Update on fungal keratitis in France: a case–control study

Abstract

Purpose: To report an epidemiological update of documented fungal keratitis (FK) in a French tertiary ophthalmological centre from 2014 to 2018 in comparison with a previous period from 1993 to 2008. Methods: Sixty-two consecutive FK documented by microbiological corneal scrapings were compared with the 64 FK of the previous study. Amphotericin B and voriconazole eye drops were administered hourly. Population characteristics, clinical findings, aetiological organisms and treatments were analysed. Results: The most frequently identified fungi were Fusarium (61%), Aspergillus (6.5%) and Candida (5%). Thirty out of 44 cases examined with in vivo confocal microscopy (IVCM) presented filaments. Ten required conventional crosslinking, 9 therapeutic penetrating keratoplasty, and 2 enucleation. Risk factors significantly associated with the absence of response to medical treatment were patient age (p = 0.01), presence of a deep stromal infiltrate at presentation (p = 0.04) and high numbers of filaments in IVCM images (p = 0.01). The two populations were comparable in age, but not in sex ratio males/females (18/44 versus 37/26 in the previous study; p = 0.001). The frequency of contact lensassociated infection increased from 35.5% to 71% (p = 0.0001) between the two periods. Since then, filamentous FK increased from 69% (44/64) to 95% (59/62) (p = 0.0001). A history of keratoplasty was less frequently reported during the last period (3.2% (2/62) versus 17% (11/64) of cases (p = 0.01)). A clear decrease in the frequency of therapeutic keratoplasty was noted from 39% (25/ 64) to 14% (9/62) (p = 0.02). Conclusion:The frequency of filamentous keratomycosis is currently increasing. Elderly patients and the presence of numerous filaments in IVCM are associated with poor clinical outcomes.

Dynamic full-field optical coherence tomography for live-cell imaging and growth-phase monitoring in Aspergillus fumigatus

“…These could focus on the potential of D-FF-OCT for extemporaneous diagnosis of invasive aspergillosis following biopsy or surgical resection, as well as dermatophyte-associated or even direct invasive superficial fungal infections in vivo . Note that a recent report on real-time cellular imaging of the human cornea with dedicated and optimized non-contact OCT systems ( Mazlin et al., 2020 ) might be of particular interest for the development and future improvements regarding in vivo diagnosis of fungal keratitis ( Olivier et al., 2022 ). In addition to the conventional morphological aspect, the ability to record the live metabolic activity of any microbiological sample in routine practice, notably fungi, opens access to a novel kind of D-FF-OCT-based direct examination which is of particular interest in either mechanistic studies toward experimental mycology or for the development of a potential D-FF-OCT-guided diagnosis of superficial fungal infections.…”

“…Superficial fungal infections refer to a rather large and heterogeneous class of fungal diseases in both immunocompromised and non-immunocompromised patients. These range from dermatophyte infections ( Schwartz, 2004 ) to more complex cutaneous manifestations of invasive fungal infections (IFIs) ( Shields et al., 2019 ) and even fungal keratitis ( Olivier et al., 2022 ). In the case of invasive aspergillosis, the existence of specific diagnostic criteria ( Donnelly et al., 2020 ) may be useful to identify a given population in view of future clinical trials.…”

Therapy for contact lens-related ulcers

“…Fungal and Acanthamoeba keratitis comprise a smaller, but significant proportion of CLMK [9,18,19]. In particular, the rise of Fusarium among fungal keratitis has been strongly correlated with contact lens use [19][20][21]. The current generation of multipurpose contact lens solution preservatives do not have full antimicrobial activity and while the most prevalent types, polyquaternium-1 and polyhexamethylene biguanides (PHMB) are effective against most bacteria, they are less effective against fungi, and have no effectivity against Acanthamoeba [22].…”

Antifungal susceptibility profiles for fungal isolates from corneas and contact lenses in the United Kingdom

“…Estimates of the incidence of fungal keratitis in Europe vary for between 0.3 and 1.5 cases per million population per year, 4-6 where the most common isolates are Fusarium spp (range 19-61%), Aspergillus spp (7-33%) and yeasts (5-57%), 4-8 However, the number of Fusarium spp infections reported from European centres continues to rise, and between 33%-73% of mould infections are now associated with prescription contact lens wear. 4,5,[7][8][9][10] Clinical signs may support a fungal keratitis diagnosis. 11 However, there is overlap with other forms of microbial infection, 12 and it is usual to perform investigations to con rm the nature of the pathogen.…”