Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes

Tananuvat, Napaporn; Upaphong, Phit; Tangmonkongvoragul, Chulaluck; Niparugs, Muanploy; Chaidaroon, Winai; Pongpom, Monsicha

doi:10.1016/j.jinf.2021.05.016

Cited by 11 publications

(11 citation statements)

References 39 publications

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“…Fusarium spp., dematiaceous fungi, and Aspergillus spp. were the top three most common pathogens [ 13 ]. This agrees with studies in India and Nepal in which the dematiaceous fungi has also been reported to be the second most common fungal pathogen [ 6 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been a limited number of studies on dematiaceous fungal keratitis in Thailand, partly due to the lack of definitive microbiological results for the identification of the species [ 8 , 13 ]. However, as most dematiaceous fungal keratitis cases are severe and often require corneal transplantation, the specimens are available for further microbiological identification.…”

Section: Introductionmentioning

confidence: 99%

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The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand

Tangmonkongvoragul

Chokesuwattanaskul

Tananuvat

et al. 2021

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Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand

Tangmonkongvoragul

Chokesuwattanaskul

Tananuvat

et al. 2021

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“…The estimated annual incidence ranged from 73 per 100,000 in South Asia to just 0.02 per 100,000 in Europe [ 4 ]. In four large case series from Pakistan [ 12 ], East Africa [ 8 ], Germany [ 13 ] and Thailand [ 14 ], 8–11.5% of patients required eviscerations, which represents an annual loss of 84,000–167,000 eyes. Using outcome data from the Pakistan study for low-income and middle-income countries, it is predicted that over 600,000 eyes will go blind because of fungal keratitis each year [ 12 ].…”

Section: Epidemiology and Association With Povertymentioning

confidence: 99%

“…Natamycin has a broad spectrum of antifungal activity and is active a low concentration. Outcomes are better if antifungal therapy is administered within the first 24 h of presentation [ 14 ]. Fungal keratitis usually responds to treatment slowly over several weeks.…”

Section: Treatmentmentioning

confidence: 99%

The Case for Fungal Keratitis to Be Accepted as a Neglected Tropical Disease

Brown

Kamwiziku

Oladele

et al. 2022

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Amongst the treatable cause of blindness among young people, fungal keratitis ranks high. There are an estimated 1,051,787 to 1,480,916 eyes affected annually, with 8–11% of patients having to have the eye removed. Diagnosis requires a corneal scraping, direct microscopy and fungal culture with a large number of airborne fungi implicated. Treatment involves the intensive application of antifungal eye drops, preferably natamycin, often combined with surgery. In low-resource settings, inappropriate corticosteroid eye drops, ineffective antibacterial therapy, diagnostic delay or no diagnosis all contribute to poor ocular outcomes with blindness (unilateral or bilateral) common. Modern detailed guidelines on fungal keratitis diagnosis and management are lacking. Here, we argue that fungal keratitis should be included as a neglected tropical disease, which would facilitate greater awareness of the condition, improved diagnostic capability, and access to affordable antifungal eye medicine.

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“…Microbial keratitis (MK) or infectious keratitis (IK) is the primary cause of corneal opacification, and the fifth leading cause of visual impairment in the developing world [2]. If such infections are not detected and treated early, they can cause irreversible corneal blindness due to perforation, endophthalmitis and panophthalmitis [3][4][5][6]. FK in particular, is challenging to treat at later stages and may necessitate surgery.…”

Section: Introductionmentioning

confidence: 99%

Multi-Scale Convolutional Neural Network for Accurate Corneal Segmentation in Early Detection of Fungal Keratitis

Mayya

Kulkarni

et al. 2021

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Microbial keratitis is an infection of the cornea of the eye that is commonly caused by prolonged contact lens wear, corneal trauma, pre-existing systemic disorders and other ocular surface disorders. It can result in severe visual impairment if improperly managed. According to the latest World Vision Report, at least 4.2 million people worldwide suffer from corneal opacities caused by infectious agents such as fungi, bacteria, protozoa and viruses. In patients with fungal keratitis (FK), often overt symptoms are not evident, until an advanced stage. Furthermore, it has been reported that clear discrimination between bacterial keratitis and FK is a challenging process even for trained corneal experts and is often misdiagnosed in more than 30% of the cases. However, if diagnosed early, vision impairment can be prevented through early cost-effective interventions. In this work, we propose a multi-scale convolutional neural network (MS-CNN) for accurate segmentation of the corneal region to enable early FK diagnosis. The proposed approach consists of a deep neural pipeline for corneal region segmentation followed by a ResNeXt model to differentiate between FK and non-FK classes. The model trained on the segmented images in the region of interest, achieved a diagnostic accuracy of 88.96%. The features learnt by the model emphasize that it can correctly identify dominant corneal lesions for detecting FK.

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Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes

Cited by 11 publications

References 39 publications

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand

The Case for Fungal Keratitis to Be Accepted as a Neglected Tropical Disease

Multi-Scale Convolutional Neural Network for Accurate Corneal Segmentation in Early Detection of Fungal Keratitis

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