-NT-NLCs showed entrapment efficiency of 80.9 ± 2.9 and 98.7 ± 1.9% for CIP and NT, respectively. CIP-NT-NLCs-IGformulation with 0.2% w/v gellan gum demonstrated the most favorable viscoelastic characteristics for ocular application. CIP-NT-NLCs and CIP-NT-NLCs-IG formulations exhibited a sustained release pattern for both drugs over 24 h. Moreover, CIP-NT-NLCs and CIP-NT-NLC-IG formulations showed 4.0- and 2.2-folds, and 5.0- and 2.5-folds enhancement in ex vivo transcorneal permeability of CIP and NT, respectively, compared to the control formulations. Conclusion The results suggest that this dual nanoparticulate-based in-situ gelling drug delivery system can serve as a promising topical delivery platform for the treatment of ocular infections.
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Affiliation(s)
- Ahmed Adel Ali Youssef
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh, 33516, Egypt
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS, 38677, USA
| | - Narendar Dudhipala
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS, 38677, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS, 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS, 38677, USA
- Correspondence: Soumyajit Majumdar, Department of Pharmaceutics and Drug Delivery,School of Pharmacy, University of Mississippi, 113J TCRC West, Oxford, MS, 38677, USA, Tel +1 662 915-3793, Email
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SRINIVASAN MUTHIAH, RAVILLA THULASIRAJ, VIJAYAKUMAR VALAGURU, YESUNESAN DEVANESAM, MANI ISWARYA, WHITCHER JOHNP, OLDENBURG CATHERINEE, O'BRIEN KIERANS, LIETMAN THOMASM, KEENAN JEREMYD. Community Health Workers for Prevention of Corneal Ulcers in South India: A Cluster-Randomized Trial. Am J Ophthalmol 2022; 237:259-266. [PMID: 34942106 DOI: 10.1016/j.ajo.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine whether a community health worker (CHW) program increases referrals to local eye care providers and ultimately reduces the incidence of corneal ulcers. DESIGN Cluster-randomized trial performed from 2014 to 2017 in rural South India. METHODS This was a community-based study that included all inhabitants of 42 rural South Indian communities. CHWs were trained to diagnose corneal abrasions and assist participants in seeking care at a local vision center. Given the nature of the intervention, the trial was not masked. The main outcome measure was incident corneal ulcer, defined as an active infiltrate or evidence of a new opacity, as assessed by means of penlight examination during an annual door-to-door census. RESULTS Twenty-one study clusters were randomized to the CHW intervention and 21 to no intervention. Vision centers diagnosed 195 corneal abrasions from the intervention clusters during the 2-year study (rate, 223 per 100,000 person-years; 95% CI, 28-1743) and 62 from the control clusters (rate, 62 per 100,000 person-years; 95% CI, 8-496; incidence rate ratio, 3.57; 95% CI, 2.01-6.35; P < .001). The estimated incidence of corneal ulceration during the study period was 60 per 100,000 person-years (95% CI, 25-141) in the intervention group and 32 per 100,000 person-years (95% CI, 13-80) in the control group (incidence rate ratio, 1.86; 95% CI, 0.5-6.4; P = .32). CONCLUSIONS A CHW program resulted in 3.5 times more referrals to local eye care providers for corneal abrasions, but no difference could be detected in the incidence of corneal ulceration. CHW programs provide a mechanism for increasing referrals to eye hospitals. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02284698.
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Lian H, Fang X, Li Q, Liu S, Wei Q, Hua X, Li W, Liao C, Yuan X. NLRP3 Inflammasome-Mediated Pyroptosis Pathway Contributes to the Pathogenesis of Candida albicans Keratitis. Front Med (Lausanne) 2022; 9:845129. [PMID: 35463001 PMCID: PMC9020473 DOI: 10.3389/fmed.2022.845129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/03/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose Fungal keratitis is a sight-threatening corneal infection caused by fungal pathogens, and the pathogenic mechanisms have not been fully elucidated. The aim of this study was to determine whether NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome-mediated pyroptosis contributes to Candida albicans (C. albicans) keratitis and explore the underlying mechanism. Methods An in vivo mouse model of C. albicans keratitis and an in vitro culture model of human corneal epithelial cells (HCECs) challenged with heat-killed C. albicans (HKCA) were established in this study. The degree of corneal infection was evaluated by clinical scoring. Gene expression was assessed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis or immunofluorescence staining was performed to evaluate protein expression. TdT-mediated dUTP nick end labeling (TUNEL) staining was performed to examine the pyroptotic cell death. A lactate dehydrogenase (LDH) release assay was performed to assess cytotoxicity. Results Compared with the mock-infected group, we observed that the mRNA levels of NLRP3, caspase-1 (CASP1), interleukin (IL)−1β and gasdermin-D (GSDMD) in C. albicans-infected mice cornea was significantly increased. Our data also demonstrated that the protein expression of NLRP3 and the pyroptosis-related markers apoptosis-associated speck-like protein containing a CARD (ASC), cleaved CASP1, N-GSDMD, cleaved IL-1β and cleaved IL-18 as well as pyroptotic cell death were dramatically elevated in the mouse model of C. albicans keratitis. More importantly, NLRP3 knockdown markedly alleviated pyroptosis and consequently reduced corneal inflammatory reaction in C. albicans keratitis. In vitro, the presence of activated NLRP3 inflammasome and pyroptotic cell death were validated in HCECs exposed to HKCA. Furthermore, the potassium (K+) channel inhibitor glyburide decreased LDH release and suppressed NLRP3 inflammasome activation and pyroptosis in HCECs exposed to HKCA. Conclusion In conclusion, the current study revealed for the first time that NLRP3 inflammasome activation and pyroptosis occur in C. albicans-infected mouse corneas and HCECs. Moreover, NLRP3 inflammasome-mediated pyroptosis signaling is involved in the disease severity of C. albicans keratitis. Therefore, This NLRP3 inflammasome-dependent pathway may be an attractive target for the treatment of fungal keratitis.
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Affiliation(s)
- Huifang Lian
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China.,Department of Ophthalmology, Baoding First Central Hospital, Baoding, China.,State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - XiaoLong Fang
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China.,State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China.,The School of Medicine, Nankai University, Tianjin, China
| | - Qingyu Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
| | - Shuang Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qiuhong Wei
- Department of Ophthalmology, Baoding First Central Hospital, Baoding, China
| | - Xia Hua
- Aier Eye Hospital, Tianjin, China
| | - Wenguang Li
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Chunyang Liao
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Xiaoyong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China.,The School of Medicine, Nankai University, Tianjin, China
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22
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Evaluation of the different methods to detect Salmonella in poultry feces samples. Arch Microbiol 2022; 204:269. [PMID: 35441892 DOI: 10.1007/s00203-022-02840-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
Salmonella is one of the most common causes of foodborne outbreaks and infection worldwide. The gold-standard detection method of Salmonella is cultivation. There is a need to investigate rapid and accurate processes with time-consuming cultivation. The study evaluated different approaches to detect Salmonella in poultry feces samples. Poultry farm feces samples from 21 cities in Iran were collected from January 2016 to December 2019. Microbiological cultures, serological assays, and multiplex PCR (m-PCR) were used to detect and characterize Salmonella spp. isolates. Serological assays and m-PCR were used to determine the serogroups A, B, C1, C2, D1, E, H, and FliC. The m-PCR was used to detect seven Salmonella serovars, and a Chi-square test was performed to compare the discriminatory power of the methods. Of 2300 poultry feces samples, 173 (7.5%) and 166 (7.2%) samples were detected as Salmonella spp. by cultivation and m-PCR, respectively. The sensitivity of the molecular method was equal to cultivation at 0.96 (CI = 95%). Assessment of H antigenic subgroups showed the same for both m-PCR and serological tests. Therefore, the matching rate of the two methods for detecting all H antigenic subgroups was 100%. Thus, the relationship between the results obtained from both methods was significant in the contingency table test (P < 0.01). The PCR-based approach confirmed the detection of Salmonella in a shorter period (24-36 h) compared to the conventional microbiological approach (3-8 days).
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23
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Das S, D’Souza S, Gorimanipalli B, Shetty R, Ghosh A, Deshpande V. Ocular Surface Infection Mediated Molecular Stress Responses: A Review. Int J Mol Sci 2022; 23:ijms23063111. [PMID: 35328532 PMCID: PMC8952005 DOI: 10.3390/ijms23063111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Infection mediated ocular surface stress responses are activated as early defense mechanisms in response to host cell damage. Integrated stress responses initiate the host response to different types of infections and modulate the transcription of key genes and translation of proteins. The crosstalk between host and pathogen results in profound alterations in cellular and molecular homeostasis triggering specific stress responses in the infected tissues. The amplitude and variations of such responses are partly responsible for the disease severity and clinical sequelae. Understanding the etiology and pathogenesis of ocular infections is important for early diagnosis and effective treatment. This review considers the molecular status of infection mediated ocular surface stress responses which may shed light on the importance of the host stress-signaling pathways. In this review, we collated literature on the molecular studies of all ocular surface infections and summarize the results from such studies systematically. Identification of important mediators involved in the crosstalk between the stress response and activation of diverse signaling molecules in host ocular surface infection may provide novel molecular targets for maintaining the cellular homeostasis during infection. These targets can be then explored and validated for diagnostic and therapeutic purposes.
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Affiliation(s)
- Samayitree Das
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
| | - Sharon D’Souza
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Bhavya Gorimanipalli
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Rohit Shetty
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
- Correspondence: (A.G.); (V.D.)
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
- Correspondence: (A.G.); (V.D.)
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24
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Olivier R, Knoeri J, Leveziel L, Negrier P, Georgeon C, Kobal A, Bouheraoua N, Baudouin C, Nordmann J, Brignole‐Baudouin F, Merabet L, Borderie V. Update on fungal keratitis in France: a case-control study. Acta Ophthalmol 2022; 100:159-163. [PMID: 34031997 DOI: 10.1111/aos.14910] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To report an epidemiological update of documented fungal keratitis (FK) in a French tertiary ophthalmological centre from 2014 to 2018 in comparison with a previous period from 1993 to 2008. METHODS Sixty-two consecutive FK documented by microbiological corneal scrapings were compared with the 64 FK of the previous study. Amphotericin B and voriconazole eye drops were administered hourly. Population characteristics, clinical findings, aetiological organisms and treatments were analysed. RESULTS The most frequently identified fungi were Fusarium (61%), Aspergillus (6.5%) and Candida (5%). Thirty out of 44 cases examined with in vivo confocal microscopy (IVCM) presented filaments. Ten required conventional cross-linking, 9 therapeutic penetrating keratoplasty, and 2 enucleation. Risk factors significantly associated with the absence of response to medical treatment were patient age (p = 0.01), presence of a deep stromal infiltrate at presentation (p = 0.04) and high numbers of filaments in IVCM images (p = 0.01). The two populations were comparable in age, but not in sex ratio males/females (18/44 versus 37/26 in the previous study; p = 0.001). The frequency of contact lens-associated infection increased from 35.5% to 71% (p = 0.0001) between the two periods. Since then, filamentous FK increased from 69% (44/64) to 95% (59/62) (p = 0.0001). A history of keratoplasty was less frequently reported during the last period (3.2% (2/62) versus 17% (11/64) of cases (p = 0.01)). A clear decrease in the frequency of therapeutic keratoplasty was noted from 39% (25/64) to 14% (9/62) (p = 0.02). CONCLUSION The frequency of filamentous keratomycosis is currently increasing. Elderly patients and the presence of numerous filaments in IVCM are associated with poor clinical outcomes.
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Affiliation(s)
- Roxane Olivier
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
- Faculté de médecine Hyacinthe Bastaraud Pointe‐à‐Pitre France
| | - Juliette Knoeri
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Loïc Leveziel
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Pierre Negrier
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Cristina Georgeon
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Alfred Kobal
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Nacim Bouheraoua
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
- Sorbonne Université UM80 INSERM UMR 968 CNRS UMR 7210 Institut de la Vision IHU ForeSight Paris France
| | - Christophe Baudouin
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
- Sorbonne Université UM80 INSERM UMR 968 CNRS UMR 7210 Institut de la Vision IHU ForeSight Paris France
| | - Jean‐Philippe Nordmann
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Françoise Brignole‐Baudouin
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
- Sorbonne Université UM80 INSERM UMR 968 CNRS UMR 7210 Institut de la Vision IHU ForeSight Paris France
| | - Lilia Merabet
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
| | - Vincent Borderie
- GRC32 Sorbonne Université Centre Hospitalier National d'Ophtalmologie des Quinze‐Vingts Paris France
- Sorbonne Université UM80 INSERM UMR 968 CNRS UMR 7210 Institut de la Vision IHU ForeSight Paris France
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25
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Menard M, Shah YS, Stroh IG, Zafar S, Sriparna M, Zhang N, Agarwal AA, Shekhawat N, Srikumaran D, Woreta F. Microbial Profile and Clinical Outcomes of Fungal Keratitis at a Single-Center Tertiary Care Hospital. Clin Ophthalmol 2022; 16:389-399. [PMID: 35177897 PMCID: PMC8846617 DOI: 10.2147/opth.s346227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate baseline characteristics, microbiological spectrum, management, and outcomes of patients with culture-proven fungal keratitis. METHODS Retrospective review of all patients with culture-proven fungal keratitis seen over 6 years at a tertiary referral center. RESULTS The present study included 62 eyes from 62 patients. Infection with filamentous organisms was more common than with yeast (66.1% vs 27.4%). The most common filamentous organisms were Fusarium (17.7%) and Aspergillus (16.1%), while the most common yeast was Candida (24.2%). The main predisposing factor for filamentous keratitis was contact lens use. Yeast keratitis is most associated with an immunocompromised host and ocular surface disease. Corneal perforation (20.0%) and surgical interventions (46.8%) were common, with 27.4% of eyes requiring at least one penetrating keratoplasty. Filamentous keratitis is more likely than yeast keratitis to require urgent penetrating keratoplasty or enucleation and to receive more than one topical and systemic antifungal agent. Visual outcomes were poor with nearly half of the eyes remaining at 20/200 or worse upon resolution of infection. Worse visual outcomes were associated with poor vision at presentation and a history of ocular surface disease. Antifungal susceptibility testing was not routinely performed, but it demonstrated a relatively high minimum inhibitory concentration for at least one antifungal drug in 90% of cases when performed (16.1%) and guided the direction of treatment for 80% of the cases. CONCLUSION Fungal keratitis is visually devastating. Infections with filamentous fungi predominated over yeast and were generally treated more aggressively both medically and surgically. Filamentous and yeast keratitis had similar durations of infections and visual outcomes. Antifungal susceptibility testing influenced treatment in 80% of cases in which it was performed.
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Affiliation(s)
| | - Yesha S Shah
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Inna G Stroh
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manjari Sriparna
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Zhang
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ank A Agarwal
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nakul Shekhawat
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika Woreta
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Correspondence: Fasika Woreta, Division of Cornea and External Disease, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Wilmer B20, Baltimore, MD, 21287, USA, Tel +410 955-5650, Email
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26
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Sharma R, Chopra A, Solanki S, Gupta R. Microbial profile of infectious corneal ulcer in a remote Himalayan teaching hospital in Himachal Pradesh (India). JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2022. [DOI: 10.4103/jcor.jcor_174_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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27
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Tuft S, Somerville TF, Li JPO, Neal T, De S, Horsburgh MJ, Fothergill JL, Foulkes D, Kaye S. Bacterial keratitis: identifying the areas of clinical uncertainty. Prog Retin Eye Res 2021; 89:101031. [PMID: 34915112 DOI: 10.1016/j.preteyeres.2021.101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis is a common corneal infection that is treated with topical antimicrobials. By the time of presentation there may already be severe visual loss from corneal ulceration and opacity, which may persist despite treatment. There are significant differences in the associated risk factors and the bacterial isolates between high income and low- or middle-income countries, so that general management guidelines may not be appropriate. Although the diagnosis of bacterial keratitis may seem intuitive there are multiple uncertainties about the criteria that are used, which impacts the interpretation of investigations and recruitment to clinical studies. Importantly, the concept that bacterial keratitis can only be confirmed by culture ignores the approximately 50% of cases clinically consistent with bacterial keratitis in which investigations are negative. The aetiology of these culture-negative cases is unknown. Currently, the estimation of bacterial susceptibility to antimicrobials is based on data from systemic administration and achievable serum or tissue concentrations, rather than relevant corneal concentrations and biological activity in the cornea. The provision to the clinician of minimum inhibitory concentrations of the antimicrobials for the isolated bacteria would be an important step forward. An increase in the prevalence of antimicrobial resistance is a concern, but the effect this has on disease outcomes is yet unclear. Virulence factors are not routinely assessed although they may affect the pathogenicity of bacteria within species and affect outcomes. New technologies have been developed to detect and kill bacteria, and their application to bacterial keratitis is discussed. In this review we present the multiple areas of clinical uncertainty that hamper research and the clinical management of bacterial keratitis, and we address some of the assumptions and dogma that have become established in the literature.
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Affiliation(s)
- Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Tobi F Somerville
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Timothy Neal
- Department of Clinical Microbiology, Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - Surjo De
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
| | - Malcolm J Horsburgh
- Department of Infection and Microbiomes, University of Liverpool, Crown Street, Liverpool, L69 7BX, UK.
| | - Joanne L Fothergill
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Daniel Foulkes
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Stephen Kaye
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
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28
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Verma S, Singh A, Varshney A, Chandru RA, Acharya M, Rajput J, Sangwan VS, Tiwari AK, Bhowmick T, Tiwari A. Infectious Keratitis: An Update on Role of Epigenetics. Front Immunol 2021; 12:765890. [PMID: 34917084 PMCID: PMC8669721 DOI: 10.3389/fimmu.2021.765890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
Epigenetic mechanisms modulate gene expression and function without altering the base sequence of DNA. These reversible, heritable, and environment-influenced mechanisms generate various cell types during development and orchestrate the cellular responses to external stimuli by regulating the expression of genome. Also, the epigenetic modifications influence common pathological and physiological responses including inflammation, ischemia, neoplasia, aging and neurodegeneration etc. In recent past, the field of epigenetics has gained momentum and become an increasingly important area of biomedical research As far as eye is concerned, epigenetic mechanisms may play an important role in many complex diseases such as corneal dystrophy, cataract, glaucoma, diabetic retinopathy, ocular neoplasia, uveitis, and age-related macular degeneration. Focusing on the epigenetic mechanisms in ocular diseases may provide new understanding and insights into the pathogenesis of complex eye diseases and thus can aid in the development of novel treatments for these diseases. In the present review, we summarize the clinical perspective of infectious keratitis, role of epigenetics in infectious keratitis, therapeutic potential of epigenetic modifiers and the future perspective.
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Affiliation(s)
- Sudhir Verma
- Department of Zoology, Deen Dayal Upadhyaya College (University of Delhi), New Delhi, India
| | - Aastha Singh
- Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Akhil Varshney
- Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - R Arun Chandru
- Pandorum Technologies Ltd., Bangalore Bioinnovation Centre, Bangalore, India
| | - Manisha Acharya
- Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Jyoti Rajput
- Pandorum Technologies Ltd., Bangalore Bioinnovation Centre, Bangalore, India
| | | | - Amit K Tiwari
- Department of Pharmacology and Experimental Therapeutics, The University of Toledo, Toledo, OH, United States
| | - Tuhin Bhowmick
- Pandorum Technologies Ltd., Bangalore Bioinnovation Centre, Bangalore, India
| | - Anil Tiwari
- Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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29
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Wespiser S, Fabacher T, Gomart G, Sauer A, Bourcier T. Practice patterns in the management of fungal and acanthamoeba keratitis: a five-continent survey. Acta Ophthalmol 2021; 99:e1250-e1251. [PMID: 34096156 DOI: 10.1111/aos.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Simon Wespiser
- Ophthalmology Department Strasbourg University Hospital FMTS Strasbourg France
| | - Thibaut Fabacher
- Public Health Department Strasbourg University Hospital FMTS Strasbourg France
| | - Gabrielle Gomart
- Ophthalmology Department Strasbourg University Hospital FMTS Strasbourg France
| | - Arnaud Sauer
- Ophthalmology Department Strasbourg University Hospital FMTS Strasbourg France
| | - Tristan Bourcier
- Ophthalmology Department Strasbourg University Hospital FMTS Strasbourg France
- EA7290 University of Strasbourg Strasbourg France
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30
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Ting DSJ, Li J, Verma CS, Goh ETL, Nubile M, Mastropasqua L, Said DG, Beuerman RW, Lakshminarayanan R, Mohammed I, Dua HS. Evaluation of Host Defense Peptide (CaD23)-Antibiotic Interaction and Mechanism of Action: Insights From Experimental and Molecular Dynamics Simulations Studies. Front Pharmacol 2021; 12:731499. [PMID: 34690770 PMCID: PMC8528955 DOI: 10.3389/fphar.2021.731499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Aim: Host defense peptides (HDPs) have the potential to provide a novel solution to antimicrobial resistance (AMR) in view of their unique and broad-spectrum antimicrobial activities. We had recently developed a novel hybrid HDP based on LL-37 and human beta-defensin-2, named CaD23, which was shown to exhibit good in vivo antimicrobial efficacy against Staphylococcus aureus in a bacterial keratitis murine model. This study aimed to examine the potential CaD23-antibiotic synergism and the secondary structure and underlying mechanism of action of CaD23. Methods: Peptide-antibiotic interaction was evaluated against S. aureus, methicillin-resistant S. aureus (MRSA), and Pseudomonas aeruginosa using established checkerboard and time-kill assays. Fractional inhibitory concentration index (FICI) was calculated and interpreted as synergistic (FIC<0.5), additive (FIC between 0.5-1.0), indifferent (FIC between >1.0 and ≤4), or antagonistic (FIC>4). SYTOX green uptake assay was performed to determine the membrane-permeabilising action of CaD23. Molecular dynamics (MD) simulations were performed to evaluate the interaction of CaD23 with bacterial and mammalian mimetic membranes. Circular dichroism (CD) spectroscopy was also performed to examine the secondary structures of CaD23. Results: CaD23-amikacin and CaD23-levofloxacin combination treatment exhibited a strong additive effect against S. aureus SH1000 (FICI = 0.60-0.69) and MRSA43300 (FICI = 0.56-0.60) but an indifferent effect against P. aeruginosa (FIC = 1.03-1.15). CaD23 (at 25 μg/ml; 2xMIC) completely killed S. aureus within 30 min. When used at sub-MIC concentration (3.1 μg/ml; 0.25xMIC), it was able to expedite the antimicrobial action of amikacin against S. aureus by 50%. The rapid antimicrobial action of CaD23 was attributed to the underlying membrane-permeabilising mechanism of action, evidenced by the SYTOX green uptake assay and MD simulations studies. MD simulations revealed that cationicity, alpha-helicity, amphiphilicity and hydrophobicity (related to the Trp residue at C-terminal) play important roles in the antimicrobial action of CaD23. The secondary structures of CaD23 observed in MD simulations were validated by CD spectroscopy. Conclusion: CaD23 is a novel alpha-helical, membrane-active synthetic HDP that can enhance and expedite the antimicrobial action of antibiotics against Gram-positive bacteria when used in combination. MD simulations serves as a powerful tool in revealing the peptide secondary structure, dissecting the mechanism of action, and guiding the design and optimisation of HDPs.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom.,Anti-Infectives Research Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Jianguo Li
- Anti-Infectives Research Group, Singapore Eye Research Institute, Singapore, Singapore.,Bioinformatics Institute (AStar), Singapore, Singapore
| | - Chandra S Verma
- Bioinformatics Institute (AStar), Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Eunice T L Goh
- Anti-Infectives Research Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Mario Nubile
- Ophthalmic Clinic, University "G d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | | | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Roger W Beuerman
- Anti-Infectives Research Group, Singapore Eye Research Institute, Singapore, Singapore
| | | | - Imran Mohammed
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
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Halim I, Singh P, Sarfraz A, Kokkayil P, Pati BK, Thakuria B, Raj A. Fungal Keratitis Due to Fusarium lichenicola: A Case Report and Global Review of Fusarium lichenicola Keratitis. J Fungi (Basel) 2021; 7:jof7110889. [PMID: 34829178 PMCID: PMC8620856 DOI: 10.3390/jof7110889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Fusarium species are among the most commonly isolated causes of fungal keratitis. Most species of the genus Fusarium belong to Fusarium solani species complex (FSSC). Fusarium lichenicola, a member of the FSSC complex, is a well-established plant and human pathogen. However, reports of fungal keratitis due to Fusarium lichenicola have not been frequently reported. To the best of our knowledge, only twelve cases of Fusarium lichenicola keratitis have been reported in the past fifty years. Clinical cases of Fusarium lichenicola may have most likely been misidentified because of the lack of clinical and microbiological suspicion, as well as inadequate diagnostic facilities in many tropical countries where the burden of the disease may be the highest. We report a case of fungal keratitis caused by Fusarium lichenicola and present a global review of the literature of all cases of fungal keratitis caused by this potentially blinding fungus.
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Affiliation(s)
- Isra Halim
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (I.H.); (P.K.); (B.K.P.); (B.T.)
| | - Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (P.S.); (A.R.)
| | - Asim Sarfraz
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (I.H.); (P.K.); (B.K.P.); (B.T.)
- Correspondence: ; Tel.: +91-995-5360-903
| | - Prathyusha Kokkayil
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (I.H.); (P.K.); (B.K.P.); (B.T.)
| | - Binod Kumar Pati
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (I.H.); (P.K.); (B.K.P.); (B.T.)
| | - Bhaskar Thakuria
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (I.H.); (P.K.); (B.K.P.); (B.T.)
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna 801507, India; (P.S.); (A.R.)
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Palioura S, Tsiampali C, Dubovy SR, Yoo SH. Endothelial Biopsy for the Diagnosis and Management of Culture-Negative Retrocorneal Fungal Keratitis With the Assistance of Optical Coherence Tomography Imaging. Cornea 2021; 40:1193-1196. [PMID: 33332896 PMCID: PMC8206233 DOI: 10.1097/ico.0000000000002626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of a culture-negative deep fungal corneal infection that was diagnosed after histopathology of an anterior segment optical coherence tomography-guided endothelial biopsy. METHODS A 22-year-old woman with history of contact lens wear and concomitant topical steroid use presented with a mid-stromal corneal infiltrate that failed to respond to oral acyclovir and topical fortified antibiotics. Although cornea stains, cultures, and confocal microscopy showed negative results, there was high clinical suspicion for fungal keratitis. After 2 months on topical natamycin, oral voriconazole, and serial intrastromal and intracameral voriconazole injections, the infiltrate enlarged and deepened. Imaging with anterior segment optical coherence tomography revealed that the infection had progressed to an endothelial plaque. RESULTS Diagnostic endothelial biopsy was performed in the operating room. Cultures showed again negative results, whereas histopathology of the removed specimen revealed fungal elements. The postoperative edema at the site of the biopsy resolved over the course of 4 weeks, and a posterior stromal scar formed. Serial intrastromal and intracameral voriconazole injections were continued for the first postoperative month. At the 1-year and the 3-year follow-up examinations, the patient's vision was 20/20 without recurrence. CONCLUSIONS Intraoperative scraping of the endothelial plaque and histopathologic evaluation of the specimen proved to be of utmost importance for definitive diagnosis and resolution of the culture-negative deep fungal infection in this case. This young patient's cornea was retained and vision remains excellent.
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Affiliation(s)
- Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Athens Vision Eye Institute, Cornea Service, Athens, Greece
| | - Chara Tsiampali
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sander R. Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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33
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Ting DSJ, Cairns J, Gopal BP, Ho CS, Krstic L, Elsahn A, Lister M, Said DG, Dua HS. Risk Factors, Clinical Outcomes, and Prognostic Factors of Bacterial Keratitis: The Nottingham Infectious Keratitis Study. Front Med (Lausanne) 2021; 8:715118. [PMID: 34458289 PMCID: PMC8385317 DOI: 10.3389/fmed.2021.715118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 01/20/2023] Open
Abstract
Background/Aim: To examine the risk factors, clinical characteristics, outcomes, and prognostic factors of bacterial keratitis (BK) in Nottingham, UK. Methods: This was a retrospective study of patients who presented to the Queen's Medical Centre, Nottingham, with suspected BK during 2015–2019. Relevant data, including the demographic factors, risk factors, clinical outcomes, and potential prognostic factors, were analysed. Results: A total of 283 patients (n = 283 eyes) were included; mean age was 54.4 ± 21.0 years and 50.9% were male. Of 283 cases, 128 (45.2%) cases were culture-positive. Relevant risk factors were identified in 96.5% patients, with ocular surface diseases (47.3%), contact lens wear (35.3%) and systemic immunosuppression (18.4%) being the most common factors. Contact lens wear was most commonly associated with P. aeruginosa whereas Staphylococci spp. were most commonly implicated in non-contact lens-related BK cases (p = 0.017). At presentation, culture-positive cases were associated with older age, worse presenting corrected-distance-visual-acuity (CDVA), use of topical corticosteroids, larger epithelial defect and infiltrate, central location and hypopyon (all p < 0.01), when compared to culture-negative cases. Hospitalisation was required in 57.2% patients, with a mean length of stay of 8.0 ± 8.3 days. Surgical intervention was required in 16.3% patients. Significant complications such as threatened/actual corneal perforation (8.8%), loss of perception of light vision (3.9%), and evisceration/enucleation (1.4%) were noted. Poor visual outcome (final corrected-distance-visual-acuity of <0.6 logMAR) and delayed corneal healing (>30 days from initial presentation) were significantly affected by age >50 years, infiltrate size >3 mm, and reduced presenting vision (all p < 0.05). Conclusion: BK represents a significant ocular morbidity in the UK, with ocular surface diseases, contact lens wear, and systemic immunosuppression being the main risk factors. Older age, large infiltrate, and poor presenting vision were predictive of poor visual outcome and delayed corneal healing, highlighting the importance of prevention and early intervention for BK.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jessica Cairns
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Bhavesh P Gopal
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Charlotte Shan Ho
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Lazar Krstic
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Ahmad Elsahn
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Michelle Lister
- Department of Microbiology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom.,Research Institute of Ophthalmology, Cairo, Egypt
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
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Chandra V, Chan E, Cabrera-Aguas M, Bloch A, Waters MJ, Daniell M, Watson SL. Organisms causing microbial keratitis and antibiotic resistance patterns in Australia. Clin Exp Ophthalmol 2021; 49:1111-1113. [PMID: 34427382 DOI: 10.1111/ceo.13988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/25/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Varun Chandra
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Elsie Chan
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Maria Cabrera-Aguas
- Cornea Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Aaron Bloch
- Department of Microbiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Mary J Waters
- Department of Microbiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Mark Daniell
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Stephanie L Watson
- Cornea Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
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Ueda K, Iwasaki T, Ono T, Lee J, Nejima R, Mori Y, Noguchi Y, Yagi A, Miyata K. Age factor in the fluoroquinolone susceptibility of gram-positive cocci isolates from bacterial keratitis cases between 2008 and 2016. Graefes Arch Clin Exp Ophthalmol 2021; 259:3351-3357. [PMID: 34379184 DOI: 10.1007/s00417-021-05351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the relationship between fluoroquinolone susceptibility of gram-positive cocci (GPC) isolated from patients with bacterial keratitis and the age of the patients or the date of onset. METHODS Bacterial isolates were obtained from corneal lesions of patients with infectious keratitis treated between January 2008 and December 2016. The fluoroquinolone susceptibility of GPC was assessed, and a retrospective review of microbiological records was performed. Fluoroquinolone susceptibility was measured through broth microdilution in accordance with protocols of the Clinical and Laboratory Standards Institute. Statistical analysis was performed using a generalized estimating equation and cubic spline to determine the association between fluoroquinolone susceptibility of GPC isolated from corneal lesions and patient age. RESULTS Of the 1200 bacterial isolates, 471 GPC were identified. They included Staphylococcus epidermidis (45.6%), other coagulase-negative Staphylococcus sp. (17.8%), and Staphylococcus aureus (18.3%). Levofloxacin susceptibility of GPC exhibited a negative relationship with age and had an odds ratio of 0.893 (95% confidence interval, 0.825-0.967) for every 10 years of age. A non-adjusted cubic spline curve was well correlated with year-adjusted data in a generalized additive model, and the levofloxacin susceptibility of GPC was initially stable but gradually declined after 40 years of age, before re-stabilizing again after 70 years of age. CONCLUSION The fluoroquinolone susceptibility of GPC isolated from corneal lesions of infectious keratitis is high in children under 15 years of age and declines with an increase in age of patients using a generalized estimating equation and cubic spline.
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Affiliation(s)
- Koji Ueda
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan.,Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takuya Iwasaki
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Takashi Ono
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan. .,Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Jinhee Lee
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Ryohei Nejima
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Yosai Mori
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Yukari Noguchi
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Akiko Yagi
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Kazunori Miyata
- Miyata Eye Hospital, Kurahara 6-3, Miyakonojo, Miyazaki, 885-0051, Japan
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González-Dibildox LA, Oyervidez-Alvarado JA, Vazquez-Romo KA, Ramos-Betancourt N, Hernandez-Quintela E, Beltran F, Garza-Leon M. Polymicrobial Keratitis: Risk Factors, Clinical Characteristics, Bacterial Profile, and Antimicrobial Resistance. Eye Contact Lens 2021; 47:465-470. [PMID: 33625061 DOI: 10.1097/icl.0000000000000777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe clinical characteristics, complications, and the most prevalent microorganisms causing polymicrobial keratitis and their antibiotic sensitivities. METHODS A cross-sectional study including a consecutive analysis of patient's records with a diagnosis of bacterial keratitis with a positive culture and antibiogram report were included. Patients were grouped into those having monomicrobial and polymicrobial infection. Features studied included demographic and clinical characteristics, risk factors, Gram stain, cultures, and antibiotic sensitivity. RESULTS We included 656 patients; in 31.5% more than one microorganism was found. Seven hundred and twenty-three gram-positive bacteria were isolated, and 336 (46.5%) had polymicrobial keratitis. One hundred sixty-one gram-negative bacteria were isolated, and 99 (61.5%) from polymicrobial keratitis. Fourteen (0.60%) patients presented ring infiltrate, and 10 (71.42%) of those patients had polymicrobial keratitis (X2 10.654, P=0.001). Multivariate analysis showed that patients with history of contact lens use (odds ratio [OR] of 1.78, P=0.042), coexistent autoimmune disease (OR 4.64, P=0.03), irregular edges of the infiltrate (OR 2.06, P=0.005), and ring infiltrate (OR 6.034, P=0.005) have a higher risk for developing polymicrobial infection. In the polymicrobial group, gram-positive and gram-negative organisms showed a high sensitivity to Netilmicin. CONCLUSIONS We found a high incidence of polymicrobial keratitis. Our results suggest that it should be suspected in patients with a history of contact lens use, coexistent autoimmune disease, infiltrates with indistinct edges, and ring infiltrates. Sensitivities to moxifloxacin are lower than those reported in previous studies, but sensitivity to Netilmicin is higher.
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Affiliation(s)
- Laura A González-Dibildox
- Cornea and Refractive Surgery Department (L.A.G.-D., J.A.O.-A., K.A.V.-R., N.R.-B., E.H.-Q., F.B.), Asociación para Evitar La Ceguera en México IAP, Hospital Dr. Luis Sánchez Bulnes, Mexico City, Mexico; and Clinical Science Department (M.G.-L.), Science of Health Division, University of Monterrey, Monterrey, México
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Efficacy of Voriconazole Corneal Intrastromal Injection for the Treatment of Fungal Keratitis. J Ophthalmol 2021; 2021:5597003. [PMID: 34373790 PMCID: PMC8349281 DOI: 10.1155/2021/5597003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/14/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate efficacy and safety of novel tricyclic corneal stroma injection (TCSI) voriconazole for the treatment of fungal keratitis. Methods This retrospective cohort study included data of 57 patients (57 eyes) with fungal keratitis. The TCSI group consisted of 27 patients (27 eyes) who were injected voriconazole once via TCSI procedure within one week after enrollment, in addition to conventional antifungal treatment. The control group consisted of 30 patients (30 eyes) who were treated using conventional antifungal treatment modalities. The outcome measures consist of the 3-week and 3-month best-corrected visual acuity (BCVA) values and size of infiltrate or scar, time to re-epithelialization, corneal perforation rate and/or therapeutic penetrating keratoplasty (TPK) requirement, the preoperative and post-TCSI corneal endothelial cell density (ECD), and the intraocular pressure (IOP) of the treated eye and the respective contralateral eye. Results There were no significant differences in the baseline demographic and clinical characteristics between the two groups. 3 weeks and 3 months after enrollment, the TCSI group exhibited an increase in visual acuity (P < 0.05), and there was no significant difference in the size of infiltrate or scar between two groups (P > 0.05). Time to re-epithelialization was shorter in the TCSI group than in the control group (P < 0.05). There was no statistically significant difference between corneal ECD on the day before and 7 days after TCSI and the IOP of treated and contralateral healthy eyes on the day before and 1 day, 3 days, 7 days, and 1 month after TCSI (P > 0.05). The difference in the risk of perforation and/or TPK requirement was not statistically significant between two groups (P > 0.05). Conclusion Localized injection of voriconazole using TCSI may be a minimally invasive, safe, and effective adjuvant treatment modality for fungal keratitis.
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Abdelghany AA, D’Oria F, Alio Del Barrio J, Alio JL. The Value of Anterior Segment Optical Coherence Tomography in Different Types of Corneal Infections: An Update. J Clin Med 2021; 10:jcm10132841. [PMID: 34199039 PMCID: PMC8267702 DOI: 10.3390/jcm10132841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/03/2021] [Accepted: 06/26/2021] [Indexed: 11/06/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) is a modality that uses low-coherence interferometry to visualize and assess anterior segment ocular features, offering several advantages of being a sterile and noncontact modality that generates high-resolution cross-sectional images of the tissues. The qualitative and quantitative information provided by AS-OCT may be extremely useful for the clinician in the assessment of a wide spectrum of corneal infections, guiding in the management and follow-up of these patients. In clinical practice, infections are routinely evaluated with slit-lamp biomicroscopy, an examination and imaging modality that is limited by the physical characteristics of light. As a consequence, the depth of pathology and the eventually associated corneal edema cannot be accurately measured with the slit-lamp. Therefore, it represents a limit for the clinician, as in vivo information about corneal diseases and the response to treatment is limited. Resolution of corneal infection is characterized by an early reduction in corneal edema, followed by a later reduction in infiltration: both parameters can be routinely measured with standardized serial images by AS-OCT.
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Affiliation(s)
- Ahmed A. Abdelghany
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia 61519, Egypt;
| | - Francesco D’Oria
- Section of Ophthalmology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70124 Bari, Italy;
| | | | - Jorge L. Alio
- Vissum Miranza, Miguel Hernandez University, c/Cabañal, 1, 03016 Alicante, Spain;
- Correspondence:
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Russello G, Moramarco A, Vizzini L, Farina C, Fontana L, Carretto E. Diagnostic approach and epidemiology of Microbial Keratitis: findings from an Italian Tertiary Care center. Diagn Microbiol Infect Dis 2021; 101:115470. [PMID: 34352436 DOI: 10.1016/j.diagmicrobio.2021.115470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
Rapid identification of causative microorganisms of microbial keratitis (MK) and knowledge of the most common local pathogens are prerequisites for rational antimicrobial therapy. We retrospectively reviewed the characteristics of MK diagnosed at the IRCCS Arcispedale Santa Maria Nuova of Reggio Emilia (Italy) in a 5-years period, where the Ophthalmologist Unit is a reference center for corneal infections. During the study period, 183 MK were evaluated through corneal scrapings cultures. The positivity rate was 54,1%. A total of 107 microorganisms have been isolated: Acanthamoeba species was the etiologic agent in 19 cases. Pseudomonas aeruginosa and Staphylococcus aureus were more frequently isolated in bacterial keratitis, while Fusarium spp., Candida albicans, and Alternaria alternata were predominant among the fungal isolates. Strict cooperation between ophthalmologists and clinical microbiologists is advisable to allow the best diagnostic approach for MK.
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Affiliation(s)
- Giuseppe Russello
- Clinical Microbiology Laboratory, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Loredana Vizzini
- Clinical Microbiology Laboratory, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Claudio Farina
- Clinical Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Edoardo Carretto
- Clinical Microbiology Laboratory, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy.
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Hazarika M, Prajna NV, Senthilkumari S. Drug reservoir function of voriconazole impregnated human amniotic membrane: An in vitro study. Indian J Ophthalmol 2021; 69:1068-1072. [PMID: 33913834 PMCID: PMC8186651 DOI: 10.4103/ijo.ijo_2649_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Earlier our group has demonstrated the drug reservoir function of the human amniotic membrane (HAM) using stable moxifloxacin and fortified cefazolin ophthalmic formulations and found it as a suitable tool to deliver drugs for an extended duration. The purpose of this study was to evaluate the extended-release kinetics of voriconazole from the impregnated human amniotic membrane (HAM) in vitro. Methods: HAM buttons were incubated with freshly prepared 1% topical ophthalmic formulation of voriconazole for 5 different exposure time to investigate the ideal exposure time for the extended-release of voriconazole from HAM. The drug release kinetics was studied in simulated tear fluid for 5 weeks and the amount of voriconazole released at different intervals was estimated using high-performance liquid chromatography (HPLC) with photodiode array (PDA) detector. Results: There was a marginal increase in drug entrapment efficiency with increased drug exposure time but neither the drug entrapment nor the drug release was found to be statistically significant (P ≥ 0.5). Voriconazole was detectable even at 5 weeks. Conclusion: A sustained release of voriconazole was achieved up to 5 weeks, when voriconazole was incubated with amniotic membrane for all the studied drug soaking times. Thus, voriconazole impregnated amniotic membrane can be considered for the sustained delivery for its in fungal keratitis.
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Affiliation(s)
- Manali Hazarika
- Department of Cornea and Refractive Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Srinivasan Senthilkumari
- Department of Ocular Pharmacology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
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Tananuvat N, Upaphong P, Tangmonkongvoragul C, Niparugs M, Chaidaroon W, Pongpom M. Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes. J Infect 2021; 83:112-118. [PMID: 34038772 DOI: 10.1016/j.jinf.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate etiology and prognostic factors for treatment outcomes of fungal keratitis (FK). METHODS Culture-positive FK patients between 2012 and 2017 were reviewed. Treatment outcomes were categorized into success (resolved within two weeks), slow response and medication failure (no improvement or required surgery). Etiology and risk factors for poor treatment outcomes were analyzed. RESULTS A total of 113 eyes of 113 patients (77% males) were recruited. Ocular trauma (69.0%) was the most common predisposing factor. Of this, 80% were exposed to organic foreign bodies. The most common pathogen was Fusarium spp. (45.2%), while dematiaceous fungi were discovered in 29.6%. Medical treatment was successful in 24.8% of eyes, while 29.2% had a slow response and 42.5% failed medication. Therapeutic keratoplasty was performed in 22.1% of eyes and 11.5% eventually required eye removal. Significant risk factors for medication failure were advanced age (P = 0.005), delayed antifungal treatment (P = 0.038) and large-size lesion (P = 0.003). CONCLUSIONS Ocular trauma was the major predisposing factor of FK in the Northern Thailand. Fusarium was the most common identified pathogen. Many cases were refractory to medications and required surgical intervention. Aging, delayed treatment and a large lesion were predictors for poor outcomes.
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Affiliation(s)
- Napaporn Tananuvat
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Phit Upaphong
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Muanploy Niparugs
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Winai Chaidaroon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Monsicha Pongpom
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Ren Z, Liu Q, Li W, Wu X, Dong Y, Huang Y. Profiling of Diagnostic Information of and Latent Susceptibility to Bacterial Keratitis From the Perspective of Ocular Bacterial Microbiota. Front Cell Infect Microbiol 2021; 11:645907. [PMID: 34055665 PMCID: PMC8155582 DOI: 10.3389/fcimb.2021.645907] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/23/2021] [Indexed: 11/21/2022] Open
Abstract
The ocular surface possesses its own bacterial microbiota. Once given a chance, opportunistic pathogens within ocular microbiota may lead to corneal infection like bacterial keratitis (BK). To reveal the possible factor that makes people vulnerable to BK from the perspective of ocular bacterial microbiota, as well as to compare diagnostic information provided by high-throughput 16S rDNA sequencing and bacterial culture, 20 patients with BK and 42 healthy volunteers were included. Conjunctival swabs and corneal scrapings collected from the diseased eyes of BK patients were subjected for both high-throughput 16S rDNA sequencing and bacterial culture. Conjunctival swabs collected from the normal eyes of BK patients and healthy volunteers were sent only for sequencing. For identifying the pathogens causing BK, high-throughput 16S rDNA sequencing presented a higher positive rate than bacterial culture (98.04% vs. 17.50%), with 92.11% reaching the genus level (including 10.53% down to the species level). However, none of the sequencing results was consistent with the cultural results. The sequencing technique appears to challenge culture, and could be a complement for pathogen identification. Moreover, compared to the eyes of healthy subjects, the ocular microbiota of three sample groups from BK patients contained significantly less Actinobacteria and Corynebacteria (determinate beneficial symbiotic bacteria), but significantly more Gammaproteobacteria, Pseudomonas, Bacteroides, and Escherichia-Shigella (common ocular pathogenic bacteria). Therefore, it is speculated that the imbalance of protective and aggressive bacteria in the ocular microbiota of healthy people may trigger susceptibility to BK. Based on this speculation, it seems promising to prevent and treat infectious oculopathy through regulating ocular microbiota.
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Affiliation(s)
- Zhichao Ren
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China.,Qingdao University Medical College, Qingdao, China
| | - Qing Liu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Wenfeng Li
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xian Wu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yanling Dong
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yusen Huang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
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Corneal Culture in Infectious Keratitis: Effect of the Inoculation Method and Media on the Corneal Culture Outcome. J Clin Med 2021; 10:jcm10091810. [PMID: 33919274 PMCID: PMC8122416 DOI: 10.3390/jcm10091810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background: To compare two different methods of corneal culture in infectious keratitis: multiple sampling for direct inoculation and enrichment (standard method) and a single sample via transport medium for indirect inoculation (indirect inoculation method). Methods: Prospective inclusion of patients fulfilling predefined criteria of infectious keratitis undergoing corneal culture according to both studied methods in a randomized order. Results: The standard method resulted in a significantly higher proportion of positive culture outcomes among the 94 included episodes of infectious keratitis (61%; 57/94) than the indirect inoculation method (44%; 41/94) (p = 0.002) and a significantly higher proportion of microorganisms than the indirect inoculation method, with a Cohen’s kappa of 0.38 (95% CI: 0.28–0.49) for agreement between the methods. Subanalysis of culture results showed that direct inoculation on gonococcal agar only combined with the indirect inoculation method resulted in a similar rate of culture positive patients and proportion of detected microorganisms to the standard method. Conclusion: Indirect inoculation of one corneal sample cannot replace direct inoculation of multiple corneal samples without loss of information. A combination of directly and indirectly inoculated samples can reduce the number of corneal samples by four without statistically significant differences in culture outcome or in the proportion of detected microorganisms.
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Hoffman JJ, Burton MJ, Leck A. Mycotic Keratitis-A Global Threat from the Filamentous Fungi. J Fungi (Basel) 2021; 7:273. [PMID: 33916767 PMCID: PMC8066744 DOI: 10.3390/jof7040273] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/16/2022] Open
Abstract
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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Affiliation(s)
- Jeremy J. Hoffman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (M.J.B.); (A.L.)
- Cornea Service, Sagarmatha Choudhary Eye Hospital, Lahan 56502, Nepal
- Department of Ophthalmology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (M.J.B.); (A.L.)
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Astrid Leck
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (M.J.B.); (A.L.)
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Rohira H, Shankar S, Yadav S, Shah SG, Chugh A. Enhanced in vivo antifungal activity of novel cell penetrating peptide natamycin conjugate for efficient fungal keratitis management. Int J Pharm 2021; 600:120484. [PMID: 33737097 DOI: 10.1016/j.ijpharm.2021.120484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Abstract
Natamycin is the only FDA approved drug that is used as a first line of treatment for fungal keratitis caused by filamentous fungi, however natamycin is known for poor corneal penetration. Cell penetrating peptides (CPPs) are emerging nanocarriers for the enhanced delivery of various macromolecules owing to their distinct cellular translocation ability. In the present study, tissue penetration ability and antifungal efficacy of CPP (Tat2) conjugated natamycin has been investigated and compared with natamycin alone in vivo. Results show that Tat2natamycin exhibits five- fold higher ocular penetration than natamycin alone when given topically. Complete resolution of fungal keratitis in 44% of the animals in Tat2natamycin treated group as compared to only 13% of the animals in natamycin treated group further highlights its increased antifungal efficacy. Hence, this conjugate is a promising antifungal molecule with enhanced ocular penetration as well as antifungal efficacy against selected fungal species.
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Affiliation(s)
- Harsha Rohira
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Sujithra Shankar
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Shikha Yadav
- National Institute of Biologicals, NOIDA, Uttar Pradesh 201309, India
| | - Sushmita G Shah
- Dr C M Shah Memorial Charitable Trust - Netra Mandir, Madona Colony Road, Borivali West, Mumbai, Maharashtra 400092, India.
| | - Archana Chugh
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India.
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Brown L, Leck AK, Gichangi M, Burton MJ, Denning DW. The global incidence and diagnosis of fungal keratitis. THE LANCET. INFECTIOUS DISEASES 2021; 21:e49-e57. [PMID: 33645500 DOI: 10.1016/s1473-3099(20)30448-5] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
Fungal keratitis is a severe corneal infection that often results in blindness and eye loss. The disease is most prevalent in tropical and subtropical climates, and infected individuals are frequently young agricultural workers of low socioeconomic status. Early diagnosis and treatment can preserve vision. Here, we discuss the fungal keratitis diagnostic literature and estimate the global burden through a complete systematic literature review from January, 1946 to July, 2019. An adapted GRADE score was used to evaluate incidence papers-116 studies provided the incidence of fungal keratitis as a proportion of microbial keratitis and 18 provided the incidence in a defined population. We calculated a minimum annual incidence estimate of 1 051 787 cases (736 251-1 367 323), with the highest rates in Asia and Africa. If all culture-negative cases are assumed to be fungal, the annual incidence would be 1 480 916 cases (1 036 641-1 925 191). In three case series, 8-11% of patients had to have the eye removed, which represents an annual loss of 84 143-115 697 eyes. As fungal keratitis probably affects over a million people annually, an inexpensive, simple diagnostic method and affordable treatment are needed in every country.
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Affiliation(s)
| | - Astrid K Leck
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital NHS Trust, London, UK
| | - David W Denning
- University of Manchester, Manchester, UK; National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester UK; Global Action Fund for Fungal Infections, Geneva, Switzerland.
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Ting DSJ, Ho CS, Cairns J, Elsahn A, Al-Aqaba M, Boswell T, Said DG, Dua HS. 12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study. Br J Ophthalmol 2021; 105:328-333. [PMID: 32580955 PMCID: PMC7907586 DOI: 10.1136/bjophthalmol-2020-316128] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS To examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK. METHODS A retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed. RESULTS The estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22). CONCLUSION IK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.
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Affiliation(s)
| | | | - Jessica Cairns
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ahmad Elsahn
- Academic Ophthalmology, University of Nottingham, Nottingham, UK
| | | | - Tim Boswell
- Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, University of Nottingham, Nottingham, UK
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Harminder Singh Dua
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
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Banerjee S, Denning DW, Chakrabarti A. One Health aspects & priority roadmap for fungal diseases : A mini-review. Indian J Med Res 2021; 153:311-319. [PMID: 33906993 PMCID: PMC8204821 DOI: 10.4103/ijmr.ijmr_768_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 11/29/2022] Open
Abstract
Fungal diseases have not been taken seriously in public health agendas as well as research priorities, despite of globally causing an estimated two million deaths every year, and the emergence of many troublesome fungal pathogens like Candida auris, azole resistant Aspergillus fumigatus, terbinafine and azole resistant dermatophytes, and zoonotic sporotrichosis in humans. Fungi are also responsible for huge losses of agricultural products and stored crops as well as recent massive and unexpected mortality in animals caused by white-nose syndrome in the bats and Chytridiomycosis in amphibians. This review aims to underscore the need for collaborative, multisectoral, and trans-disciplinary approach to include the One Health approach as an essential component of surveillance, prevention, and control of globally emerging fungal diseases. Rigorous evidence based surveillance of the environment as well as strengthening rapid and quality diagnosis of fungal diseases can save millions of lives and reduce significant morbidity.
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Affiliation(s)
- Sayantan Banerjee
- Department of Infectious Diseases, Beleghata Infectious Diseases & BG Hospitals, Beleghata, Kolkata, West Bengal, India
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- Center of Advanced Research in Medical Mycology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Hossain P. Microbial keratitis-the true costs of a silent pandemic? Eye (Lond) 2021; 35:2071-2072. [PMID: 33594242 DOI: 10.1038/s41433-020-01360-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Parwez Hossain
- Eye Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK. .,Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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Clinical and Microbiological Profile of Bacterial and Fungal Suspected Corneal Ulcer at University of Gondar Tertiary Eye Care and Training Centre, Northwest Ethiopia. J Ophthalmol 2021. [DOI: 10.1155/2021/3940151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. A corneal ulcer is a major cause of monocular blindness in developing countries, including Ethiopia. Its etiology varies based on its geographical location and climatic conditions. Therefore, the main objective of this research was to assess the clinical and microbiological profile of suspected bacterial and fungal corneal ulcers at the Tertiary Eye Care and Training Centre at Gondar University. Methods. A cross-sectional hospital-based study of corneal ulcer cases was performed from February to October 2019. Sociodemographic and clinical data were collected using a standardized questionnaire. Corneal scrapings were used to classify bacterial and fungal pathogens. The specimens were inoculated on BHI media and sub-cultured on culture media for the separate cultivation of bacteria and fungi. Biochemical tests have been carried out to classify bacteria. Following CLSI, the antimicrobial resistance pattern of bacterial isolates was carried out. Wet mounting, Lactophenol cotton blue staining, and colony characteristics on SDA were used to classify fungal species. The data were analyzed with version 20 of the SPSS. Results. A total of 30 suspected bacterial and fungal keratitis patients have been enrolled in this study. The visual acuity presented in 90% of the affected eyes was in the category of blindness (<3/60). In 71% of the cases, clinically presumed risk factors were identified. Trauma was the most common risk factor found in 46% of cases, followed by keratitis exposure (13%). Of the corneal scrape tests, 76.6% were positive for bacteria and fungi. Fungi were identified in 53.3% of corneal ulcers followed by 33.3% of bacterial growth. The commonest fungi and bacteria isolated were Aspergillus species (69%) and S. aureus, respectively. The prevalence of Methicillin-resistant S. aureus (MRSA) was 2 (40%). The identified Pseudomonas species were susceptible to Gentamicin and Ciprofloxacin but resistant to Ceftriaxone. Conclusion. The primary microbial agents for corneal ulcers were fungi, and trauma was the most significant risk factor associated with corneal ulcers. To avoid chronic ocular morbidity and blindness, early identification of the etiologic agent and the provision of adequate management are recommended.
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