Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia

Xuan, Rachel; Hong, Sheng Chiong; Trinh, Tanya; Coroneo, Minas T.; Petsoglou, Constantinos

doi:10.3390/jof9050589

Cited by 3 publications

(1 citation statement)

References 58 publications

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“…Overall however, the median age of all patients (34 years) with a slight male predominance (56%) was similar to a previous study from tropical North Queensland [3]. One of the other notable observations in our study was the wide variety and differences in fungal pathogens when compared to other Australian single-location series [10]. Fungal keratitis is more common in tropical regions, and most cases have been attributed to Fusarium spp.…”

Section: Discussionsupporting

confidence: 86%

Fungal Keratitis, Epidemiology and Outcomes in a Tropical Australian Setting

Kim,

Karthik,

Proudmore

et al. 2024

TropicalMed

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Background: Fungal keratitis is an ophthalmic emergency that can cause visual impairment and blindness. We reviewed the epidemiology and clinical features of fungal keratitis in a tropical Australian setting. Objectives: To document the clinical and microbiological characteristics of fungal keratitis in an Australian tropical setting. Methods: A retrospective cohort study of patients with fungal keratitis from October 2014 to December 2022 was conducted at Royal Darwin Hospital, Northern Territory, Australia. We reviewed all patients with culture-proven fungal keratitis and their outcomes. Results: There were 31 patients identified. Aboriginal and Torres Strait Islander (ATSI) patients were of a significantly younger median age (28 years) compared to non-ATSI patients (42 years), and they also presented later to health care. Contact lens use and ocular trauma were the most common predisposing factors. Most patients presented with a corneal infiltrate and corneal epithelial defect, and the central visual axis was affected in 54% of patients. Curvularia spp. and Fusarium spp. were the commonest causative fungi (39% and 30% respectively). Conclusions: Our series is different and reveals a wider range of fungal species identified over the 7 years of the study, in particular, a range of Curvularia spp. were detected. Access to eye health services in rural and remote settings is important, particularly for ATSI patients, as morbidity remains high.

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Section: Discussionsupporting

confidence: 86%

Fungal Keratitis, Epidemiology and Outcomes in a Tropical Australian Setting

Kim,

Karthik,

Proudmore

et al. 2024

TropicalMed

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Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections

Neoh,

Chen,

Lanternier

et al. 2024

Clin Microbiol Rev

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SUMMARY Although Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.

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Fungal Keratitis in Northwestern Spain: Epidemiology, Risk Factors and Outcomes

Lamas-Francis,

Navarro,

Mansilla

et al. 2024

JoF

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Purpose: To review the clinical features, risk factors, microbiological profile, and treatment regimens of fungal keratitis in Galicia, a region in Northwestern Spain with temperate humid weather. Patients and methods: A retrospective case series was employed, including patients with fungal keratitis from nine hospitals within the region of Galicia, Spain, between 2010 and 2020. Data obtained from clinical records were analysed. Results: Out of 654 cases of infectious keratitis, 77 cases (9.9%) were identified as fungal keratitis. The median age of affected patients was 68.0 years, with a higher incidence in rural areas (62.3%). Candida spp. infections were the most frequent type (55.8%) and were associated with a higher median age than were the non-dermatophyte mould infections. The primary risk factors included steroid eyedrop use (29.9%), recent keratoplasty (18.2%), ocular trauma (19.5%), and contact with vegetable matter (11.7%). Most ulcers displayed stromal involvement, and 37.7% presented corneal thinning. The median duration of infection was longer in fungal than in bacterial keratitis, and surgical intervention was required in 48.1% of cases. Conclusions: Fungal keratitis, mainly involving Candida spp., accounted for 9.9% of microbial keratitis cases in Galicia, Spain, with significant risk factors being topical steroid use, ocular trauma, and contact with vegetable matter. Delayed diagnosis often resulted in poor outcomes, highlighting the need for early detection through awareness and new technologies to improve prognosis.

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Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia

Cited by 3 publications

References 58 publications

Fungal Keratitis, Epidemiology and Outcomes in a Tropical Australian Setting

Fungal Keratitis, Epidemiology and Outcomes in a Tropical Australian Setting

Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections

Fungal Keratitis in Northwestern Spain: Epidemiology, Risk Factors and Outcomes

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