Fungal keratitis: study of increasing trend and common determinants

Acharya, Yogesh; Acharya, Bhawana; Karki, Pratap

doi:10.3126/nje.v7i2.17975

Cited by 68 publications

(55 citation statements)

References 45 publications

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“…2 In a study from Nepal by Yogesh Acharya et al Aspergillus species, Fusarium species and Candida species are some of the common etiological agents for fungal keratitis. 22 In another study by Gopinathan U et al from South India fungal cause of keratitis was 95.4% which is much higher than present study. 23 Microbial Keratitis is a significant health problem and the differences seen in the number of cases is due to variety of predisposing factors such as contact lens users, trauma due to vegetative matter, injury, foreign body or insects, steroid use, underlying diseases such as diabetes to name a few.…”

Section: Discussioncontrasting

confidence: 54%

Microbial Keratitis- Microbial Pattern in a Tertiary Care Centre of a Metropolitan City

MorePatil¹,

Malik²,

Ramakrishnan³

et al. 2019

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BACKGROUND Microbial keratitis is a potentially vision threatening state requiring prompt diagnosis & treatment, and is a leading cause of preventable blindness. We wanted to study the spectrum and sensitivity of microbiological isolates from patients of microbial keratitis at a tertiary care centre of a metropolitan city. METHODS Descriptive data collection and analysis was carried out in a tertiary care centre over a period of 3 years. The cases were the grouped based upon their positivity in microscopy and culture results and correlated with clinical data. RESULTS 258 clinical cases were studied, of which 173 cases were bacterial keratitis, and 85 were fungal keratitis. Of 173 (67.05%) bacterial cases, 68 (39.30%) cases showed positive findings on gram stain, and 25 (36.76%) of these cases were confirmed by culture. Of 85 (32.94%) fungal cases, 37 (43.53%) cases were positive on KOH mount & 21 (56.76%) of these cases were confirmed by culture. CONCLUSIONS Incidence of bacterial keratitis is higher than fungal keratitis. Emphasis should be on using microbiological diagnosis as an important tool to aid the ophthalmologist in appropriate management of these cases.

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Section: Discussioncontrasting

confidence: 54%

Microbial Keratitis- Microbial Pattern in a Tertiary Care Centre of a Metropolitan City

MorePatil¹,

Malik²,

Ramakrishnan³

et al. 2019

jemds

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“…Additionally, we confirmed that ATF4 expression was upregulated with the addition of A. fumigatus conidia both in HCECs and THP-1 macrophages at 16 hours after stimulation. Fungal keratitis is often caused by ocular trauma resulting from eye irritation by vegetative matter [1, 25]. From an anatomical point of view, the epithelium is one of the earliest corneal structures to come in contact with pathogenic fungi.…”

Section: Discussionmentioning

confidence: 99%

ATF4 Involvement in TLR4 and LOX-1-Induced Host Inflammatory Response to Aspergillus fumigatus Keratitis

Zhang

Meng

Liu

et al. 2018

Journal of Ophthalmology

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Purpose Activating transcription factor 4 (ATF4) is induced by various stressors. Here, we investigated the expression of ATF4 in the host inflammatory response to Aspergillus fumigatus (A. fumigatus) keratitis. Methods A. fumigatus keratitis mouse models developed by intrastromal injection as well as corneal epithelium scratching were examined daily with a slit lamp microscope for corneal opacification and ulceration. Subsequent in vitro experimentation was carried out in human corneal epithelial cells (HCECs) as well as THP-1 macrophages infected with A. fumigatus. Inhibitors, including CLI-095, Poly (I), SCH772984, and SP600125, were used to assess the role of proteins like toll-like receptor 4 (TLR4), lectin-type oxidized LDL receptor 1 (LOX-1), extracellular signal-regulated kinases (ERK1/2), and c-Jun N-terminal kinase (JNK) in ATF4 expression as a response to A. fumigatus infection. This assessment was made in both mouse models and HCECs using western blot. Results Compared to the controls, ATF4 was increased in corneas from two kinds of A. fumigatus keratitis models at 3 days after infection. ATF4 expression was upregulated with A. fumigatus conidia both in HCECs and THP-1 macrophages 16 hours after stimulation. Furthermore, ATF4 expression in response to A. fumigatus infection was shown to be dependent on TLR4 and LOX-1 expression, and ERK1/2 and JNK contributed to the expression of ATF4 in response to A. fumigatus. Conclusion Our results clearly indicate that ATF4 was involved in the host antifungal immune response to A. fumigatus keratitis; expression was found to be dependent on TLR4, LOX-1 expression, and MAPKs pathway.

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“…[1][2][3][4] The incidences of keratitis account for an estimated 930,000 visits to the doctor's office and outpatient clinics and *58,000 emergency department visits with *76.5% of the keratitis visits requiring drug prescriptions. [2][3][4][5] Episodes of keratitis and other ocular corneal infections led to an estimated $175 million in direct health care expenditures in the United States annually, including $58 million for Medicare patients and $12 million for Medicaid patients, according to an analysis by Collier et al in Morbidity and Mortality Weekly Report for the Centers for Disease Control and Prevention. 2,3,5 The polyene and azole antifungals have been the mainstay in the pharmacotherapy of invasive systemic fungal infections due to their broad antifungal spectrum and potent biological activity.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] Episodes of keratitis and other ocular corneal infections led to an estimated $175 million in direct health care expenditures in the United States annually, including $58 million for Medicare patients and $12 million for Medicaid patients, according to an analysis by Collier et al in Morbidity and Mortality Weekly Report for the Centers for Disease Control and Prevention. 2,3,5 The polyene and azole antifungals have been the mainstay in the pharmacotherapy of invasive systemic fungal infections due to their broad antifungal spectrum and potent biological activity. 6,7 The polyene class, comprising amphotericin B, nystatin, and natamycin, has been widely used in therapy ow-ing to the antifungal activity against Candida spp., Aspergillus spp., Fusarium spp., Scedosporium spp., and Zygomycetes classes of fungi, which are the common causative species for fungal infections.…”

Section: Introductionmentioning

confidence: 99%

Challenges in the Polyene- and Azole-Based Pharmacotherapy of Ocular Fungal Infections

Lakhani

Patil

Majumdar

2019

Journal of Ocular Pharmacology and Therapeutics

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Polyenes and azoles constitute 2 major drug classes in the antifungal armamentarium used to treat fungal infections of the eye such as fungal keratitis, endophthalmitis, conjunctivitis, and blepharitis. These classes of drugs have come to occupy an important niche in ophthalmic antifungal therapy due to their broad spectrum of activity against a variety of filamentous and yeast-like fungi. Natamycin suspension (Natacyn Ò), a polyene antifungal drug, is currently the only US FDA-approved formulation for treating ophthalmic fungal infections, whereas the other polyene and azole antifungals such as amphotericin B, fluconazole, itraconazole, ketoconazole, miconazole, voriconazole, and posaconazole are routinely used off-label in the clinical setting. Despite potent antifungal activity, the clinical utility of these agents in ophthalmic infections has been challenged by their physicochemical properties, the unique ocular anatomy and physiology, selective antifungal activity, ocular and systemic toxicity, emergence of resistance and cross-resistance, and absence of reliable techniques for developing a robust in vitroin vivo correlation. This review discusses the aforementioned challenges and the common approaches undertaken to circumnavigate the difficulties associated with the polyene-and azole-based pharmacotherapy of ophthalmic fungal infections.

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Fungal keratitis: study of increasing trend and common determinants

Cited by 68 publications

References 45 publications

Microbial Keratitis- Microbial Pattern in a Tertiary Care Centre of a Metropolitan City

Microbial Keratitis- Microbial Pattern in a Tertiary Care Centre of a Metropolitan City

ATF4 Involvement in TLR4 and LOX-1-Induced Host Inflammatory Response to Aspergillus fumigatus Keratitis

Challenges in the Polyene- and Azole-Based Pharmacotherapy of Ocular Fungal Infections

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