Pediatric Fungal Keratitis: Predisposing Factors, Clinical Features, and Outcomes During a 24-Year Study

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Pediatric fungal keratitis (FK) poses a significant threat to vision in children.
• Understanding regional trends in causative fungi and their susceptibility is crucial for effective treatment.

Purpose of the Study:

• To analyze the clinical characteristics, antifungal susceptibility, and treatment outcomes of pediatric FK.
• To identify key risk factors and predictors of treatment duration in pediatric FK cases.

Main Methods:

• Retrospective analysis of 88 pediatric FK cases from July 2000 to October 2023 at Beijing Tongren Hospital.
• Data collected included demographics, predisposing factors, clinical signs, microbiological findings, treatment regimens, and patient outcomes.
• Fungal identification was confirmed by culture or microscopy.

Main Results:

• Trauma, particularly from toys and writing tools, was the leading predisposing factor (35.2%).
• Common clinical features included dense infiltrates (100%), feathery margins (69.2%), and multifocal lesions (38.5%).
• Fusarium (43.9%) and Aspergillus (25.8%) were the most common fungal isolates; Amphotericin B demonstrated in vitro and clinical efficacy.

Conclusions:

• Fusarium and Aspergillus are predominant pathogens in North China's pediatric FK, with trauma as the primary risk factor.
• Amphotericin B is an effective antifungal agent for pediatric FK.
• Early diagnosis and prompt treatment are essential to improve visual outcomes and reduce treatment duration, with ocular surgery and toddler age being significant predictors.