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Keratomycosis: clinical and microbiologic experience with dematiaceous fungi
P Garg1, U Gopinathan, K Choudhary
1Sight Savers' Corneal Training Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India. prashant@lvpeye.stph.net
Objective:
To assess the significance of dematiaceous fungi in the causation of keratomycosis.
Design:
Retrospective, noncomparative case series.
Participants:
Eighty-eight cases of dematiaceous fungal keratitis seen at the L. V. Prasad Eye Institute, Hyderabad, India from January 1991 through December 1996.
Intervention:
Only culture-proven cases were analyzed.
Main Outcome Measures:
Predisposing factors, clinical characteristics, microbiology, treatment methods, and outcome.
Results:
Of 557 cases of fungal keratitis seen during the study period, dematiaceous fungi were the etiologic agents in 88 (15.7%), after Fusarium in 210 (37.6%) and Aspergillus species in 170 cases (30.4%), respectively. Trauma was the most common predisposing factor (47.7%). Fifty-three eyes (61.3%) had the classical clinical picture of yellow-white, dry raised infiltrate with feathery hyphate edges at initial examination. The characteristic macroscopic pigmentation was seen in only 24 eyes (27.27%). Septate branching fungal filaments were identified in 78 smears (88.63%) on light microscopy, of which 5 (5.7%) also showed the presence of bacteria. Curvularia species dominated the spectrum (22.7%). Treatment was started in 48 eyes with topical antifungal agents, whereas 37 received both oral and topical antifungal agents. Outcome data were available for 68 cases. Forty-nine (72%) responded to medical therapy, whereas 13 eyes required therapeutic penetrating keratoplasty and 6 eyes had to be eviscerated.
Conclusions:
This is the largest series of keratitis caused by dematiaceous fungi reported to date. It clearly brings out the clinical importance of this group of corneal infections.
Insights
Dematiaceous fungi are significant causes of keratomycosis, accounting for 15.7% of cases. Trauma is a common predisposing factor, and while many cases respond to medical therapy, some require surgical intervention.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis is a significant cause of visual impairment globally.
- Dematiaceous fungi, characterized by dark pigmentation, represent a distinct group of fungal pathogens.
- Understanding their role in keratomycosis is crucial for effective management.
Purpose of the Study:
- To evaluate the clinical significance of dematiaceous fungi in causing keratomycosis.
- To analyze the epidemiological, clinical, and microbiological features of dematiaceous fungal keratitis.
- To assess treatment outcomes for this specific group of fungal corneal infections.
Main Methods:
- A retrospective case series analysis of 88 culture-proven cases of dematiaceous fungal keratitis.
- Data collected included predisposing factors, clinical presentation, microbiological findings, treatment modalities, and patient outcomes.
- The study was conducted at a single tertiary eye care center over a six-year period.
Main Results:
- Dematiaceous fungi were identified in 15.7% of fungal keratitis cases, with Curvularia species being the most prevalent.
- Trauma was the most frequent predisposing factor (47.7%).
- While 72% of patients responded to medical therapy, 13 eyes required penetrating keratoplasty and 6 were eviscerated.
Conclusions:
- Dematiaceous fungi are important etiologic agents in fungal keratitis, particularly in the Indian subcontinent.
- The clinical presentation can be variable, and prompt diagnosis and treatment are essential.
- This study highlights the clinical importance and management challenges associated with dematiaceous fungal keratitis.