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Clinical Characteristics and Treatment Outcomes of Pediatric Fungal Keratitis
Jing Zhang1,2,3, Huabo Chen1,2,3, Vishal Jhanji4
1Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.
Insights
Pediatric fungal keratitis, often caused by trauma, requires prompt treatment. While voriconazole shows promise, many children need keratoplasty, with neutrophil/lymphocyte ratio predicting surgical intervention.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Fungal keratitis is a rare but serious eye infection in children.
- Understanding its characteristics is crucial for effective management.
Purpose of the Study:
- To analyze the clinical features and treatment outcomes of fungal keratitis in pediatric patients.
- To identify key factors influencing treatment success and the need for surgery.
Main Methods:
- Retrospective review of medical records for children diagnosed with fungal keratitis (1996-2021).
- Data collected included demographics, etiology, clinical presentation, and treatment outcomes.
- Statistical analysis, including logistic regression, was used to identify significant associations.
Main Results:
- Ocular trauma was the primary cause, with Fusarium and Aspergillus as common pathogens.
- Only 16.7% of cases resolved with medication; 66.7% required therapeutic keratoplasty.
- Corneal ulcer size correlated with the need for surgery; neutrophil/lymphocyte ratio predicted surgical intervention.
Conclusions:
- Ocular trauma is the leading cause of pediatric fungal keratitis.
- Voriconazole demonstrated the highest antifungal drug sensitivity.
- Two-thirds of pediatric fungal keratitis cases necessitate surgical treatment, highlighting the severity of the condition.
Background:
Fungal keratitis is relatively rare in children. This study aimed to analyze the clinical characteristics and treatment outcomes of pediatric fungal keratitis.
Methods:
A retrospective review of medical records was conducted for children (aged <18 years) diagnosed with fungal keratitis from 1996 to 2021. Demographic features, etiology, clinical characteristics, and treatment outcomes were collected.
Results:
Forty-seven children (48 eyes) were included (31 males, 16 females). The mean age of onset was 11.8±4.1 (range: 1-17) years. The leading cause of fungal keratitis was trauma including dust or ocular foreign body (29.2%) and vegetative matter (25.0%). Fusarium (41.7%) and Aspergillus (20.8%) were the main causative organisms. 16.7% (8/48) of the infected eyes were treated successfully with medications. Voriconazole had the highest drug sensitivity rate (70.0%). 66.7% (32/48) of the eyes required therapeutic keratoplasty (21 eyes penetrating keratoplasty, 11 eyes lamellar keratoplasty). The diameter of the corneal ulcer was significantly associated with keratoplasty (OR 3.556, p = 0.014). The peripheral blood neutrophil/lymphocyte ratio (NLR) showed positive correlation with the age of onset (r = 0.437, p = 0.002) and the diameter of corneal ulcer (r = 0.298, p = 0.04). Logistic regression analysis revealed a significant association between NLR and the need for surgical treatment (odds ratio = 117.926, p = 0.019).
Conclusion:
In the current study, ocular trauma was the leading cause of fungal keratitis in the pediatric age group. Fusarium was the most common organism. Voriconazole was the preferred antifungal drug. Surgical treatment was necessary in two-thirds of the eyes.
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