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Seitzman GD, Keenan JD, Lietman TM, Ruder K, Zhong L, Chen C, Liu Y, Yu D, Abraham T, Hinterwirth A, Doan T. Human Conjunctival Transcriptome in Acanthamoeba Keratitis: An Exploratory Study. Cornea 2024:00003226-990000000-00561. [PMID: 38771726 DOI: 10.1097/ico.0000000000003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/26/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE The purpose of this study was to identify conjunctival transcriptome differences in patients with Acanthamoeba keratitis compared with keratitis with no known associated pathogen. METHODS The host conjunctival transcriptome of 9 patients with Acanthamoeba keratitis (AK) is compared with the host conjunctival transcriptome of 13 patients with pathogen-free keratitis. Culture and/or confocal confirmed Acanthamoeba in 8 of 9 participants with AK who underwent metagenomic RNA sequencing as the likely pathogen. Cultures were negative in all 13 cases where metagenomic RNA sequencing did not identify a pathogen. RESULTS Transcriptome analysis identified 36 genes differently expressed between patients with AK and patients with presumed sterile, or pathogen-free, keratitis. Gene enrichment analysis revealed that some of these genes participate in several biologic pathways important for cellular signaling, ion transport and homeostasis, glucose transport, and mitochondrial metabolism. Notable relatively differentially expressed genes with potential relevance to Acanthamoeba infection included CPS1, SLC35B4, STEAP2, ATP2B2, NMNAT3, and AKAP12. CONCLUSIONS This research suggests that the local transcriptome in Acanthamoeba keratitis may be sufficiently robust to be detected in the conjunctiva and that corneas infected with Acanthamoeba may be distinguished from the inflamed cornea where no pathogen was identified. Given the low sensitivity for corneal cultures, identification of differentially expressed genes may serve as a suggestive transcriptional signature allowing for a complementary diagnostic technique to identify this blinding parasite. Knowledge of differentially expressed genes may also direct investigation of disease pathophysiology and suggest novel pathways for therapeutic targets.
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Affiliation(s)
- Gerami D Seitzman
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
- Department of Ophthalmology, University of California, San Francisco, California
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
- Department of Ophthalmology, University of California, San Francisco, California
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
- Department of Ophthalmology, University of California, San Francisco, California
| | - Kevin Ruder
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - Cindi Chen
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - YuHeng Liu
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - Danny Yu
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - Thomas Abraham
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco, California; and
- Department of Ophthalmology, University of California, San Francisco, California
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2
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Ngarmsom R, Horatanaruang O. Epidemiology of Microbial Keratitis at a Tertiary Care Hospital in Southern Thailand. Clin Ophthalmol 2024; 18:1267-1275. [PMID: 38737595 PMCID: PMC11088849 DOI: 10.2147/opth.s464935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study aimed to ascertain the microbial profiles and predisposing risk factors for microbial keratitis and to analyze the trend of mixed microbial infection cases over 8 years. Patients and Methods In this retrospective analysis, we reviewed the electronic medical records of inpatients diagnosed with microbial keratitis between January 2012 and December 2019. Data on demographics, risk factors, and causative pathogens were analyzed. Multivariate logistic regression models were utilized to identify risk factors associated with pathogens. Results This study included 640 eyes of 638 patients. Trauma was the most common predisposing risk factor (57.2%), followed by a combination of factors (14.4%). Among diagnostic test results, bacteria, fungi, and mixed pathogens were identified in 46.72%, 46.56%, and 21.41% of cases, respectively. Positive culture results were obtained in 324 eyes (53.6%), with Pseudomonas aeruginosa (25.1%) and Fusarium spp. (17.4%) being the most prevalent pathogens. In the multivariate logistic regression model, contact lens use, presence of diabetes mellitus, and HIV infection were statistically significant risk factors for Pseudomonas aeruginosa infection (p = 0.001, p = 0.046, and p = 0.04, respectively). Trauma was associated with Fusarium spp. infection (p = 0.001). An increase in the percentage of mixed microbial infection cases was observed when comparing the periods of 2016-2019 with 2012-2015 (p = 0.023). Conclusion Bacteria and fungi are equally common causes of microbial keratitis, with Pseudomonas aeruginosa and Fusarium spp. being the predominant pathogens causing bacterial and fungal infections. Trauma is the primary predisposing risk factor for microbial keratitis. There was a notable increase in mixed infection cases over the study period.
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Affiliation(s)
- Ratchapol Ngarmsom
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Orasa Horatanaruang
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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3
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Brekke SR, Giri P, Byanju R, Pradhan S, Bhandari G, Bhandari S, Kandel RP, Poudyal B, Gonzales JA, Srinivasan M, Upadhyay M, Whitcher JP, O'Brien KS, Lietman TM, Keenan JD. Risk factors for corneal abrasions in Nepal: a community-based study. Eye (Lond) 2024; 38:945-950. [PMID: 37949975 DOI: 10.1038/s41433-023-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND South Asia is experiencing rapid urbanization, which may be changing the risk factor profile for ocular trauma. The objective of this study was to compare risk factors for traumatic corneal abrasions in rural versus urban Nepal, and to assess if any risk factors were associated with a poor outcome. METHODS In a prospective, cross-sectional, community-based study performed as part of a cluster-randomized trial, community health workers from Nepal were trained to diagnose and treat traumatic corneal abrasions. Participants with an abrasion were invited to complete a risk factor survey. The main exposure variable was the object of eye injury, stratified by rural-urban residence. The main outcome measure was a lack of corneal healing after a three-day course of antimicrobials. RESULTS Of 3657 participants diagnosed with a corneal abrasion, 2265 completed a survey. Eye trauma occurred most frequently during agricultural activities. The most common object of injury was vegetative matter, accounting for approximately 40% of injuries in rural, peri-urban, and urban communities. Wood injuries were more common in rural communities (24%) compared with urban or peri-urban communities (13%). Eye injury from an animal was more likely to result in a non-healing corneal abrasion after 3 days of treatment compared with other types of trauma (prevalence ratio 2.59, 95%CI 1.16-5.76). CONCLUSIONS Health promotion activities for prevention of corneal ulcers in Nepal should focus on agricultural trauma in both rural and urban areas. Community members experiencing eye trauma from an animal may benefit from early referral to an eye clinic.
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Affiliation(s)
- Sylvia R Brekke
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - Puspa Giri
- Bharatpur Eye Hospital, Bharatpur, Nepal
| | | | | | | | | | | | | | - John A Gonzales
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Muthiah Srinivasan
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India
| | - Madan Upadhyay
- BP Eye Foundation, Children's Hospital for Eye, Ear, and Rehabilitation Services (CHEERS), Kathmandu, Nepal
| | - John P Whitcher
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Kieran S O'Brien
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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4
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Rosenberg CR, Prajna V, Srinivasan MK, Lalitha PC, Krishnan T, Rajaraman R, Venugopal A, Acharya N, Seitzman GD, Rose-Nussbaumer J, Woodward MA, Lietman TM, Campbell JP, Keenan JD, Redd TK. Locality is the strongest predictor of expert performance in image-based differentiation of bacterial and fungal corneal ulcers from India. Indian J Ophthalmol 2024; 72:526-532. [PMID: 38454845 PMCID: PMC11149525 DOI: 10.4103/ijo.ijo_3396_22] [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: 12/30/2022] [Accepted: 09/21/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE This study sought to identify the sources of differential performance and misclassification error among local (Indian) and external (non-Indian) corneal specialists in identifying bacterial and fungal keratitis based on corneal photography. METHODS This study is a secondary analysis of survey data assessing the ability of corneal specialists to identify acute bacterial versus fungal keratitis by using corneal photography. One-hundred images of 100 eyes from 100 patients with acute bacterial or fungal keratitis in South India were previously presented to an international cohort of cornea specialists for interpretation over the span of April to July 2021. Each expert provided a predicted probability that the ulcer was either bacterial or fungal. Using these data, we performed multivariable linear regression to identify factors predictive of expert performance, accounting for primary practice location and surrogate measures to infer local fungal ulcer prevalence, including locality, latitude, and dew point. In addition, Brier score decomposition was used to determine experts' reliability ("calibration") and resolution ("boldness") and were compared between local (Indian) and external (non-Indian) experts. RESULTS Sixty-six experts from 16 countries participated. Indian practice location was the only independently significant predictor of performance in multivariable linear regression. Resolution among Indian experts was significantly better (0.08) than among non-Indian experts (0.01; P < 0.001), indicating greater confidence in their predictions. There was no significant difference in reliability between the two groups ( P = 0.40). CONCLUSION Local cornea experts outperformed their international counterparts independent of regional variability in tropical risk factors for fungal keratitis. This may be explained by regional characteristics of infectious ulcers with which local corneal specialists are familiar.
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Affiliation(s)
| | - Venkatesh Prajna
- Department of Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Prajna C Lalitha
- Department of Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Tiru Krishnan
- Department of Ophthalmology, Aravind Eye Hospital, Pondicherry, Tamil Nadu, India
| | - Revathi Rajaraman
- Department of Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Anitha Venugopal
- Department of Ophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Nisha Acharya
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Gerami D Seitzman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - John Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Travis K Redd
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
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5
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Konwar C, Gogoi T, Chakraborty A, Nimje V, Gogoi N, Nath R. Keratitis due to Lasiodiplodia theobromae successfully treated with voriconazole: A case series from Assam. Indian J Med Microbiol 2024; 48:100558. [PMID: 38458337 DOI: 10.1016/j.ijmmb.2024.100558] [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: 11/23/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
Lasiodiplodia theobromae is a dematiaceous fungus which rarely causes keratitis and is mostly resistant to the commonly used antifungal drugs. Here, we report three cases of keratitis caused by L.theobromae from Assam. All the cases were successfully treated with 1% voriconazole and surgical debridement. To the best of our knowledge and literature search, this is the first case series of keratitis caused by L.theobromae reported from eastern India.
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Affiliation(s)
- Chaitali Konwar
- ICMR Advanced Mycology Diagnostic and Research Center, Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, Assam, India.
| | - Tapan Gogoi
- Department of Ophthalmology, Assam Medical College and Hospital, Dibrugarh, Assam, India.
| | - Abhishikta Chakraborty
- Department of Ophthalmology, Assam Medical College and Hospital, Dibrugarh, Assam, India.
| | - Vivek Nimje
- Department of Ophthalmology, Assam Medical College and Hospital, Dibrugarh, Assam, India.
| | - Navonil Gogoi
- ICMR Advanced Mycology Diagnostic and Research Center, Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, Assam, India.
| | - Reema Nath
- ICMR Advanced Mycology Diagnostic and Research Center, Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, Assam, India.
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6
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Eleiwa TK, Youssef GH, Elsaadani IA, Abdelrahman SN, Khater AA. Debulking corneal biopsy with tectonic amniotic membrane transplantation in refractory clinically presumed fungal keratitis. Sci Rep 2024; 14:521. [PMID: 38177182 PMCID: PMC10767135 DOI: 10.1038/s41598-023-50987-4] [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: 10/28/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
The treatment of fungal keratitis (FK) is challenging due to the subacute indolent course, and initial misdiagnosis. In this retrospective case series, we highlight both the diagnostic and therapeutic roles of corneal biopsy together with amniotic membrane transplantation (AMT) in patients with refractory clinically presumed FK. Debulking biopsy and tectonic AMT were performed during the initial presentation. Biopsy specimens were sent for KOH smears and cultures. After KOH smears confirmed the presence of fungal elements, topical voriconazole 1% was prescribed for the first 72 h then tailored according to the clinical response and the culture results. The outcome measures were complete resolution of infection and restoration of corneal integrity. Cases associated with culture proven bacterial keratitis were excluded. Twelve cases were included in the study. KOH smears confirmed the presence of fungal growth in all specimens. Cultures grew Aspergillus in 6/12 cases, sensitive to voriconazole (5/6) and amphotericin (3/6); Fusarium (4/12), sensitive to both voriconazole and amphotericin; and no growth in 2/12 cases. Amphotericin 0.15% eye drops were added to the 7 cases with proven sensitivity and to the remaining 2 culture negative cases. Gradual resolution of infection was seen in all cases after 35.6 ± 7.8 days. In FK, a debulking biopsy simultaneously with AMT help decrease the microbial load, suppress the inflammatory process, support the corneal integrity, confirm the presence of fungal pathogen.
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Affiliation(s)
- Taher K Eleiwa
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt.
| | - Gehad H Youssef
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt
| | - Ibrahim Abdelkhalik Elsaadani
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt
| | - Samar N Abdelrahman
- Department of Clinical Pathology, Benha University Hospitals, Benha University, Benha, Egypt
| | - Ahmed A Khater
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt
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7
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Owusu-Afriyie B, Gende T, Silki F, Ishmael B, Kuiaha J. Epidemiology of eye diseases: outcomes from a free provincial eye clinic in Papua New Guinea. Front Med (Lausanne) 2023; 10:1272337. [PMID: 38179281 PMCID: PMC10765577 DOI: 10.3389/fmed.2023.1272337] [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: 08/04/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Aim To ascertain the prevalence and pattern of eye problems in Madang Province, Papua New Guinea. Materials and methods A six-month retrospective study was performed at Madang Provincial Hospital Eye Clinic. Convenience sampling was used in this study and all patient records from January to June 2020 were included. Data was extracted using Microsoft Excel and the data included gender, age, occupation, district where the patient lived, presenting visual acuity, and diagnosis. It was then analyzed using International Business Machines Corporation's Statistical Package for the Social Sciences version 26. A p-value of ≤0.05 was considered statistically significant. Results A total of 1,715 patients received services at the eye clinic between January and June 2020, and 1,664 were included in this study. The mean age of the patients was 39.3 ± 20.3 years. There were slightly more males (50.4%) than females. The overall leading ocular morbidities were corneal ulcers and keratitis (20.7%), refractive errors (17.4%), and cataracts (16.8%). More than half of the patients (56.2%) were either visually impaired or blind. Nearly half of the patients (41.8%) traveled long distances to seek services at the eye clinic. There was a significant association between demographic characteristics, diagnosis, and level of visual impairment. Conclusion There is a high prevalence of potential causes of visual impairment and blindness in Madang Province and these conditions affect all age groups and genders. It is essential to increase accessibility to eye care services in the country.
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Affiliation(s)
- Bismark Owusu-Afriyie
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Theresa Gende
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Frederick Silki
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Bolgii Ishmael
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Joelda Kuiaha
- The Fred Hollows Foundation PNG Inc., Madang, Papua New Guinea
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Knutsson KA, Rama P, Tombolini B, Di Biase C, Senni C, Buffoli F, Clementi N, Tonelli M, Carletti S, Mancini N, Ferrari G, Paganoni G, Bandello F. Beauveria bassiana Keratitis: A Case Series and Review of Literature. J Clin Med 2023; 12:7601. [PMID: 38137670 PMCID: PMC10744012 DOI: 10.3390/jcm12247601] [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: 10/22/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Beauveria bassiana is a filamentous fungus commonly used as an insecticide that rarely causes keratitis. METHODS Patients affected by Beauveria bassiana keratitis were retrospectively recruited at San Raffaele Hospital (Milan, Italy) between 2020 and 2022. All subjects underwent comprehensive ophthalmic evaluation, including in vivo confocal microscopy (IVCM) and microbiologic examination of corneal scrapings. Beauveria bassiana was identified using 18S rDNA targeted PCR. RESULTS Four eyes of four patients (51 ± 8.8 years old) were evaluated. The main risk factors were soft contact lens wear (75%) and trauma with vegetative matter (50%). A superficial infiltrate was displayed in the majority of patients. Three cases (75%) showed hyphae on IVCM. All patients showed clinical improvement after topical antifungal therapy, although mostly through a combination of two antifungals (75%). One patient with a deeper infection required a systemic antifungal agent after one month of topical therapy. All cases required debridement to reduce the microbial load and enhance drug penetration. All patients experienced keratitis resolution following medical treatment (average: 3.3 months). CONCLUSIONS The identification of risk factors and the early diagnosis of Beauveria bassiana keratitis are fundamental in order to avoid its penetration in the deeper corneal stromal layers. Topical antifungal drugs, possibly accompanied by ulcer debridement, may be a successful treatment if instilled from the early phases of the disease.
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Affiliation(s)
- Karl Anders Knutsson
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Paolo Rama
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (P.R.); (C.D.B.)
| | - Beatrice Tombolini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Carlo Di Biase
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (P.R.); (C.D.B.)
| | - Carlotta Senni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Fabio Buffoli
- Laboratory of Medical Microbiology and Virology, University Vita-Salute San Raffaele, 20132 Milan, Italy; (F.B.); (N.C.); (S.C.)
| | - Nicola Clementi
- Laboratory of Medical Microbiology and Virology, University Vita-Salute San Raffaele, 20132 Milan, Italy; (F.B.); (N.C.); (S.C.)
- Laboratory of Medical Microbiology and Virology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Marco Tonelli
- Laboratory of Medical Microbiology and Virology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Silvia Carletti
- Laboratory of Medical Microbiology and Virology, University Vita-Salute San Raffaele, 20132 Milan, Italy; (F.B.); (N.C.); (S.C.)
| | - Nicasio Mancini
- Laboratory of Medical Microbiology and Virology, University of Insubria, 21100 Varese, Italy;
| | - Giulio Ferrari
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Giorgio Paganoni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
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9
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Hamerski C, Proia AD. Lasiodiplodia theobromae keratitis: A rare tropical fungal keratitis in a non-tropical climate. Am J Ophthalmol Case Rep 2023; 32:101944. [PMID: 37915727 PMCID: PMC10616133 DOI: 10.1016/j.ajoc.2023.101944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/12/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose We present the clinical and histopathological findings of a geographically unique Lasiodiplodia theobromae fungal keratitis case in North Carolina. L. theobromae is a rare cause of fungal keratitis, and all but one of the 51 previously reported cases have occurred in patients living in the tropics. Observations A man in his early 50s developed L. theobromae keratitis after being struck in the left eye by a piece of debris while using a flexible-cord weed trimmer. Intracapsular lensectomy and penetrating keratoplasty were necessary when initial antimicrobial therapy was ineffective. The best-corrected visual acuity was 20/40 four years postoperatively. Conclusions and Importance Our patient is only the second example of L. theobromae keratitis in a patient living in a sub-tropical climate and the first case in the U.S.A. outside of Florida. Additional in-vitro antibiotic sensitivity testing and documentation of more clinical cases are needed to define the optimal therapy for Lasiodiplodia theobromae keratitis.
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Affiliation(s)
- Calvin Hamerski
- Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC, 27546, USA
| | - Alan D. Proia
- Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC, 27546, USA
- Departments of Pathology and Ophthalmology, Duke University Medical Center, Durham, NC, 27710, USA
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10
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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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11
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Aftab N, Raj A, Chandra B, Pati BK, Singh P. Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study. Indian J Ophthalmol 2023; 71:3522-3527. [PMID: 37870018 PMCID: PMC10752327 DOI: 10.4103/ijo.ijo_2752_22] [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: 10/20/2022] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Method Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. Results In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Conclusion Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.
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Affiliation(s)
- Naila Aftab
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Bhawesh Chandra
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Binod Kumar Pati
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
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Kusumesh R, Ambastha A, Arya LK, Kumari A, Kumari N, Sinha BP, Mohan N, Kumari N. Epidemiological and microbiological profiles of microbial keratitis in a tertiary eye center in Eastern India (Bihar). Indian J Ophthalmol 2023; 71:3506-3512. [PMID: 37870015 PMCID: PMC10752331 DOI: 10.4103/ijo.ijo_1605_23] [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: 06/19/2023] [Revised: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To determine the demography, risk factors, and causative organisms of microbial keratitis (MK) in Bihar, an eastern state of India. Design Retrospective study. Methods We reviewed the demographic, clinical, and microbiological data of 2303 patients with MK (non-viral) presenting between January 2019 and December 2022. Results This study revealed a predominance of males (65.0%) compared to females (34.9%), with a mean age of 48.4 ± 16.5 years. The majority of patients (63.1%) presented after 2 weeks from the onset of symptoms. The most common risk factor observed was corneal injury (58.1%), followed by ocular surface diseases (13.6%) and diabetes mellitus (13.3%). The majority of patients (73.16%) were involved in agriculture. Prior to presentation, almost all patients (92%) had received topical antibiotics. Unsupervised use of topical corticosteroids was observed in 29.2% of the patients for the median duration of 3 days (odds ratio, 0.17). At presentation, the median size of corneal ulcers was 5 mm, the best-corrected visual acuity was less than 20/400 in 51.4% of patients, and corneal perforation was in 14% of patients. The smear and culture positivity rate were 75.4% and 47.9%, respectively. The common causative organism was fungus (48.8%), followed by bacteria (17.4%). Aspergillus spp. and Staphylococcus spp. were the most commonly identified organisms; a quarter of the patients (24.5%) remained unidentified. All bacteria showed good sensitivity to vancomycin. Conclusion MK is a significant cause of ocular morbidity in Bihar. The knowledge of epidemiology, risk factors, and microbiological profiles of MK can provide a valuable approach to disease prevention, diagnosis, and management.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambastha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Lalan K Arya
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Kumari
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neha Kumari
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti P Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nilesh Mohan
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Namrata Kumari
- Department of Microbiology Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Joshi LS, Kaiti R, Shyangbo R, Bogati B. Positive Microbiological Culture among Patients with Infective Keratitis Visiting the Cornea Unit of a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:775-778. [PMID: 38289787 PMCID: PMC10579763 DOI: 10.31729/jnma.8285] [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: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Keratitis is the infection and inflammation of the cornea. Microbial keratitis is a potentially sight-threatening corneal condition. The aim of this study was to find out the prevalence of positive microbiological culture among patients with infective keratitis visiting the Cornea Unit of a tertiary care centre. Methods A descriptive cross-sectional study was conducted among patients with a clinical diagnosis of infective keratitis presenting to the Cornea Unit of a tertiary eye care centre from 16 October 2020 to 16 March 2021 after obtaining ethical approval from the Ethical Review Board. After slit-lamp examination, corneal scrapings were performed under aseptic conditions which were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 428 patients, 337 (78.73%) (73.24-84.33, 95% Confidence Interval) had a positive microbiological culture. A total of 213 (49.76%) of enrolled samples had a prior history of ocular trauma. Aspergillus species 68 (20.17%) and Streptococcus species 33 (9.79%) were the most common organisms isolated from fungal and bacterial corneal ulcers respectively. Conclusions The prevalence of positive microbiological culture among patients with infective keratitis from this study is similar to the pattern reported from similar settings. Keywords corneal ulcer; keratitis; prevalence.
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Affiliation(s)
| | - Raju Kaiti
- Department of Optometry, Nepal Eye Hospital, Tripureshwor, Kathmandu, Nepal
| | - Ranjila Shyangbo
- Department of Optometry, National Academy of Medical Sciences, Mahaboudha, Kathmandu, Nepal
| | - Birkha Bogati
- Department of Optometry, National Academy of Medical Sciences, Mahaboudha, Kathmandu, Nepal
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Shah S, Wozniak RAF. Staphylococcus aureus and P seudomonas aeruginosa infectious keratitis: key bacterial mechanisms that mediate pathogenesis and emerging therapeutics. Front Cell Infect Microbiol 2023; 13:1250257. [PMID: 37671149 PMCID: PMC10475732 DOI: 10.3389/fcimb.2023.1250257] [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: 06/29/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Bacterial keratitis (bacterial infection of the cornea) is a major cause of vision loss worldwide. Given the rapid and aggressive nature of the disease, immediate broad-spectrum antibiotics are essential to adequately treat this disease. However, rising antibiotic resistance continues to accelerate, rendering many commonly used therapeutics increasingly ineffective. As such, there is a significant effort to understand the basic pathogenesis of common causative organisms implicated in keratitis in part, to fuel the development of novel therapies to treat this blinding disease. This review explores two common causes of bacterial keratitis, Staphylococcus aureus and Pseudomonas aeruginosa, with regards to the bacterial mediators of virulence as well as novel therapies on the horizon.
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Affiliation(s)
| | - Rachel A. F. Wozniak
- Department of Ophthalmology, The University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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Rammohan R, Baidwal S, Venkatapathy N, Lorenzo-Morales J, Raghavan A. A 5-Year Review of Coinfections in Acanthamoeba keratitis From South India. Eye Contact Lens 2023; 49:334-338. [PMID: 37232397 DOI: 10.1097/icl.0000000000001005] [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: 04/24/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To ascertain the frequency of coinfections in Acanthamoeba keratitis, the nature of copathogens involved, and to analyze the implications in the context of current research on amoebic interactions. METHODS A retrospective case review from a Tertiary Care Eye Hospital in South India. Smear and culture data for coinfections in Acanthamoeba corneal ulcers were collected from records over a 5-year period. The significance and relevance of our findings in the light of current research on Acanthamoeba interactions were analyzed. RESULTS Eighty-five cases of culture-positive Acanthamoeba keratitis were identified over a 5-year period (43 of them being coinfections). Fusarium was most commonly identified species, followed by Aspergillus and the dematiaceous fungi. Pseudomonas spp was the commonest bacterial isolate. CONCLUSION Coinfections with Acanthamoeba are common at our centre, and account for 50% of Acanthamoeba keratitis. The diverse nature of the organisms involved in coinfections suggest that such amoebic interactions with other organisms are probably more widespread than recognized. To the best of our knowledge, this is the first documentation from a long-term study of pathogen diversity in Acanthamoeba coinfections. It is possible that Acanthamoeba itself may be virulence enhanced and secondary to the co-organism, breaching the ocular surface defenses in an already compromised cornea. However, observations from the existing literature on Acanthamoeba interactions with bacteria and certain fungi are based mainly on nonocular or nonclinical isolates. It would be illuminating if such studies are performed on Acanthamoeba and coinfectors from corneal ulcers-to ascertain whether interactions are endosymbiotic or virulence enhanced through amoebic passage.
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Affiliation(s)
- Ram Rammohan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology (R.R., N.V., A.R.), Coimbatore; Fortis Hospital (S.B.), Chandigarh Road, Ludhiana, India; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC) (J.L.-M.), Universidad de La Laguna (ULL), La Laguna, Tenerife, Spain; Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología (J.L.-M.), Universidad de La Laguna, Tenerife, Spain; and Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC) (J.L.-M.), Instituto de Salud Carlos III, Madrid, Spain
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Rathi A, Ramazanova K, Murthy SI, Mohamed A, Joseph J, Doctor MB, Pandey S, Rathi VM. Clinical and Microbiological Spectra and Therapeutic Outcomes of Polymicrobial Keratitis. Cornea 2023; 42:946-953. [PMID: 35965400 DOI: 10.1097/ico.0000000000003107] [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: 03/17/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the risk factors, microbiology, and treatment outcomes of polymicrobial keratitis (PMK). METHODS We retrospectively analyzed 65 patients diagnosed with PMK between 2016 and 2019. The clinical and microbiological characteristics and outcomes were evaluated. The primary outcome measure was clinical resolution of keratitis. Absolute success (group A) was defined as resolution of infection with medical treatment, qualified success (group B) was resolution with medical therapy and additional minor procedures, and failure (group C) was defined as worsening of infection and presence of corneal melting or perforation requiring therapeutic penetrating keratoplasty or evisceration. RESULTS Of 4764 cases of microbial keratitis, PMK was identified in 65 eyes of 65 patients (1.36%). Infiltrate was central in 60% (39 eyes). Predisposing factors were higher in group C and included uncontrolled diabetes mellitus in 25% (7/28), history of trauma/foreign body in 57.1% (16/28), and poor presenting visual acuity (0.9 for group A vs. 1.79 for group B vs. 3.00 logarithm of the minimum angle of resolution for group C; P = 0.02). Microbiological profiling revealed that a majority (95%: 62/65) had bacterial with fungal keratitis. High fluoroquinolone resistance was noted (57%; 34/59). Absolute success was achieved in 28.3% (17/60), qualified success in 16.6% (10/60), and treatment failure was noted in 55% (33/60). The final best corrected visual acuity in group A was significantly better than that in group B and C (0.44 vs. 3.00 vs. 2.78; P < 0.001). CONCLUSIONS PMK is extremely rare but responds poorly to medical therapy. Bacterial with fungal etiology is predominant. Early surgical intervention to improve overall outcome is advocated.
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Affiliation(s)
- Anubha Rathi
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | | | | | - Ashik Mohamed
- Ophthalmic Biophysics, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, India . and
- Ramoji Foundation for Ocular Infections (RFCOI), Hyderabad, India
| | | | - Suchita Pandey
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, India . and
| | - Varsha M Rathi
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
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Das AV, Joseph J. The microbiological landscape and epidemiology of ocular infections in a multi-tier ophthalmology network in India: an electronic medical record driven analytics report. Eye (Lond) 2023; 37:1590-1595. [PMID: 35907944 PMCID: PMC10219986 DOI: 10.1038/s41433-022-02191-3] [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: 01/29/2022] [Revised: 06/29/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To study the epidemiology and landscape of ocular infections in patients undergoing microbiological investigations across a multi-tier ophthalmology network in India. METHODS This cross-sectional hospital-based study included 15,822 patients in whom microbiology samples were analysed between September 2013 and December 2021. Ocular tissue of patients in whom a microbiology sample was processed in at least one eye were included. The data were collected using an indigenously developed electronic medical record system. RESULTS Among the 15,822 patients, bacteria (51.06%) was the most common aetiology followed by fungus (38.27%). The majority of the patients were male (68.10%) and adults (90.01%). The most common age group was during the sixth decade of life with 2,914 (18.42%) patients. The patients were more commonly from the lower socio-economic status (51.61%) and from the rural geography (46.82%). Majority of the specimens sent for microbiological analysis were corneal scrapings (68.61%) followed by vitreous (8.77%). The most common bacteria isolated was Staphylococcus aureus (14.45%) followed by Pseudomonas aeruginosa (12.53%) and among the fungus were Fusarium (30.53%) and Aspergillus species (29.86%). Acanthamoeba (1.26%) and Microsporidia (0.38%) accounted for a minority of the infections in the samples. Fungus (53.10%; p ≤ 0.00001) and virus (51.08%; p = 0.000673) aetiology was found to be significantly higher in patients presenting from the rural geography. CONCLUSION The most common aetiology of infection in ocular disease is bacterial but fungal infections also accounted for a significant proportion. The majority of the patients with ocular infections presented from the rural geography and from lower socio-economic status.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research Centre, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India.
- The Ramoji Foundation for Ocular Infections, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Parmar GS, Meena AK, Borde P, Prasad S. Microbial keratitis and antibiotic sensitivity patterns: A retrospective analysis at a tertiary center in Central India. Indian J Ophthalmol 2023; 71:2455-2459. [PMID: 37322659 PMCID: PMC10417949 DOI: 10.4103/ijo.ijo_2070_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report on the microbiological profile and antibiotic sensitivity patterns of infectious keratitis at a tertiary center in central India. Methods The suspected case of severe keratitis underwent microbiological culture and identification using the VITEK 2 technique. Antibiotic susceptibility for different sensitivity and resistance patterns was analyzed. Demographics, clinical profile, and socioeconomic history was also documented. Results Culture was positive in 233/455 (51.2%) patients. Pure bacterial growth was present in 83 (35.62%) patients and pure fungus was present in 146 (62.66%) patients. The most common bacterial cause of infectious keratitis was Pseudomonas followed by Staphylococcus and Bacillus. Pseudomonas showed 65%-75% resistance against levofloxacin, ceftazidime, imipenem, gentamycin, ciprofloxacin, and amikacin. Staphylococcus showed 65%-70% resistance against levofloxacin, erythromycin, and ciprofloxacin, with Streptococcus being 100% resistant to erythromycin. Conclusion This study highlights the current trend of microbiological profiles of infectious keratitis and their antibiotic susceptibility at a rural setup in central India. Fungal predominance and increased resistance against the commonly used antibiotics were noted.
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Affiliation(s)
- Gautam Singh Parmar
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Ashok Kumar Meena
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Prashant Borde
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Sonali Prasad
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
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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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Masoumi A, Soleimani M, Azizkhani M, Izadi A, Cheraqpour K, Tabatabaei SA, Khodaveisi S, Aminzadeh M. Clinical Features, Risk Factors, and Management of Candida Keratitis. Ocul Immunol Inflamm 2023:1-6. [PMID: 37141453 DOI: 10.1080/09273948.2023.2203752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND/AIMS To determine the clinical features, predisposing factors, and management of infectious keratitis caused by Candida spp. METHODS Retrospective chart review. RESULTS The medical records of 52 patients (54 eyes) with Candida keratitis were available for statistical analysis. Thinning of the corneal stroma was identified in 34 eyes (63.0%), and corneal perforation occurred in 16 eyes (29.6%). Corneal thinning and perforation were more common in Candida albicans compared with non-albicans (P-val < .001, P = .09, respectively). The most common predisposing factors for Candida keratitis were topical steroid use (21 patients, 40.4%), previous corneal transplantation (17 patients, 32.7%), and preexisting ocular surface disease (15 patients, 28.8%). Fourteen eyes (25.9%) required cyanoacrylate glue application and 10 eyes (18.5%) underwent therapeutic penetrating keratoplasty (TPK). CONCLUSION Local immunosuppression and ocular surface disease play an important role in Candida keratitis. C. albicans appears to be more invasive compared with non-albicans spp.
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Affiliation(s)
- Ahmad Masoumi
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Momeneh Azizkhani
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Izadi
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodaveisi
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Aminzadeh
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Das AV, Bagga B, Joseph J. Clinical Profile and Demographic Distribution of Acanthamoeba Keratitis: An Electronic Medical Record-Driven Data Analytics from an Eye Care Network in India. Ocul Immunol Inflamm 2023:1-5. [PMID: 37084281 DOI: 10.1080/09273948.2023.2199331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To describe the clinical profile of patients presented with Acanthamoeba keratitis (AK) to a multi-tier ophthalmology hospital network in India. METHODS This cross-sectional hospital-based study included 1945339 new patients registering between September 2016 and May 2022. Patients with clinically confirmed diagnosis of AK in one or both eyes were included in the study. All the relevant data were documented using an electronic medical record (EMR) system. RESULTS A total of 245 (0.013%) patients were diagnosed with AK and majority were male (62.86%) with unilateral (99.59%) affliction. The most common age group was during the fourth decade of life, 65 (26.53%) patients and predominantly were adults (95.51%). The prevalence of the infection was higher in patients from a lower socioeconomic status (43.27%) from rural geography (52.24%) and in agriculture-related work (28.16%). The most common inciting factor was injury with vegetative matter (8.98%), dust (7.76%) and contact lens wear (4.49%). The majority of the eyes had blindness (20/400 to 20/1200) in 116 (47.15%) eyes with a presenting visual acuity (logMAR) of 2.14 ± 1.04. Among the surgical interventions, therapeutic keratoplasty was performed in 41 (16.67%) eyes, penetrating keratoplasty in 22 (8.94%) eyes, and evisceration in 2 (0.81%) eyes. CONCLUSION AK more commonly affects males presenting during the fourth decade of life from lower socio-economic status and is predominantly unilateral. A fourth of the affected eyes underwent keratoplasty and the majority had significant visual impairment at presentation.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research Centre, Hyderabad, India
| | - Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- The Ramoji Foundation Centre for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- The Ramoji Foundation Centre for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India
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Sakr SI, Nayel AA, Habeel CS, Elkhabiry HK, Ibrahim GM, Tolba MM, Ghaith AA. Epidemiological profile of microbial keratitis in Alexandria-Egypt a 5 years retrospective study. J Ophthalmic Inflamm Infect 2023; 13:18. [PMID: 37055636 PMCID: PMC10102273 DOI: 10.1186/s12348-023-00332-7] [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: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE To evaluate the epidemiologic profile of microbial keratitis in Alexandria- Egypt, with special emphasis on risk factors, visual outcome and microbiological results. METHODS This retrospective study reviewed files of patients treated for microbial keratitis during a period of 5 years at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria- Egypt, between February 2017 and June 2022. The patients were evaluated for the risk factors e.g., trauma, eyelid disorders, co-morbidities, and contact lens use. They were also evaluated for their clinical picture, the identified microorganisms, visual outcomes, and complications. Non-microbial keratitis and incomplete files were excluded from the study. RESULTS A total of 284 patients were diagnosed as microbial keratitis in our study. Viral keratitis was the most common cause of microbial keratitis (n = 118 (41.55%)), followed by bacterial keratitis (n = 77 (27.11%)), mixed keratitis (n = 51 (17.96%)), acanthamoeba keratitis (n = 22 (7.75%)) and the least cause was fungal keratitis (n = 16 (5.63%)). Trauma was the most common risk factor for microbial keratitis (29.2%). Fungal keratitis had a statistically significant association with trauma (p < 0.001), while the use of contact lenses had a statistically significant association with Acanthamoeba keratitis (p < 0.001). The percentage of culture-positive results in our study was 76.8%. Gram-positive bacteria were the most frequently isolated bacterial isolate (n = 25 (36.2%)), while filamentous fungi were the most frequently isolated fungi (n = 13(18.8%)). After treatment, there was a significant increase in the mean visual acuity among all groups; it was significantly higher in Acanthamoeba keratitis group with a mean difference of 0.262 ± 0.161 (p = 0.003). CONCLUSION Viral keratitis followed by bacterial keratitis were the most frequent etiologic agents causing microbial keratitis found in our study. Although trauma was the most frequent risk factor for microbial keratitis, contact lens wear was found an important preventable risk factor for microbial keratitis in young patients. Performing culture properly whenever indicated before starting antimicrobial treatment increased the cultures' positive results.
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Affiliation(s)
- Suzan Ibrahim Sakr
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt.
| | - Amira Ahmed Nayel
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Christeena Saeed Habeel
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Hala Kamal Elkhabiry
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Ghada Mahmoud Ibrahim
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | | | - Alaa Atef Ghaith
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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23
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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24
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Lu NJ, Koliwer-Brandl H, Gilardoni F, Hafezi N, Knyazer B, Achiron A, Zbinden R, Egli A, Hafezi F. The Antibacterial Efficacy of High-Fluence PACK Cross-Linking Can Be Accelerated. Transl Vis Sci Technol 2023; 12:12. [PMID: 36757342 PMCID: PMC9924428 DOI: 10.1167/tvst.12.2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Purpose To determine whether high-fluence photoactivated chromophore for keratitis cross-linking (PACK-CXL) can be accelerated. Methods Solutions of Staphylococcus aureus and Pseudomonas aeruginosa with 0.1% riboflavin were prepared and exposed to 365 nm ultraviolet (UV)-A irradiation of intensities and fluences from 9 to 30 mW/cm2 and from 5.4 to 15.0 J/cm2, respectively, representing nine different accelerated PACK-CXL protocols. Irradiated solutions and unirradiated controls were diluted, plated, and inoculated on agar plates so that the bacterial killing ratios (BKR) could be calculated. Additionally, strains of Achromobacter xylosoxidans, Staphylococcus epidermidis, and Stenotrophomonas maltophilia were exposed to a single accelerated PACK-CXL protocol (intensity: 30 mW/cm2, total fluence: 15.0 J/cm2). Results With total fluences of 5.4, 10.0, and 15.0 J/cm2, the range of mean BKR for S. aureus was 45.78% to 50.91%, 84.13% to 88.16%, and 97.50% to 99.90%, respectively; the mean BKR for P. aeruginosa was 69.09% to 70.86%, 75.37% to 77.93%, and 82.27% to 91.44%, respectively. The mean BKR was 41.97% for A. xylosoxidans, 65.38% for S. epidermidis, and 78.04% for S. maltophilia for the accelerated PACK-CXL protocol (30 mW/cm2, 15 J/cm2). Conclusions The BKR of high-fluence PACK-CXL protocols can be accelerated while maintaining a high, but species-dependent, BKR. The Bunsen to Roscoe law is respected in fluences up to 10 J/cm2 in S. aureus and P. aeruginosa, whereas fluences above 10 J/cm2 show strain dependence. Translational Relevance The high-fluence PACK-CXL protocols can be accelerated in clinical practice while maintaining high levels of BKR.
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Affiliation(s)
- Nan-Ji Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China,School of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,ELZA Institute, Dietikon, Zurich, Switzerland
| | | | | | - Nikki Hafezi
- School of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,ELZA Institute, Dietikon, Zurich, Switzerland
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Adrian Egli
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Farhad Hafezi
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China,ELZA Institute, Dietikon, Zurich, Switzerland,Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland,USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Vanathi M, Naik R, Sidhu N, Ahmed NH, Gupta N, Tandon R. Evaluation of antifungal susceptibility and clinical characteristics in fungal keratitis in a tertiary care center in North India. Indian J Ophthalmol 2022; 70:4270-4283. [PMID: 36453329 PMCID: PMC9940598 DOI: 10.4103/ijo.ijo_855_22] [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] [Indexed: 12/12/2022] Open
Abstract
Purpose To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North Indian population. Methods Prospective study of the antifungal sensitivity testing (natamycin, amphotericin B, voriconazole, itraconazole, fluconazole, posaconazole, caspofungin, micafungin) of fungal isolates from 50 cases of culture positive fungal keratitis by using E test method. Details noted included demographic data, visual acuity, clinical details, grade of keratitis, healing time, and success in medical management. Results Of 50 patients with fungal keratitis (mean age: 40.28 ± 16.77 years), 12 eyes healed within 3 weeks, 14 had a delayed healing response, and 24 had chronic keratitis. Among the 15 cases of Fusarium isolates, 93.3% were sensitive to natamycin, while 40% to amphotericin B; 66.6% to voriconazole, 13.4% to itraconazole and fluconazole each. 80% of Fusarium cases (n = 12) showed susceptibility to posaconazole. Among Aspergillus flavus isolates, 53.4% (n = 8) were sensitive to natamycin, with only 40% (n = 7) showing sensitivity to amphotericin B and good susceptibility to azoles. MIC against susceptible Fusarium spp. for natamycin was 3-16 μg/mL, amphotericin B: 1-8 μg/mL, voriconazole: 0.5-1.5 μg/mL, itraconazole: 0.5-12 μg/mL, posaconazole: 0.094-1.5 μg/mL. MIC against Aspergillus flavus was natamycin: 8-32 μg/mL, amphotericin B: 0.5-16 μg/mL, voriconazole: 0.025-4 μg/mL, itraconazole: 0.125-8 μg/mL, posaconazole: 0.047-0.25 μg/mL; against Aspergillus niger isolates, to natamycin was 6 μg/mL (n=1), amphotericin B 8-12 μg/mL (n = 3), voriconazole: 0.125-0.19 μg/mL (n = 3), itraconazole: 0.38-0.75 μg/mL, posaconazole: 0.064-0.19 μg/mL and against Aspergillus fumigatus (n = 1), was natamycin4 μg/mL, amphotericin B - 8 μg/mL, voriconazole 0.25 μg/mL, itraconazole 1 μg/mL, and posaconazole 0.19 μg/mL. MIC against susceptible Acremonium spp. for natamycin was 1.5-16 μg/mL, amphotericin B: 0.5-8 μg/mL, voriconazole: 0.19-3 μg/mL, itraconazole: 0.125 μg/mL, posaconazole: 0.125-0.5 μg/mL and against susceptible Curvularia was natamycin 0.75-4 μg/mL, amphotericin B 0.5-1 μg/mL, voriconazole 0.125-0.19 μg/mL, itraconazole 0.047-0.094 μg/mL, posaconazole 0.047-0.094 μg/mL. MIC against Mucor spp.+ Rhizopus spp. (n = 1) was natamycin: 8 μg/mL, amphotericin B: 0.75 μg/mL, posaconazole: 1.5 μg/mL. MIC against of Alternaria (n = 1) was voriconazole: 0.19 μg/mL, posaconazole: 0.094 μg/mL. MIC against Penicillium (n=1) was natamycin: 8 μg/mL, voriconazole: 0.25 μg/mL, itraconazole: 0.5 μg/mL, and Posaconazole: 0.125 μg/mL. Conclusion Our observations highlight the variations in susceptibility to antifungal agents. Posaconazole seems to be effective with low MIC against common corneal pathogenic fungal isolates.
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Affiliation(s)
- Murugesan Vanathi
- Cornea, Lens and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Dr. Murugesan Vanathi, Professor of Ophthalmology Cornea and Ocular Surface, Cataract and Refractive Services Dr. R. P. Center for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| | - Ravinder Naik
- Cornea, Lens and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
| | - Navneet Sidhu
- Cornea, Lens and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
| | - Nishat Hussain Ahmed
- Ocular Microbiology Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea, Lens and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea, Lens and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
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Priyadarshini SR, Soni T, Sahu SK, Mohanty A, Sharma S, Mitra S, Ali MH, Das S. Acremonium keratitis: Risk factors, clinical characteristics, management, and outcome in 65 cases. Indian J Ophthalmol 2022; 70:3522-3527. [PMID: 36190039 PMCID: PMC9789801 DOI: 10.4103/ijo.ijo_659_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To study the risk factors, clinical presentation, management options, and outcomes in cases of culture-proven Acremonium keratitis. Methods Medical and microbiology records of culture-proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients. Results During the 13-year study period, 65 cases of culture-proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm2 at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60). Conclusion When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection.
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Affiliation(s)
| | - Tanvi Soni
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikant Kumar Sahu
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Amrita Mohanty
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Savitri Sharma
- Jhaveri Microbiology Center, Hyderabad, Telangana, India
| | - Sanchita Mitra
- Ocular Microbiology Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Mohammad Hasnat Ali
- Department of Biostatistics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India,Correspondence to: Dr. Sujata Das, Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha - 751 024, India. E-mail:
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27
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Goel S, Sharma A, Sinha R. Successful management of recalcitrant fungal keratitis with topical caspofungin. GMS OPHTHALMOLOGY CASES 2022; 12:Doc19. [PMID: 36299295 PMCID: PMC9577386 DOI: 10.3205/oc000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To report a case of recalcitrant fungal keratitis successfully managed with topical caspofungin acetate in North India. Methods Case report and literature review. Results An 18-year-old male patient presented with complaints of redness, watering, pain and diminution of vision in the right eye and was referred to our centre as a case of corneal ulcer. The patient was examined and found to have a near total epithelial defect, with corneal infiltrates approximately 8x8 mm. A provisional diagnosis of polymicrobial keratitis was made based on corneal scraping suggestive of S tap h ylococcus aureus and confocal scan revealing fungal hyphae. The patient failed to respond to topical voriconazole 1%, natamycin 5% and moxifloxacin hydrochloride 0.5% with oral voriconazole. In view of the poor response to these drugs, the patient was subsequently administered topical caspofungin 0.5% in place of natamycin and continued on topical and oral voriconazole, in addition to topical moxifloxacin and cycloplegics, which finally led to healing with minimal scarring. The patient attained a best corrected visual acuity (BCVA) of 6/12. Conclusion Topical caspofungin may be used as a useful and effective alternative in cases of recalcitrant fungal keratitis. It may result in healing with minimal scarring.
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Affiliation(s)
- Siddhi Goel
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Arpit Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,*To whom correspondence should be addressed: Rajesh Sinha, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi 110029, India, Phone: +91 9868937900, E-mail:
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28
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Polat HK, Kurt N, Aytekin E, Bozdağ Pehlivan S, Çalış S. Novel Drug Delivery Systems to Improve the Treatment of Keratitis. J Ocul Pharmacol Ther 2022; 38:376-395. [PMID: 35763406 DOI: 10.1089/jop.2021.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Keratitis is a disease characterized by inflammation of the cornea caused by different pathogens. It can cause serious visual morbidity if not treated quickly. Depending on the pathogen causing keratitis, eye drops containing antibacterial, antifungal, or antiviral agents such as besiloxacin, moxifloxacin, ofloxacin, voriconazol, econazole, fluconazole, and acyclovir are used, and these drops need to be applied frequently due to their low bioavailability. Studies are carried out on formulations with extended residence time in the cornea and increased permeability. These formulations include various new drug delivery systems such as inserts, nanoparticles, liposomes, niosomes, cubosomes, microemulsions, in situ gels, contact lenses, nanostructured lipid carriers, carbon quantum dots, and microneedles. Ex vivo and in vivo studies with these formulations have shown that the residence time of the active substances in the cornea is prolonged, and their ocular bioavailability is increased. In addition, in vivo studies have shown that these formulations successfully treat keratitis. However, it has been observed that fluoroquinolones are used in most of the studies; similar drug delivery systems are generally preferred for antifungal drugs, and studies for viral and acanthameba keratitis are limited. There is a need for new studies on different types of keratitis and different drug active substances. At the same time, proving the efficacy of drug delivery systems, which give promising results in in vivo animal models, with clinical studies is of great importance for progress in the treatment of keratitis.
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Affiliation(s)
- Heybet Kerem Polat
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Nihat Kurt
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Eren Aytekin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sibel Bozdağ Pehlivan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sema Çalış
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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Puri LR, Burn H, Roshan A, Biswakarma R, Burton M. Epidemiology and clinical outcomes of microbial keratitis in South East Nepal: a mixed-methods study. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001031. [PMID: 36161837 PMCID: PMC9214385 DOI: 10.1136/bmjophth-2022-001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the epidemiology of microbial keratitis in patients presenting to a tertiary eye hospital in South East Nepal alongside qualitative interviews exploring patient perspectives on barriers to accessing eye care services. Methods and analysis All patients with microbial keratitis (>16 years) presenting to Sagarmatha Choudhary Eye Hospital, Nepal between 1 May 2017 and 31 July 2017 were recruited. Data were collected on patient demographics, precipitating factors and pathway to care. Clinical examination was performed and microbiological samples collected. Visual acuity was measured at final follow-up. Semistructured interviews and focus group discussions explored the patient journey and barriers to accessing care. Results We recruited 174 participants; 88 (51%) were male (mean age of 47 years) and 126 (72%) were farmers. Ocular trauma with vegetative matter was reported by 79 (45%) and 84 (48%) had fungal infections. Visual acuity was <3/60 in 107 (61%) of affected eyes at presentation, reducing to 73 (42%) at last follow-up. Factors associated with poor visual outcome were trauma with vegetative matter, delayed presentation and poor visual acuity at presentation. Qualitative interviews with 40 patients identified lack of awareness of the disease and available services, poor knowledge and practice of community health workers and lack of affordability and accessibility of treatment as important barriers. Conclusion The epidemiology of microbial keratitis in this region was similar to other tropical regions. Patient interviews highlighted need for public health awareness campaigns on microbial keratitis, training of community health staff on the urgency of this condition and improvements in accessibility and affordability of ocular treatments.
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Affiliation(s)
- Lila Raj Puri
- The Fred Hollows Foundation, Alexandria, New South Wales, Australia
| | - Helen Burn
- London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | | | | | - Matthew Burton
- London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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30
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Tawde Y, Singh S, Das S, Rudramurthy SM, Kaur H, Gupta A, Kataki M, Gogoi P, Ghosh AK. Clinical and mycological profile of fungal keratitis from North and North-East India. Indian J Ophthalmol 2022; 70:1990-1996. [PMID: 35647967 PMCID: PMC9359279 DOI: 10.4103/ijo.ijo_1602_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary-care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations. Methods: All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts. Results: Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions. Conclusion: The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region-specific clinico-epidemiological profile.
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Affiliation(s)
- Yamini Tawde
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Sourav Das
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | | | - Harsimran Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Amit Gupta
- Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Mounjuri Kataki
- Department of Medical Microbiology, Dibrugarh Medical College, Assam, India
| | - Pranami Gogoi
- Department of Medical Microbiology, Dibrugarh Medical College, Assam, India
| | - Anup K Ghosh
- Department of Medical Microbiology, PGIMER, Chandigarh, India
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Redd TK, Prajna NV, Srinivasan M, Lalitha P, Krishnan T, Rajaraman R, Venugopal A, Acharya N, Seitzman GD, Lietman TM, Keenan JD, Campbell JP, Song X. Image-Based Differentiation of Bacterial and Fungal Keratitis Using Deep Convolutional Neural Networks. OPHTHALMOLOGY SCIENCE 2022; 2:100119. [PMID: 36249698 PMCID: PMC9560557 DOI: 10.1016/j.xops.2022.100119] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 01/02/2023]
Abstract
Purpose Develop computer vision models for image-based differentiation of bacterial and fungal corneal ulcers and compare their performance against human experts. Design Cross-sectional comparison of diagnostic performance. Participants Patients with acute, culture-proven bacterial or fungal keratitis from 4 centers in South India. Methods Five convolutional neural networks (CNNs) were trained using images from handheld cameras collected from patients with culture-proven corneal ulcers in South India recruited as part of clinical trials conducted between 2006 and 2015. Their performance was evaluated on 2 hold-out test sets (1 single center and 1 multicenter) from South India. Twelve local expert cornea specialists performed remote interpretation of the images in the multicenter test set to enable direct comparison against CNN performance. Main Outcome Measures Area under the receiver operating characteristic curve (AUC) individually and for each group collectively (i.e., CNN ensemble and human ensemble). Results The best-performing CNN architecture was MobileNet, which attained an AUC of 0.86 on the single-center test set (other CNNs range, 0.68-0.84) and 0.83 on the multicenter test set (other CNNs range, 0.75-0.83). Expert human AUCs on the multicenter test set ranged from 0.42 to 0.79. The CNN ensemble achieved a statistically significantly higher AUC (0.84) than the human ensemble (0.76; P < 0.01). CNNs showed relatively higher accuracy for fungal (81%) versus bacterial (75%) ulcers, whereas humans showed relatively higher accuracy for bacterial (88%) versus fungal (56%) ulcers. An ensemble of the best-performing CNN and best-performing human achieved the highest AUC of 0.87, although this was not statistically significantly higher than the best CNN (0.83; P = 0.17) or best human (0.79; P = 0.09). Conclusions Computer vision models achieved superhuman performance in identifying the underlying infectious cause of corneal ulcers compared with cornea specialists. The best-performing model, MobileNet, attained an AUC of 0.83 to 0.86 without any additional clinical or historical information. These findings suggest the potential for future implementation of these models to enable earlier directed antimicrobial therapy in the management of infectious keratitis, which may improve visual outcomes. Additional studies are ongoing to incorporate clinical history and expert opinion into predictive models.
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Affiliation(s)
- Travis K. Redd
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | | | | | | | - Tiru Krishnan
- Aravind Eye Hospital, Pondicherry, Tamil Nadu, India
| | | | | | - Nisha Acharya
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Gerami D. Seitzman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - J. Peter Campbell
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Xubo Song
- Department of Medical Informatics and Clinical Epidemiology and Program of Computer Science and Electrical Engineering, Oregon Health & Science University, Portland, Oregon
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Poudyal P, Singh SK, Rajbanshi A, Anwar A. Positive Microbiological Stains of Corneal Scrapings among Patients with Keratitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:546-550. [PMID: 35690971 PMCID: PMC9275455 DOI: 10.31729/jnma.7538] [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: 05/15/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Keratitis, an ocular emergency, requires rapid and accurate treatment to prevent vision impairment. Wet mount direct microscopy examination of corneal scraping smear using gram and 10% potassium hydroxide stain helps in early diagnosis and treatment. The main objective of this study was to find out the prevalence of positive microbiological stains of corneal scrapings among patients with keratitis in a tertiary care centre. Methods A descriptive cross-sectional study was conducted in the Department of Ophthalmic Pathology and Laboratory Medicine from January, 2018 to December, 2019. Data collection was done after taking ethical approval from the Institutional Review Committee of the hospital (Reference number: BEH-IRC-35/A). All corneal smear samples received in this department were included in this study. Case records with incomplete data were excluded. Whole sampling was done. The data were analyzed using Statistical Package for the Social Sciences version 22.0. Frequency and percentage was calculated for binary data. Results Among 4631 corneal scrapings, microbiological stains were positive in 3538 (76.40%) patients. Conclusions The prevalence of positive microbiological stains of corneal scrapings in our study was higher in comparison to other studies done in similar settings. This technique could be used where culture facilities are unavailable or unaffordable. Keywords keratitis; microscopy; Nepal.
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Affiliation(s)
- Prija Poudyal
- Department of Ophthalmic Pathology and Laboratory Medicine, Biratnagar Eye Hospital, Rani, Biratnagar, Morang, Nepal,Correspondence: Dr Prija Poudyal, Biratnagar Eye Hospital, Rani, Biratnagar, Morang, Nepal. , Phone: +977-9808200915
| | - Sanjay Kumar Singh
- Department of Cornea, Biratnagar Eye Hospital, Rani, Biratnagar, Morang, Nepal
| | - Amit Rajbanshi
- Department of Ophthalmic Pathology and Laboratory Medicine, Biratnagar Eye Hospital, Rani, Biratnagar, Morang, Nepal
| | - Afaque Anwar
- Department of Health Education, Biratnagar Eye Hospital, Rani, Biratnagar, Morang, Nepal
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Swift T, Pinnock A, Shivshetty N, Pownall D, MacNeil S, Douglas I, Garg P, Rimmer S. GENERATION AND USE OF FUNCTIONALISED HYDROGELS THAT CAN RAPIDLY SAMPLE INFECTED SURFACES. MethodsX 2022; 9:101684. [PMID: 35540105 PMCID: PMC9078998 DOI: 10.1016/j.mex.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
This paper outlined our method for developing polymer-linked contact lens type materials for rapid detection and differentiation of Gram-positive, Gram-negative bacteria and fungi in infected corneas. It can be applied to both model synthetic or ex-vivo corneal models and has been successfully trialed in an initial efficacy tested animal study. First a hydrogel substrate for the swab material is selected, we have demonstrated selective swabs using a glycerol monomethacrylate hydrogel. Alternatively any commercial material with carboxylic acid functional groups is suitable but risks nonspecific adhesion. This is then functionalised via use of N-hydroxysuccinimide reaction with amine groups on the specified highly branched polymer ligand (either individually gram negative, gram positive or fungal binding polymers or a combination of all three can be employed for desired sensing application). The hydrogel is then cut into swabs suitable for sampling, used, and then the presence of gram positive, game negative and fungi are disclosed by the sequential addition of dyes (fluorescent vancomycin, fluorescein isothiocyanate and calcofluor white). In summary this method presents: Method to produce glycerol monomethacrylate hydrogels to minimize nonspecific binding Methods of attaching pathogen binding highly branched polymers to produce selective hydrogel swabs Method for disclosing bound pathogens to this swab using sequential dye addition
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Affiliation(s)
| | | | | | | | | | | | | | - Stephen Rimmer
- University of Bradford, Bradford UK
- Corresponding author.
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O’Brien KS, Byanju R, Kandel RP, Poudyal B, Gonzales JA, Porco TC, Whitcher JP, Srinivasan M, Upadhyay M, Lietman TM, Keenan JD, Byanju R, Khadka KB, Bista D, Gautam M, Giri P, Kayastha S, Parajuli TP, Shah RK, Sharma N, Sharma P, Shrestha A, Shrestha M, Subedi P, Chaudhary DS, Ghimire R, Adhikari M, Hamal V, Bhandari G, Dahal G, Poudyal B, Bhandari S, Gurung J, Bhattarai D, Bhattarai R, Chapagain D, Chaudhary AK, Gautam SK, Gurau D, Kandel D, Lamichhane PC, Rijal R, Giri G, Upadhyay M, Lietman TM, Acharya NR, Gonzales JA, Keenan JD, McLeod SD, Ramirez DA, Ray KJ, Rose-Nussbaumer J, Whitcher JP, O'Brien KS, Cotter SY, Kim J, Lee S, Maamari RN, Porco TC, Basset K, Chase H, Evans L, Gilbert S, Kandel RP, Moses D, Tenzing C, Choudhary S, Dhakwa P, Fletcher DA, Reber CD. Village-integrated eye workers for prevention of corneal ulcers in Nepal (VIEW study): a cluster-randomised controlled trial. Lancet Glob Health 2022; 10:e501-e509. [PMID: 35303460 PMCID: PMC9814976 DOI: 10.1016/s2214-109x(21)00596-9] [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: 09/14/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Corneal ulcers are a common cause of blindness in low-income and middle-income countries, usually resulting from traumatic corneal abrasions during agricultural work. Antimicrobial prophylaxis of corneal abrasions can help prevent corneal ulcers, but delays in the initiation of therapy are frequent. We aimed to assess whether a community-based programme for corneal ulcer prevention would reduce the incidence of corneal ulceration. METHODS A cluster-randomised trial was performed in village development committees (VDCs) in Nepal. VDCs in the catchment area of Bharatpur Eye Hospital, Nepal with less than 15 000 people were eligible for inclusion. We randomly assigned (1:1) VDCs to either an intervention group or a control group. In the intervention VDCs, existing female community health volunteers (FCHVs) were trained to diagnose corneal abrasions and provide a 3-day course of ophthalmic antimicrobials to their patients. In the control VDCs, FCHVs did not provide this intervention. Participants were not masked given the nature of the intervention. Both groups were followed up for 3 years for photographic evidence of corneal ulceration. The primary outcome was the incidence of corneal ulceration, determined by masked assessment of corneal photographs. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01969786. FINDINGS We assessed 112 VDCs, of which 24 were enrolled. The study was performed between Feb 4, 2014, and Oct 20, 2017. 12 VDCs were randomly assigned to the intervention group and 12 to the control group. 252 539 individuals were included in the study (130 579 in the intervention group and 121 960 in the control group). FCHVs diagnosed and provided antimicrobials for 4777 corneal abrasions. The census identified 289 corneal ulcers among 246 893 person-years in the intervention group (incidence 1·21 cases [95% CI 0·85-1·74] per 1000 person-years) and 262 corneal ulcers among 239 170 person-years in the control group (incidence 1·18 cases [0·82-1·70] per 1000 person-years; incidence rate ratio 1·03 [95% CI 0·63-1·67]; p=0·93). Medication allergy was self-reported in 0·2% of participants. INTERPRETATION We did not detect a reduction in the incidence of corneal ulceration during the first 3 years of a community-based corneal ulcer prevention programme. Further study might be warranted in more rural areas where basic eye care facilities are not available. FUNDING National Eye Institute.
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Affiliation(s)
- Kieran S O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | | | - Ram Prasad Kandel
- Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal,Seva Foundation, Berkeley, CA, USA and Kathmandu, Nepal
| | | | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - John P Whitcher
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | | | - Madan Upadhyay
- BP Eye Foundation, Children’s Hospital for Eye, Ear, and Rehabilitation Services (CHEERS), Kathmandu, Nepal
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Sharma A, Sharma R, Nirankari VS. Voriconazole-impregnated multilayered AMT and intracorneal plus intracameral injection in recalcitrant fungal corneal ulcer. BMJ Case Rep 2022; 15:e246659. [PMID: 35351742 PMCID: PMC8966544 DOI: 10.1136/bcr-2021-246659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/03/2022] Open
Abstract
We describe the management of a referred man in his 50s with corneal ulcer in the left eye. Slit-lamp biomicroscopy revealed an infiltrate (4.5×3.5 mm), involving full corneal thickness, corneal melt less than one-third corneal thickness and hypopyon (3.0 mm). Branched septate hypha on direct microscopy and Aspergillus flavus in Sabaraud's dextrose agar confirmed the clinical diagnosis of fungal corneal ulcer. We used natamycin 5% suspension 1 hourly, voriconazole 1% 1 hourly, gatifloxacin 0.5% three times and atropine 1% three times per day, for 2 weeks. However, there was no improvement and the corneal melt increased. We used intracameral plus intracorneal voriconazole injection with voriconazole-impregnated amniotic membrane transplant. We observed a significant decrease in conjunctival congestion, size/depth of infiltrate and hypopyon at the first week of antifungal therapy. Subsequently, at 6 weeks, corneal infiltrate had decreased and superficial corneal vascularisation appeared. Later, at 12 weeks, the patient developed corneal opacity.
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Affiliation(s)
- Ashok Sharma
- Ophthalmology, Cornea Center, Chandigarh, India
- Dr Ashok Sharma's Cornea Centre, Chandigarh, India
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Absence of Streptococcus pneumoniae Capsule Increases Bacterial Binding, Persistence, and Inflammation in Corneal Infection. Microorganisms 2022; 10:microorganisms10040710. [PMID: 35456761 PMCID: PMC9025271 DOI: 10.3390/microorganisms10040710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
The role of the pneumococcal polysaccharide capsule is largely unclear for Streptococcus pneumoniae keratitis, an ocular inflammatory disease that develops as a result of bacterial infection of the cornea. In this study, capsule-deficient strains were compared to isogenic parent strains in their ability to adhere to human corneal epithelial cells. One isogenic pair was further used in topical ocular infection of mice to assess the contribution of the capsule to keratitis. The results showed that non-encapsulated pneumococci were significantly more adherent to cells, persisted in significantly higher numbers on mouse corneas in vivo, and caused significant increases in murine ocular IL9, IL10, IL12-p70, MIG, and MIP-1-gamma compared to encapsulated S. pneumoniae. These findings indicate that the bacterial capsule impedes virulence and the absence of capsule impacts inflammation following corneal infection.
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Wang LM, Yang H, Yan HJ, Ge RF, Wang YX, Xue SS, Li L, Lyu LY, Che CY. Thymol Protects against Aspergillus Fumigatus Keratitis by Inhibiting the LOX-1/IL-1β Signaling Pathway. Curr Med Sci 2022; 42:620-628. [PMID: 35292873 DOI: 10.1007/s11596-022-2512-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the anti-inflammatory effects and mechanisms of action of thymol in Aspergillus fumigatus (A. fumigatus) keratitis. METHODS The minimum inhibitory concentration of thymol against A. fumigatus was detected. To characterize the anti-inflammatory effects of thymol, mouse corneas and human corneal epithelial cells were pretreated with thymol or dimethyl sulfoxide (DMSO) before infection with A. fumigatus spores. Slit-lamp microscopy, immunohistochemistry, myeloperoxidase detection, quantitative real-time polymerase chain reaction, and Western blotting were used to assess infection. Neutrophil and macrophage recruitment, in addition to the secretion of LOX-1 and IL-1β, were quantified to evaluate the relative contribution of thymol to the inflammatory response. RESULTS We confirmed that the growth of A. fumigatus was directly inhibited by thymol. In contrast with the DMSO group, there was a lower degree of inflammation in the mouse corneas of the thymol-pretreated group. This was characterized by significantly lower clinical scores, less inflammatory cell infiltration, and lower expression of LOX-1 and IL-1β. Similarly, in vitro experiments indicated that the production of LOX-1 and IL-1β was significantly inhibited after thymol treatment, in contrast with the DMSO-pretreated group. CONCLUSION Our findings demonstrate that thymol exerted a direct fungistatic activity on A. fumigatus. Furthermore, thymol played a protective role in fungal keratitis by inhibiting LOX-1/IL-1β signaling pathway and reducing the recruitment of neutrophils and macrophages.
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Affiliation(s)
- Li-Mei Wang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Hua Yang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Hai-Jing Yan
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Rui-Feng Ge
- Department of Otorhinolaryngology-Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yun-Xiao Wang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Sha-Sha Xue
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Lin Li
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Le-Yu Lyu
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Cheng-Ye Che
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Khurana A, Kumar A, Chauhan L. Clinical profile and treatment outcomes of Fusarium keratitis. Indian J Ophthalmol 2022; 70:852-859. [PMID: 35225530 PMCID: PMC9114586 DOI: 10.4103/ijo.ijo_999_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis. Methods: A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019. Results: The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4–13.3; P = 0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9–71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis. Conclusion: Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.
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Affiliation(s)
- Ashi Khurana
- Department of Cornea and Anterior Segment Services, C L Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Ajit Kumar
- Department of Cornea and Anterior Segment Services, C L Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Lokesh Chauhan
- Department of Clinical and Public Health Research, C L Gupta Eye Institute, Moradabad, Uttar Pradesh, India
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Yarımada S, Barut Selver Ö, Palamar M, Eğrilmez S, Aydemir SŞ, Hilmioğlu Polat S, Yağcı A. Comparison of Culture-Positive and -Negative Microbial Keratitis. Turk J Ophthalmol 2022; 52:1-5. [PMID: 35196833 PMCID: PMC8876779 DOI: 10.4274/tjo.galenos.2021.98046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate and compare the risk factors, presenting features, and outcomes of patients with culture-positive and culturenegative microbial keratitis (MK) who presented to a tertiary referral center. Materials and Methods: We conducted a retrospective review of the medical records of 314 patients who were diagnosed with MK in our clinic between 2012 and 2019. Results: Among 314 patients, 142 had positive cultures (45.2%). The mean ages of the culture-positive and -negative patients at the time of diagnosis were 51.39±21.31 (range, 14-90) years and 56.68±21.34 (7-94) years, respectively (p=0.028). The mean best corrected visual acuity (BCVA) of the culture-positive and -negative patients were1.74±1.25 (0-3.1) LogMAR and 1.91±1.23 (0-3.1) LogMAR prior to treatment and increased to 1.21±1.30 (0-3.1) LogMAR and 1.27± 1.29 (0-3.1) LogMAR at last visit, respectively. There was no statistically significant difference between culture-positive and -negative patients’ BCVA levels at presentation or last visit. Ninety-two patients (64.7%) were infected with bacteria and 50 patients (35.2%) with fungi. The most common pathogen was Pseudomonas aeruginosa (18.3%), followed by Streptococcus pneumoniae (11.2%) and Fusarium spp. (11.2%). Keratitis foci were either centrally or paracentrally located in 105 eyes (73.9%) of culture-positive patients and 149 eyes (86.6%) of culture-negative patients. Multiple foci were present mostly in culture-positive patients (p=0.001). There was no significant difference between the culture-positive and -negative groups in terms of hypopyon presence (p=0.364). The proportion of contact lens (CL) wearers was 33% (n=47) among culturepositive MK patients and 13.3% (n=23) among culture-negative MK patients, respectively (p<0.001). Culture positivity was found to be significantly higher in keratitis associated with CL use (p=0.0001). Conclusion: Microbiological analysis and culture evaluation are important steps in order to manage proper treatment in microbial keratitis. Prognosis mostly depends on the infectivity of the microbiological agent.
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Affiliation(s)
- Semir Yarımada
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Özlem Barut Selver
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Melis Palamar
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Sait Eğrilmez
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | | | | | - Ayşe Yağcı
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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Hoffman JJ, Yadav R, Sanyam SD, Chaudhary P, Roshan A, Singh SK, Arunga S, Hu VH, Macleod D, Leck A, Burton MJ. Microbial Keratitis in Nepal: Predicting the Microbial Aetiology from Clinical Features. J Fungi (Basel) 2022; 8:jof8020201. [PMID: 35205955 PMCID: PMC8879647 DOI: 10.3390/jof8020201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Fungal corneal infection (keratitis) is a common clinical problem in South Asia. However, it is often challenging to distinguish this from other aetiologies, such as bacteria or acanthamoeba. In this prospective study, we investigated clinical and epidemiological features that can predict the microbial aetiology of microbial keratitis in Nepal. We recruited patients presenting with keratitis to a tertiary eye hospital in lowland eastern Nepal between June 2019 and November 2020. A structured assessment, including demographics, history, and clinical signs, was carried out. The aetiology was investigated with in vivo confocal microscopy and corneal scrape for microscopy and culture. A predictor score was developed using odds ratios calculated to predict aetiology from features. A fungal cause was identified in 482/642 (75.1%) of cases, which increased to 532/642 (82.9%) when including mixed infections. Unusually, dematiaceous fungi accounted for half of the culture-positive cases (50.6%). Serrated infiltrate margins, patent nasolacrimal duct, raised corneal slough, and organic trauma were independently associated with fungal keratitis (p < 0.01). These four features were combined in a predictor score. The probability of fungal keratitis was 30.1% if one feature was present, increasing to 96.3% if all four were present. Whilst microbiological diagnosis is the "gold standard" to determine the aetiology of an infection, certain clinical signs can help direct the clinician to find a presumptive infectious cause, allowing appropriate treatment to be started without delay. Additionally, this study identified dematiaceous fungi, specifically Curvularia spp., as the main causative agent for fungal keratitis in this region. This novel finding warrants further research to understand potential implications and any trends over time.
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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; (S.A.); (V.H.H.); (D.M.); (A.L.); (M.J.B.)
- Correspondence:
| | - Reena Yadav
- Sagarmatha Choudhary Eye Hospital, Lahan 56502, Nepal; (R.Y.); (S.D.S.); (P.C.); (A.R.); (S.K.S.)
| | - Sandip Das Sanyam
- Sagarmatha Choudhary Eye Hospital, Lahan 56502, Nepal; (R.Y.); (S.D.S.); (P.C.); (A.R.); (S.K.S.)
| | - Pankaj Chaudhary
- Sagarmatha Choudhary Eye Hospital, Lahan 56502, Nepal; (R.Y.); (S.D.S.); (P.C.); (A.R.); (S.K.S.)
| | - Abhishek Roshan
- Sagarmatha Choudhary Eye Hospital, Lahan 56502, Nepal; (R.Y.); (S.D.S.); (P.C.); (A.R.); (S.K.S.)
| | - Sanjay Kumar Singh
- Sagarmatha Choudhary Eye Hospital, Lahan 56502, Nepal; (R.Y.); (S.D.S.); (P.C.); (A.R.); (S.K.S.)
| | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (S.A.); (V.H.H.); (D.M.); (A.L.); (M.J.B.)
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Victor H. Hu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (S.A.); (V.H.H.); (D.M.); (A.L.); (M.J.B.)
| | - David Macleod
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (S.A.); (V.H.H.); (D.M.); (A.L.); (M.J.B.)
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Astrid Leck
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (S.A.); (V.H.H.); (D.M.); (A.L.); (M.J.B.)
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (S.A.); (V.H.H.); (D.M.); (A.L.); (M.J.B.)
- 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
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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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42
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Repeated High-Fluence Accelerated Slitlamp-Based Photoactivated Chromophore for Keratitis Corneal Cross-Linking for Treatment-Resistant Fungal Keratitis. Cornea 2022; 41:1058-1061. [DOI: 10.1097/ico.0000000000002973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
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43
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Arunachalam D, Ramanathan SM, Menon A, Madhav L, Ramaswamy G, Namperumalsamy VP, Prajna L, Kuppamuthu D. Expression of immune response genes in human corneal epithelial cells interacting with Aspergillus flavus conidia. BMC Genomics 2022; 23:5. [PMID: 34983375 PMCID: PMC8728928 DOI: 10.1186/s12864-021-08218-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background Aspergillus flavus, one of the causative agents of human fungal keratitis, can be phagocytosed by human corneal epithelial (HCE) cells and the conidia containing phagosomes mature into phagolysosomes. But the immunological responses of human corneal epithelial cells interacting with A. flavus are not clear. In this study, we report the expression of immune response related genes of HCE cells exposed to A. flavus spores using targeted transcriptomics. Methods Human corneal epithelial cell line and primary cultures were grown in a six-well plate and used for coculture experiments. Internalization of the conidia was confirmed by immunofluorescence microscopy of the colocalized endosomal markers CD71 and LAMP1. Total RNA was isolated, and the quantity and quality of the isolated RNA were assessed using Qubit and Bioanalyzer. NanoString nCounter platform was used for the analysis of mRNA abundance using the Human Immunology panel. R-package and nSolver software were used for data analysis. KEGG and FunRich 3.1.3 tools were used to analyze the differentially expressed genes. Results Different morphotypes of conidia were observed after 6 h of coculture with human corneal epithelial cells and found to be internalized by epithelial cells. NanoString profiling showed more than 20 differentially expressed genes in immortalized human corneal epithelial cell line and more than ten differentially expressed genes in primary corneal epithelial cells. Distinct set of genes were altered in their expression in cell line and primary corneal epithelial cells. KEGG pathway analysis revealed that genes associated with TNF signaling, NF-KB signaling, and Th17 signaling were up-regulated, and genes associated with chemokine signaling and B cell receptor signaling were down regulated. FunRich pathway analysis showed that pathways such as CDC42 signaling, PI3K signaling, and Arf6 trafficking events were activated by the clinical isolates CI1123 and CI1698 in both type of cells. Conclusions Combining the transcript analysis data from cell lines and primary cultures, we showed the up regulation of immune defense genes in A. flavus infected cells. At the same time, chemokine signaling and B cell signaling pathways are downregulated. The variability in the expression levels in the immortalized cell line and the primary cultures is likely due to the variable epigenetic reprogramming in the immortalized cells and primary cultures in the absence of any changes in the genome. It highlights the importance of using both cell types in host-pathogen interaction studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-08218-5.
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Affiliation(s)
- Divya Arunachalam
- Proteomics Department, Aravind Medical Research Foundation, Dr. G. Venkataswamy Eye Research Institute, Aravind Eye Care System, Madurai, Tamil Nadu, India.,Department of Biotechnology, Alagappa University, Karaikudi, Tamil Nadu, India
| | - Shruthi Mahalakshmi Ramanathan
- Proteomics Department, Aravind Medical Research Foundation, Dr. G. Venkataswamy Eye Research Institute, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Athul Menon
- Theracues Innovations Private Limited, Bangalore, India, Karnataka
| | - Lekshmi Madhav
- Theracues Innovations Private Limited, Bangalore, India, Karnataka
| | | | | | - Lalitha Prajna
- Department of Ocular Microbiology, Aravind Eye Hospital, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Dharmalingam Kuppamuthu
- Proteomics Department, Aravind Medical Research Foundation, Dr. G. Venkataswamy Eye Research Institute, Aravind Eye Care System, Madurai, Tamil Nadu, India. .,Department of Biotechnology, Alagappa University, Karaikudi, Tamil Nadu, India. .,Aravind Medical Research Foundation, Dr. G.Venkataswamy Eye Research Institute, Aravind Eye Care System, No.1 Anna Nagar, Madurai, Tamil Nadu, India.
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44
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Gupta A, Joshi G, Sengupta P. Demographical and etiological diagnosis of infective corneal ulcer in a tertiary care center in West Bengal: A cross-sectional study. KERALA JOURNAL OF OPHTHALMOLOGY 2022. [DOI: 10.4103/kjo.kjo_1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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45
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Gandhi A, Sabharwal S. Protocols involved in training allied ophthalmic personnel and setting up ocular microbiology laboratories in peripheral centers. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2022. [DOI: 10.4103/jcor.jcor_235_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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46
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Redd TK, Lalitha P, Prajna NV, Sikha M, Gunasekaran R, Hinterwirth A, Chen C, Zhong L, Liu Z, Lietman TM, Keenan JD, Doan T, Seitzman GD. Impact of Sample Collection Order on the Diagnostic Performance of Metagenomic Deep Sequencing for Infectious Keratitis. Cornea 2022; 41:39-44. [PMID: 34870622 PMCID: PMC8649208 DOI: 10.1097/ico.0000000000002766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this article was to evaluate the impact of sample collection order on the diagnostic yield of metagenomic deep sequencing (MDS) for determining the causative pathogen in infectious keratitis. METHODS We performed a cross-sectional diagnostic test evaluation among subjects with infectious keratitis at Aravind Eye Hospital in Madurai, India. All subjects underwent corneal scrapings of the affected eye to obtain potassium hydroxide smear, Gram stain, bacterial culture, and fungal culture, in this order. The order of MDS specimen collection relative to smear and culture samples was randomized and served as the primary predictor. Outcomes included the normalized copy number of pathogenic RNA detected by MDS, the proportion of MDS samples that were diagnostic, and the agreement of MDS results with cultures. RESULTS MDS samples from 46 subjects with corneal ulcers were evaluated. MDS was positive in 33 subjects (76%) and had 74% overall agreement with culture results. There was no association between order of MDS sample collection and normalized copy number of genetic material detected (P = 0.62) or the likelihood of MDS positivity (P = 0.46). However, the likelihood of agreement between MDS and cultures decreased when MDS corneal swabs were collected after other diagnostic corneal scrapings (P = 0.05). CONCLUSIONS The overall yield of MDS for detecting the cause of infectious keratitis was not affected by sample collection order. However, diagnostic agreement between MDS and cultures decreased when MDS samples were collected after other specimens. Additional investigation is warranted to determine whether this represents increased sensitivity of MDS compared with cultures or higher susceptibility to contaminants.
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Affiliation(s)
- Travis K. Redd
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
- Casey Eye Institute, Oregon Health & Science University, OR, USA
| | | | | | - Misra Sikha
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Cindi Chen
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Zijun Liu
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
| | - Gerami D. Seitzman
- Francis I. Proctor Foundation, University of California San Francisco, CA, USA
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47
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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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Kamath A, Pai A, Reddy JK. Nocardia Endophthalmitis- Prophylactic Prevention with an Innovative Approach. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Nocardia is a common cause of endophthalmitis in southern India. It is an aggressive disease with a poor prognosis.
Objective:
This study was conducted using an amikacin antibiotic in the drip irrigation of balanced saline solution (BSS) during the surgery to prophylactically study the occurrence of Nocardia endophthalmitis and any subsequent toxic effects of the antibiotics used.
Methods:
Prospective study period was of 6 months, starting from July to December-2018. Preoperative and postoperative specular counts and macular thickness using Ocular Coherence Tomography (OCT) were compared with any incidence of Nocardia endophthalmitis. A total of 500 patients operated for manual SICS were randomly assigned into 2 groups. The first group of 250 patients received antibiotic amikacin added to the Balanced Saline Solution (BSS) irrigating solution throughout the course of the surgery. The second control group received no antibiotics. Manual SICS was performed on all 500 patients by a single surgeon and was found to be uneventful. Pre- and postoperative corneal endothelial cell density and mean macular thickness using OCT were taken and recorded of all the patients, respectively, and data obtained were statistically compared.
Results:
No incidence of Nocardia endophthalmitis among the cataract surgeries operated was found. There was no drug-related toxicity to the cornea or macula. Furthermore, no incidence of Nocardia endophthalmitis has been reported since 2018 after using antibiotics.
Conclusion:
A simple routine of adding amikacin in the drip prophylactically during the course of surgery helped us prevent Nocardia endophthalmitis with no side effects. Also, it will be an innovative technique that is economically feasible and effective in regions where Nocardia endophthalmitis is prevalent.
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49
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Mabrouk NA, Abdelkader MF, Abdelhakeem MA, Mourad KM, Abdelghany AA. Epidemiology, clinical profile and treatment outcomes of bacterial and fungal keratitis. Int Ophthalmol 2021; 42:1401-1407. [PMID: 34839447 DOI: 10.1007/s10792-021-02128-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study is to determine the microbiological etiology, epidemiological factors, and clinical profile and treatment outcomes of infective keratitis in Ophthalmology department, Minia University, Egypt. METHODS Prospective, nonrandomized, observational clinical series of cases, including 150 patients with mean age 30 (range 12 to 85 years), 90 patients (60%) were males and 60 (40%) were females, clinically diagnosed as infective corneal ulcer, attending the Ophthalmology Department-Faculty of Medicine. Minia University, Minia, Egypt. From December 2018 to December 2020. Detailed history taking and all clinical findings were collected. Corneal scrapings were obtained from patients and subjected to staining and culture for bacterial and fungal pathogens; Bacterial and fungal growth were identified by standard laboratory procedures. RESULTS Corneal trauma by a vegetative matter was the commonest risk factor associated with infective keratitis in 92 cases (61.3%). Smear and culture was positive in 83 cases (58.4%) of 142 corneal scrapings obtained, of which 60 cases were fungal (72.3%), 21 cases were bacterial (25.3%) and two cases were mixed bacterial and fungal (2.4%), Aspergillus species was the commonest fungal species isolated in fungal keratitis. One hundred forty-two cases (94.67%) healed completely with scar. Only six cases (4%) required evisceration due to aggressive presentation from the start and keratoplasty was performed for two cases (1.33%). CONCLUSIONS Fungal keratitis was the commonest type in cases attending to our department. Adequate diagnosis, management and follow-up helped in achieving high successful curative outcomes. CLINICAL TRIAL NUMBER Clinical Trials.gov ID: NCT04894630. Time of registration 1 December 2018.
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Affiliation(s)
| | | | | | - Khaled M Mourad
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, 61111, Egypt
| | - Ahmed A Abdelghany
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, 61111, Egypt.
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50
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Singh RB, Das S, Chodosh J, Sharma N, Zegans ME, Kowalski RP, Jhanji V. Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis. Prog Retin Eye Res 2021; 88:101028. [PMID: 34813978 DOI: 10.1016/j.preteyeres.2021.101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we are expeditiously developing our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we have provided an overview of the established classical diagnostic techniques and therapeutics for keratitis caused by various bacteria. We have extensively reported our recent in-roads through novel tools for accurate diagnosis of mono- and poly-bacterial corneal infections. Furthermore, we outlined the recent progress by our group and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discussed in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Leiden University Medical Center, 2333, ZA Leiden, the Netherlands
| | - Sujata Das
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneshwar, India
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Michael E Zegans
- Department of Ophthalmology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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