BACKGROUNDThis study was to review the distribution and shifting trend of fungal of culture specimens isolated from eyes of patients at the Beijing Institute of Ophthalmology, Tongren Hospital, Beijing, China.

METHODSThe fungal culture-positive rate, the distribution and change of isolates of 2609 specimens collected in a 12-year period (1989 - 2000) were retrospectively analyzed.

RESULTSIn 775 positive cultures, 707 specimens (91.2%) were from the cornea, 22 (2.8%) from the conjunctiva, 15 (1.9%) from the anterior chamber, 9 (1.2%) from the vitreous body, 3 (0.4%) from the lacrimal sac, and 19 (2.5%) from other parts of the eye. The average culture-positive rate was 29.7%. The ratio of the positive cultures in the first half year (from January to June) to those in the second half (from July to December) was 1:2.1. The main genus cultured was Fusarium sp (58.7%), followed by Aspergirum sp (16.8%). The percentage of Fusarium sp was increased from 53.6% (1989 - 1994) to 60.2% (1995 - 2000), whereas the percentage of Aspergirum sp was decreased from 22.3% (1989 - 1994) to 15.1% (1995 - 2000).

CONCLUSIONSFusaruim sp is one of the most predominant pathogens of ocular fungal infection in northern China and its incidence tends to increase, but that of Aspergirum sp to decrease. It is very important to recognize the distribution and shifting trend of pathogenic fungi in the diagnosis, prevention and treatment of fungal keratitis.

Aspergillus ; isolation & purification ; Eye Infections, Fungal ; etiology ; Fusarium ; isolation & purification ; Humans ; Retrospective Studies ; Time Factors

The genus Alternaria contains several species of melanized hypomycetes that cause opportunistic human infections. The most frequent clinical manifestations of alternariosis are cutaneous and subcutaneous infections, followed by oculomycosis, invasive and non-invasive rhinosinusitis, and onychomycosis. So far, only 17 cases of rhinosinusitis caused by Alternaria species have been reported since 1977. Although several domestic cases of cutaneous alternariosis have been reported, there is no report of Alternaria rhinosinusitis in Korea. The majority of Alternaria rhinosinusitis involves immunocompromised patients. We report the first case of alternariosis in a patient with neutropenia and myelodysplastic syndrome that was treated with endoscopic debridement and a conventional antifungal agent.
Alternaria ; Alternariosis ; Debridement ; Eye Infections, Fungal ; Humans ; Immunocompromised Host ; Korea ; Myelodysplastic Syndromes ; Neutropenia ; Onychomycosis ; Sinusitis

PURPOSE: To describe the successful treatment of a series of fungal ocular infections with voriconazole. METHODS: A retrospective chart review was conducted for six eyes of five patients: four eyes of four patients with fungal keratitis, and two eyes of one patient with fungal endophthalmitis who were treated with topical and intracameral voriconazole. A battery of analyses on corneal isolates, clinical outcomes, duration of treatment, time to remission, complications, concomitant medication, and visual acuity at the initial and last visits was performed. RESULTS: Six eyes of five patients were treated in total. Three eyes with fungal keratitis were treated with 5% topical voriconazole, and infection was controlled. Therapeutic penetrating keratoplasty was performed on one eye with fungal keratitis due to impending corneal perforation; this eye was treated successfully with topical voriconazole without recurrent inflammation. Both eyes of one patient with fungal endophthalmitis were given an intracameral voriconazole (100 microgram/0.1 cc) injection twice in the right eye and once in the left eye, and infection was controlled with continued topical voriconazole therapy. There was no clinically remarkable corneal epithelial toxicity from topical application. No corneal endothelial toxicity was observed after an intracameral injection of voriconazole. CONCLUSIONS: Voriconazole is known to penetrate efficiently into ocular tissues. As shown in our case series, voriconazole is a new, promising therapy for intractable fungal ocular infection.
Endophthalmitis ; Eye ; Eye Infections, Fungal ; Humans ; Inflammation ; Keratitis ; Keratoplasty, Penetrating ; Pyrimidines ; Retrospective Studies ; Time-to-Treatment ; Triazoles ; Visual Acuity

INTRODUCTIONThis study was conducted to determine the epidemiological pattern and risk factors associated with corneal ulcers in rural areas of western Maharashtra, India, and to identify the bacterial and fungal agents responsible for causing keratitis.

METHODSA total of 852 patients with corneal ulceration were included in the study. Sociodemographic data and information pertaining to risk factors were collected. Corneal scrapings obtained from these patients were processed for bacterial and fungal agents using standard techniques.

RESULTSOut of the 852 patients studied, 537 (63.02%) were culture positive. A majority of the culture-positive patients were farmers (52.32%), and ocular trauma was the most common predisposing factor (60.15%). Among these patients, fungal isolates (57.91%) were more frequent than bacterial isolates (42.08%). The most common fungal isolate was Fusarium spp. (35.04%) followed by Aspergillus spp. (18.00%). Streptococcus pneumoniae was the predominant bacterial isolates (32.74%) followed by Staphylococcus spp. (17.25%).

CONCLUSIONCorneal trauma from plant parts or organic matter was found to be the most common risk factor associated with corneal ulceration in the rural areas of western Maharashtra. Epidemiology and aetiology of microbial keratitis vary from region to region, and therefore, careful history taking and proper identification of aetiological agents are necessary for the institution of appropriate therapy.

Adult ; Cornea ; microbiology ; Corneal Ulcer ; epidemiology ; microbiology ; Eye Infections, Bacterial ; epidemiology ; microbiology ; Eye Infections, Fungal ; epidemiology ; microbiology ; Female ; Hospitals, Rural ; Humans ; India ; epidemiology ; Male ; Risk Factors ; Young Adult

INTRODUCTIONCorneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management. This study analyses the prevalence, microbiology, demography, therapeutic and visual outcome of infectious microbial keratitis in the paediatric age group seen at a tertiary eye care hospital in south India.

MATERIALS AND METHODSA retrospective review of all cases presenting with keratitis to the ocular microbiology and cornea service at Aravind Eye Hospital, Coimbatore, from February 1997 to January 2004, was done to screen the patients for microbial keratitis. Their records were further analysed for clinical and microbiological details. Cases with culture-proven non-viral keratitis in children

RESULTSOf the 310 patients who attended the cornea clinic, 97 (31.2%) patients were confirmed to be positive for microbial keratitis. 54.6% of cases were male. The most common predisposing cause of ulceration was trauma (69%) with organic matter. Pure bacterial cultures were obtained from 64 (65.9%) eyes, whereas pure fungal cultures were obtained from 37 (38.1%) eyes. Four (4.1%) eyes showed mixed growth.

CONCLUSIONThe most commonly isolated organism was Pseudomonas aeruginosa. The most common predisposing cause of infectious microbial keratitis was corneal trauma. Early stage of diagnosis and formulation of an uncompromising management protocol can prevent profound visual morbidity.

Adolescent ; Child ; Child, Preschool ; Eye Infections, Bacterial ; diagnosis ; therapy ; transmission ; Eye Infections, Fungal ; diagnosis ; therapy ; transmission ; Female ; Humans ; India ; Infant ; Keratitis ; diagnosis ; etiology ; microbiology ; therapy ; Male

Adult ; Antifungal Agents ; therapeutic use ; Eye Infections, Fungal ; diagnosis ; drug therapy ; Humans ; Keratitis ; diagnosis ; drug therapy ; Male

OBJECTIVETo analyze the epidemiological and etiologic characteristics of ocular fungal infection in Haikou.

METHODSThe samples of corneal, conjunctivae, anterior chambers, lacrimal sacs were taken from the outpatients and inpatients in the Department of Ophthalmology for fungal culture. The positivity rates of fungal culture were statistically analyzed to describe the seasonal and genus distribution of the fungal infections.

RESULTSA total of 683 patients were involved in this study, and the total positivity rate of fungal culture was 27.96%. The positivity rate was 33.42% in male patients and 21.52% in female patients (P<0.01). The positivity rates were 31.42%, 11.32%, 10.81%, 21.28% and 29.17% in the cornea, conjunctivae, anterior chambers, lacrimal sacs and other locations (P<0.01), and were 34.88%, 22.58%, 11.76%, 4.11%, 21.43% and 13.33% in farmers, workers, teachers, government officers, students and personnel of other occupations (Chi2=39.550, P=0.001), respectively. In terms of age, the rate was 32.30% in 21-40 years group, 31.72% in 41-60 years group, 17.12% in over 60 years group and 26.61% in below 20 years group, showing significant differences (P<0.01). The rates were higher in August, September, October, December, November, all above 30%, but lower in March. Nine genera were identified, including Candida (49.21%), Aspergillus (19.37%), Fusarium (9.42%), mucor (5.76%), Actinomyces (5.24%), Penicillium (3.66%), Saccharomyces (2.62%), non-spore group (1.57%), Alternaria (1.57%), and other genera (1.57%). Among the 94 strains of Candida, 63 (67.02%) belonged to Candida albicans and 14 to Candida tropicalis (14.89%).

CONCLUSIONOcular fungal infection occurs more often in male patients and in the cornea. The common pathogen of ocular fungal infection is Candida, which is different from the etiological characteristics in other areas possibly in association with the tropical climate.

Adult ; Candida albicans ; isolation & purification ; China ; epidemiology ; Eye Infections, Fungal ; epidemiology ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Endophthalmitis ; diagnosis ; drug therapy ; etiology ; Eye Infections, Fungal ; diagnosis ; drug therapy ; etiology ; Humans ; Infant, Newborn ; Infant, Premature ; Male

PURPOSE: To evaluate the factors affecting treatment outcome of graft infection following penetrating keratoplasty (PKP). METHODS: In this retrospective study, 28 patients who underwent PKP between January 2005 and January 2013 and who were diagnosed with graft infection were classified into a treatment success group or a treatment failure group. Demographic and clinical characteristics, as well as the results of the microbiologic investigation, were analyzed and compared. A subsequent binary logistic regression analysis was performed to identify the prognostic factors affecting treatment outcome. RESULTS: Graft infection occurred at a mean of 38.29 +/- 36.16 months (range, 1 to 96 months) after PKP. Seventeen patients developed bacterial keratitis, and 11 patients developed fungal keratitis. Overall, of the 28 patients, nine (32.1%) were classified in the treatment failure group. Multivariate analysis identified pre-existing graft failure (p = 0.019), interval longer than 72 hours between donor death and PKP (p = 0.010), and fungal infection (p = 0.026) as significant risk factors for treatment failure. CONCLUSIONS: Pre-existing graft failure, extended interval between donor death and PKP, and fungal infection were important risk factors for treatment failure of graft infection following PKP.
Adult ; Aged ; Aged, 80 and over ; Eye Infections, Bacterial/diagnosis/*etiology ; Eye Infections, Fungal/diagnosis/*etiology ; Female ; *Graft Survival ; Humans ; Keratoplasty, Penetrating/*adverse effects ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection/diagnosis/*etiology ; Treatment Outcome

In recent years, numerous cases of intraocular fungal infections have been reported. Mycotic infections of eyes have occurred after surgery, trauma, and topical antibiotics or cortisone therapy, which are considered the infections produced by exogenous origin. To know ocular mycotic infection, the normal fungal flora of the eyes becomes extremely important, because these organisms may be the source of the infection. We cultured, fungi from normal conjunctival sac by Sabouraud glucose agar media at Chonnam National University Hospital and the results obtained as follows. The results were as follows: 1. The mycotic flora of the conjunctival sac was investigated in following five groups: group I: neonates to less than 2months of eyes(44 cases), group II: 2 months to 19 years(34 cases), group III: 20 to 39 years(84 cases), group IV: 40 years and over(95 cases), group V: controls(257 cases). 2. Positive cultures were observed in 13.2% of total cases. Cultures from the group I were positive in 2 cases(4.5%), the group II were positive in 8 cases (3.5%), the group III were positive in 9 cases(10.7%), and the group IV were positive in 15 cases(15.8%). The lowest positivity(4.5%) was observed in the group I, and the highst(23.5%) in the group II. 3. There was no significant differences in positive culture rate between male and female group, as 11.4% in male and 15.4% in female group. 4. Fungi cultured were identified as the following species: Penicillium SP.(8 cases), Aspergillus SP.(6 cases), Candida SP.(6 cases), Mucor SP.(6 cases), Trichophyton(5 cases) and Cephalosporium SP.(3 cases).
Acremonium ; Agar ; Anti-Bacterial Agents ; Aspergillus ; Candida ; Cortisone ; Eye Infections, Fungal ; Female ; Fungi ; Glucose ; Humans ; Infant, Newborn ; Jeollanam-do ; Male ; Mucor ; Penicillium ; Trichophyton