Epidemiological profile of fungal keratitis in Sfax (Tunisia)

Fungal keratitis is responsible for a significant burden of blinding disease in the developing world.

The aim of this study was to determine the etiological agents, predisposing factors and therapy of keratomycosis in our region.

Retrospective study of 60 patients with clinically and cultured confirmed fungi keratitis, who were attended at department of mycology in Sfax (1995 to 2012).

The mean age of patients was 47.2 years (sex ratio: 1.58). At least, one presumed predisposing factor was identified in 83.3% of cases. Corneal traumatism was established as the most common predisposing factor (61.6%) with vegetative matter (42.4%). Patients had corneal ulcer in 40% or abscess in 47.6%. All cases were positive on direct microscopy and 93% of cultures were positive. Filamentous fungi form the major etiologic agents (83%): Fusarium species (49% with F. solani [66%]), Aspergillus sp. (22%), Alternaria (5%), Scedosporium sp. (2%); and non-identified mold in (5%). Yeast were identified in 17% of cases. Topical agents were used in 97% of cases: ketoconazole 2%, amphotericin B (0.5%). Fluconazole per os was administrated for 11% of cases, itraconazole (2 cases) and voriconazole (one case). Keratoplasty was indicated for 27% of cases. The outcome was favorable in 16% of patients. Among the patients, 71% had persistent corneal deposit sequelae. Four patients lost the eyeball.

Corneal traumatism was the principal risk factor for fungal keratitis in young and middle-aged farmers. Fusarium solani is the predominant cause in Sfax. Early diagnosis, coupled with appropriate treatment, is crucial for increasing the chance of complete recovery.