Molecular identification, phylogeny and antifungal susceptibilities of dematiaceous fungi isolated from human keratomycosis

Mythili, A.; Shobana, Coimbatore Subramanian; Krizsán, Krisztina; Hassan, Ahmed; Sangeetha, Annanthode Balakrishnan; Homa, Mónika; Papp, Tamás; Alharbi, Raed; Othaim, AyoubAl; Baazeem, Alaa; Selvam, Kanesan Panneer; Kannaiyan, Moorthy; Vágvölgyi, Csaba; Kredics, László; Palanisamy, M.

doi:10.1016/j.jiph.2022.11.018

Cited by 2 publications

(1 citation statement)

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“…Farmers are most affected by dematiaceous fungal keratitis. 5 Injury caused by soil or vegetative matter (ground nut, cereal, sugarcane) predisposes them to corneal infection. This has also been found in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Emergence of Dematiaceous Fungal Hypopyon in a Tertiary Care Hospital in Tamil Nadu: A Case Study

Shanmugam

2024

JCD

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Fungal keratitis attributed to ocular trauma is common in developing countries. Curvularia is a dematiaceous fungus ubiquitously found in the environment. In humans,Curvularia causes fungal keratitis, sinusitis, onychomycosis, endocarditis, peritonitis, mycetoma, pulmonary infection, and cerebral infection. We report a 28-year-old male patient with corneal ulcer and hypopyon caused by the Curvularia species. He developed ocular pain and diminished vision in the left eye following an injury/trauma caused due to a foreign body(vegetative matter). Ocular examination revealed a corneal ulcer with a feathery margin with hypopyon. Corneal scrapings subjected tomicrobiological examination revealed septate hyphae on KOH preparation. Culture yielded pigmented fungal colonies, which wereidentified to be Curvularia species. The patient was put on conservative management.He responded welland feltsymptomatically better on local examination.His corneal ulcer size reduced, hypopyon in the anterior chamber subsided and his vision acuity improved.Diagnosis and treatment of fungal keratitis haveprovedto be challenging. Early diagnosis usingmicrobiology helped to restore the patient's vision, prevented him from vision-threatening complications and helped in the management of the case by medical intervention without surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Emergence of Dematiaceous Fungal Hypopyon in a Tertiary Care Hospital in Tamil Nadu: A Case Study

Shanmugam

2024

JCD

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Antifungal resistance, clinical outcome and clinico-microbiological correlation in ocular infections due to common melanized fungi Curvularia lunata and Lasiodiplodia theobromae in South India

Mitra,

Garg,

Murthy

et al. 2024

Journal of Medical Microbiology

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Aim. Melanized fungi were rarely studied for their antifungal resistance (AFR) or clinical outcome, despite rising incidence of melanized fungal ocular infections and AFR in general. We report the antifungal resistance patterns, clinical outcome and clinico-microbiological correlation in two commonly isolated melanized fungi from ocular infections, Curvularia lunata and Lasiodiplodia theobromae, at a tertiary eyecare centre in South India. Gap statement. Despite melanized fungi accounting for a significant proportion of ocular fungal infections in the Indian subcontinent, and despite there being a limited selection of effective antifungal agents available for these infections, the existing data and studies on these issues remain sparse. Therefore, this study aimed to investigate the prevalence of antifungal resistance in two of the most common melanized fungal pathogens in ocular infections, Curvularia lunata and Lasiodiplodia theobromae and correlate it with the treatment given and the clinical outcome in patients. Methodology. Electronic medical records provided the clinical data. Standard broth microdilution was performed for antifungal susceptibility testing (AFST) in 30 isolates (17 C. lunata and 13 L. theobromae) for amphotericin B and natamycin (polyenes): voriconazole, ketoconazole, posaconazole, itraconazole and fluconazole (azoles) and caspofungin (echinocandin). Multidrug resistance (MDR) was defined as resistance to more than or equal to two classes of antifungals. DNA sequencing was performed for the isolates for species confirmation. The multivariate analysis was done for determining poor prognostic factors. Results. AFST showed highest susceptibility of study isolates for voriconazole (83.3% isolates), followed by natamycin (80%), fluconazole (80%), itraconazole (76.7%), ketoconazole (70%), posaconazole (66.7%), caspofungin (66.7%) and lastly amphotericin B (63.3%). All patients empirically received topical natamycin; additional oral ketoconazole/intraocular voriconazole was administered in select few. MDR was strongly associated with poor clinical outcome (multivariate analysis: P = 0.03, odds ratio = 7.8). All patients had microbial keratitis, one progressed to endophthalmitis. Additionally, therapeutic penetrating keratoplasty was required in 40% of cases. Globe salvage was possible in 80% patients, though good visual outcome was seen in only half of them. Both, anatomical and visual outcomes, were poor in 20% of patients. DNA sequencing showed C. lunata as the highest study species. Conclusion. C. lunata and L. theobromae showed varying in vitro antifungal susceptibility and clinical outcome in ocular infections. Voriconazole had significantly higher activity, while amphotericin B had lower activity in vitro for these melanized fungi. MDR isolates showed poorer clinical outcome.

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Molecular identification, phylogeny and antifungal susceptibilities of dematiaceous fungi isolated from human keratomycosis

Cited by 2 publications

References 50 publications

Emergence of Dematiaceous Fungal Hypopyon in a Tertiary Care Hospital in Tamil Nadu: A Case Study

Emergence of Dematiaceous Fungal Hypopyon in a Tertiary Care Hospital in Tamil Nadu: A Case Study

Antifungal resistance, clinical outcome and clinico-microbiological correlation in ocular infections due to common melanized fungi Curvularia lunata and Lasiodiplodia theobromae in South India

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