Aspergillus fumigatus ; Cytokines ; Humans ; Interleukin-1beta ; Keratitis ; Receptors, IgE ; Tumor Necrosis Factor-alpha ; Tumor Necrosis Factors

BACKGROUND: Fungal keratitis is common cause of corneal infection. If not diagnosed and treated promptly and effectively, significant damage can occur. OBJECTIVE: To investigate the clinical manifestations and risk factors for treatment failure in fungal keratitis. METHODS: A total of 23 patients with fungal keratitis, who were diagnosed by clinical findings, smears, and cultures and followed up for at least 6 months, were studied retrospectively. Age, sex, previous history of trauma, corticosteroid use, previous ocular disease and surgery, systemic diseases, causative organism, features of keratitis, and treatment results were reviewed. A logistic regression analysis was performed to identify the prognostic risk factors. RESULTS: Thirteen patients (57%) were male and mean age was 57 +/- 18 years. Trauma with vegetable matter (30%) was most commonly noted. The causative organisms were identified in 18 eyes (78%) and Aspergillus sp. (7 eyes, 30%) was the most common detected followed by Candida sp. (6 eyes, 26%), Fusarium sp. (3 eyes, 13%) and Penicillium sp. (2 eyes, 9%). A lesion located in the central area was 13 eyes (57%) and exceeding 10 mm2 in size was 15 eyes (65%). Hypopyon was found in 7 eyes (30%). Treatment failed in 9 eyes (39%), and predictor of treatment failure was a lesion exceeding 10 mm2 (p < 0.05). CONCLUSION: Risk factor for treatment failure included a large lesion size. Therefore, an effort should be made to discern the clinical features of fungal keratitis and to determine appropriate early treatment for a successful treatment outcome.
Aspergillus ; Candida ; Fusarium ; Humans ; Keratitis* ; Logistic Models ; Male ; Penicillium ; Retrospective Studies ; Risk Factors* ; Treatment Failure* ; Treatment Outcome ; Vegetables

BACKGROUNDHypopyon is common in eyes with fungal keratitis. The evaluation of the clinical features, culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions.

METHODSThe medical records of 1066 inpatients (1069 eyes) with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings and treatment outcomes. The incidence of hypopyon, the fungal culture positivity for hypopyon, risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined.

RESULTSWe identified 1069 eyes with fungal keratitis. Of the 850 fungal culture-positive eyes, the Fusarium species was the most frequent (73.6%), followed by Alternaria (10.0%) and Aspergillus (9.0%). Upon admission, 562 (52.6%) eyes with hypopyon were identified. The hypopyon of 66 eyes was evaluated via fungal culturing, and 31 eyes (47.0%) were positive. A total of 194 eyes had ocular hypertension, and 172 (88.7%) of these eyes had hypopyon (P < 0.001). Risk factors for incident hypopyon included long duration of symptoms (P < 0.001), large lesion size (P < 0.001) and infection caused by the Fusarium and Aspergillus species (P < 0.001). The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size. Surgical intervention was more common in cases with hypopyon (P < 0.001). Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation (P = 0.002).

CONCLUSIONSHypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension. About half of the hypopyon cases were positive based on fungal culture. Long duration of symptoms, large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon. The presence of hypopyon increases the likelihood of surgical intervention.

Adult ; Anterior Chamber ; pathology ; Aspergillus ; pathogenicity ; Eye Infections, Fungal ; microbiology ; surgery ; Female ; Fusarium ; pathogenicity ; Humans ; Keratitis ; microbiology ; surgery ; Male ; Microscopy, Confocal ; Middle Aged ; Retrospective Studies ; Risk Factors ; Treatment Outcome

BACKGROUNDFungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0.25% terbinafine eye drops comparing with 5% natamycin suspension on fungal keratitis.

METHODSA retrospective clinical trial was performed on 90 patients presenting with direct smear and/or culture positive fungal keratitis at Beijing Tongren Hospital, Beijing, China from January 2006 to May 2008. Corneal ulcers were categorized as mild or severe. Forty-five patients were treated with topical terbinafine and the next 45 cases received topical natamycin hourly.

RESULTSFilamentous fungi were found in corneal scrapings among all 90 cases. Fungal cultures were positive in 64 patients (71%). Species of Fusarium and Aspergillus were the principal isolates. Forty (89%) patients showed favorable response to terbinafine, while forty-two (93%) patients exhibited favorable response to natamycin (P > 0.05). The mean course of treatment was significantly showed in the terbinafine treatment group than natamycin group ((26.5 +/- 11.2) days versus (19.3 +/- 6.4) days; P < 0.05). In terbinafine group, twenty patients with ulcers smaller than 4 mm had favorable outcome, while 20 of 25 patients with ulcers more than 4 mm in diameter had favorable response (P < 0.05). Twenty-seven patients with depth of infiltration less than half of stroma thickness had favorable response to terbinafine, while 13 of 18 patients with depth of infiltration more than half of stroma responded to terbinafine. This difference was statistically significant (P < 0.05).

CONCLUSIONSOur findings suggest that topical terbinafine is an effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases with smaller and shallower ulcers. Its mean duration of treatment was longer than natamycin.

Antifungal Agents ; therapeutic use ; Aspergillus ; isolation & purification ; physiology ; Fusarium ; isolation & purification ; physiology ; Humans ; Keratitis ; drug therapy ; microbiology ; Naphthalenes ; therapeutic use ; Natamycin ; therapeutic use ; Retrospective Studies ; Treatment Outcome

PURPOSE: To present a case report of fungal keratitis related to prolonged overnight use of orthokeratology contact lenses. METHODS: A 13 year-old girl presented with a corneal ulcer in her left eye refractory to antibacterial medication. She had a history of wearing orthokeratology contact lenses overnight for seven months. RESULTS: The organism Aspergillus was isolated by corneal scraping, the contact lens itself, and from the storage case. The patient was treated with topical fluconazole and Natamycin pimaricin in addition to oral itraconazole, resulting in a resolution of the ocular lesion. CONCLUSIONS: The risk of fungal infection as a potential complication of the use of overnight orthkeratology contact lenses should be considered when using these lenses.
Aspergillus ; Contact Lenses ; Corneal Dystrophies, Hereditary ; Corneal Ulcer ; Eye ; Fluconazole ; Humans ; Itraconazole ; Keratitis ; Keratomileusis, Laser In Situ ; Natamycin

PURPOSE: To present a case report of fungal keratitis related to prolonged overnight use of orthokeratology contact lenses. METHODS: A 13 year-old girl presented with a corneal ulcer in her left eye refractory to antibacterial medication. She had a history of wearing orthokeratology contact lenses overnight for seven months. RESULTS: The organism Aspergillus was isolated by corneal scraping, the contact lens itself, and from the storage case. The patient was treated with topical fluconazole and Natamycin pimaricin in addition to oral itraconazole, resulting in a resolution of the ocular lesion. CONCLUSIONS: The risk of fungal infection as a potential complication of the use of overnight orthkeratology contact lenses should be considered when using these lenses.
Adolescent ; Aspergillus ; Contact Lenses ; Corneal Ulcer ; Female ; Fluconazole ; Humans ; Itraconazole ; Keratitis* ; Natamycin

PURPOSE: To measure the secretion of IL-8 from cultured human keratocytes after inoculation of conidia of A. fumigatus, and to compare the change of secretion of IL-8 following application of amphotericin B and dexamethasone. METHODS: Human corneal keraoctytes were cultured independently in vitro. The specimens were divided into 4 groups : Group I with only pure culture as control, Group II with conidia of A. fumigatus, Group III with conidia of A. fumigatus and amphotericin B, and Group IV with conidia of A. fumigatus and dexamethasone. The supernatants were aspirated from each group at different time intervals, and then were assayed for IL-8. RESULTS: Group II showed increased secretion of IL-8, at all selected time intervals except 12-h, in comparison with other three groups. Group III secreted IL-8 significantly less than the other groups(p<0.01). Group IV secreted IL-8 less than Group I and II at all selected time points(p<0.01), but more than Group III at the other time points except for 72-h(p<0.01). CONCLUSIONS: The secretion of IL-8 increased in the early stage of fungal keratitis but decreased in case of the administration of amphotericin B or dexamethasone. Amphotericin B was more potent than dexamethasone in decreasing the secretion of IL-8.
Amphotericin B* ; Aspergillus fumigatus* ; Aspergillus* ; Dexamethasone* ; Humans* ; Interleukin-8* ; Keratitis ; Spores, Fungal

Fungal corneal ulcer could lead to a devastating outcome. The relative scarcity of readily available, inexpensive but effective topical antifungal drug has left many ophthalmologists desperate and frustated in treating the condition. The use of oral itraconazole has long been proven to be of clinical value in a number of forms of mycoses. Its safety profile is extremely good with minimal reported adverse effects. We investigated an aqueous form of itraconazole which we prepared into a 0.1 mg/ml concnetration and compared its efficacy as a topical antifungal against the standard drug. Natamycin 5 percent in the treatment of fungal keratitis in rabbits. A randomized animal trial was done using 24 rabbit eyes divided into 2 treatment groups. All rabbit corneas were inoculated with Aspergillus flavus and treated after 48 hours with either Topical itraconazole or Natamycin 5 percent for a period of 2 weeks. Results showed inhibition of the disease with both treatment groups. We also found no significant difference between the severity, progression and remission of the keratitis between both treatment groups clinically and statistically. Topical itraconazole 0.1 mg/ml was shown to be comparable to our standard topical antifungal Natamycin 5 percent in treating fungal keratitis. (Author)
Animal ; ASPERGILLUS KERATITIS ; OPHTHALMOLOGY ; ASPERGILLUS FLAVUS ; NATAMYCIN ; ITRACONAZOLE ; FUNGAL CORNEAL ULCER ; FUNGAL KERATITIS

Fungal keratitis, one of devastating microbial keratitis, is difficult to diagnose and treat successfully. The authors performed prospectively an epidemiological study in Korea to identify the risk factors and to evaluate clinical manifestations, methods and results of treatment in fungal keratitis under the identical protocol from April 1995 to September 1999. Logistic regression analysis was used to evaluate possible risk factors. Sixty eight cases of fungal keratitis, which were identified by culture with corneal scraping or corneal biopsy and reported in 22 hospitals, were studied. The major causative organisms were Fusarium spp.(20 cases), Aspergillus spp.(17 cases), and Candida spp.(11 cases). The principal risk factors of fungal keratitis identified in this study were farmer, use of long-standing topical corticosteroids, and diabetes mellitus. Old age and corneal trauma with vegetable matters were the associated factors in fungal keratitis. Further evaluation of the risk factors and the establishment of the prevention in fungal keratitis are required.
Adrenal Cortex Hormones ; Aspergillus ; Biopsy ; Candida ; Diabetes Mellitus ; Epidemiologic Studies ; Epidemiology* ; Fusarium ; Keratitis* ; Korea* ; Logistic Models ; Prospective Studies ; Risk Factors ; Vegetables

Stenotrophomonas maltophilia keratitis is rare and none of it has been reported to be combined with Aspergillus keratitis.I have experienced a corneal ulcer caused by combined infection of S.maltophilia and A. fumigatus.S. maltophilia was grown on culture and a brownish pigmented anterior chamber mass containing filamentous fungi was attached to corneal ulcer area endothelium without the usual filamentous fungal keratitis findings such as feathery edge, satellite lesions, endothelial plaques, etc. A spergillusfumigatus was grown on culture of abscess which developed along the superior incision for removal of anterior chamber mass.
Abscess ; Anterior Chamber ; Aspergillus fumigatus* ; Aspergillus* ; Corneal Ulcer* ; Endothelium ; Fungi ; Keratitis ; Stenotrophomonas maltophilia* ; Stenotrophomonas*