Fungal Eye Infections

A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 15085

Special Issue Editors


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Guest Editor
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
Interests: ocular surface; keratitis; scleritis; infection; microbiology; molecular diagnosis

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Guest Editor
Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
Interests: ocular surface; tears; dry eye disease; infectious keratitis; cataract; molecular diagnosis; diagnostic technology

Special Issue Information

Dear Colleagues,

Fungal eye infections are common and can be severe, potentially leading to vision loss. The most common risk factor for fungal eye infections is ocular trauma, mainly if the injury was caused by plant material, such as a stick, a thorn, or a leaf. Depending on the injured site, ocular fungal infections may cause fungal keratitis, scleritis, or endophthalmitis. Among them, fungal keratitis affects over a million people annually, with the highest rates in Asia and Africa. Different fungal eye infections may cause various ocular complications. Many fungi, including filamentous and non-filamentous fungi, can cause opportunistic eye infections. The environmental prevalence of fungal species leads to certain fungal species with dominance in a specific climates and geographic areas. The invasiveness or virulence of different fungi to the eye is diverse. Additionally, the antifungal susceptibility of various fungi is variable. Therefore, efficient laboratory diagnosis and antifungal treatment are undoubtedly critical to rescue vision for patients with a fungal eye infection. However, substantial gaps exist, such as suboptimal fungal diagnostics and antifungal strategies, and new threats such as antifungal resistance are emerging. Considering the vision-threatening nature and highly refractory medical events of fungal eye infections, we hope to invite researchers to contribute to this Special Issue, focused on reducing the medical burden of fungal eye infections. This will require updated knowledge from multifaceted approaches, including epidemiology, novel diagnosis, antifungal susceptibility, new antifungal regimens, and prognostic evaluation. Moreover, studies are welcome that adopt in vitro analysis and animal models to elucidate the mechanism of a specific fungal eye infection, a novel diagnostic modality, or a new treatment for ocular fungal infections.

Dr. Ching-Hsi Hsiao
Dr. Ming-Tse Kuo
Guest Editors

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Keywords

  • ocular mycosis
  • keratomycosis
  • mycotic keratitis
  • fungal keratitis
  • fungal scleritis
  • fungal endophthalmitis

Published Papers (7 papers)

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Research

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14 pages, 293 KiB  
Article
A Multi-Institutional Database Review of Orbital Complications and Survival Outcomes in Adult Patients with Invasive or Non-Invasive Fungal Rhinosinusitis
by Po-Teng Chiang, Sheng-Dean Luo, Ren-Wen Ho, Ching-Nung Wu, Kuan-Chung Fang and Wei-Chih Chen
J. Fungi 2022, 8(12), 1239; https://doi.org/10.3390/jof8121239 - 23 Nov 2022
Cited by 2 | Viewed by 1493
Abstract
Background: Invasive fungal rhinosinusitis (IFS) with orbital complications has remained a challenging disease over the past few decades. Only a few studies have been conducted to investigate the factors associated with orbital complications in fungal rhinosinusitis (FRS). We aimed to review the characteristics [...] Read more.
Background: Invasive fungal rhinosinusitis (IFS) with orbital complications has remained a challenging disease over the past few decades. Only a few studies have been conducted to investigate the factors associated with orbital complications in fungal rhinosinusitis (FRS). We aimed to review the characteristics between IFS and non-invasive fungal rhinosinusitis (NIFS) and determine clinical factors associated with orbital complications and overall survival. Methods: A multi-institutional database review study was conducted using the Chang Gung Research Database (CGRD) from January 2001 to January 2019. We identified FRS patients using International Classification of Diseases diagnosis codes and SNOMED CT. We categorized patients into IFS and NIFS groups and analyzed the demographic data, underlying diseases, clinical symptoms, laboratory data, image findings, fungal infection status, and survival outcomes. Results: We included 1624 patients in our study, with 59 IFS patients and 1565 NIFS patients. The history of an organ or hematopoietic cell transplantation had a significant prognostic effect on the survival outcomes, with surgical intervention and high hemoglobin (Hb) and albumin levels recognized as positive predictors. Posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were risk factors of orbital complications. Conclusions: In NIFS patients, orbital complications were found to be associated with old age, a high WBC count, high blood glucose, and a high CRP level. For the risk factors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were recognized as predictors. Among IFS patients, a history of organ or hematopoietic cell transplantation was a risk factor for poor survival, while, conversely, surgical intervention and high Hb and albumin levels were related to improved survival. As predictors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling upon the first visit should raise attention, with close monitoring. Full article
(This article belongs to the Special Issue Fungal Eye Infections)
11 pages, 533 KiB  
Article
Fungal Keratitis: Clinical Features, Risk Factors, Treatment, and Outcomes
by Sarah Atta, Chandrashan Perera, Regis P. Kowalski and Vishal Jhanji
J. Fungi 2022, 8(9), 962; https://doi.org/10.3390/jof8090962 - 15 Sep 2022
Cited by 5 | Viewed by 2745
Abstract
Fungal keratitis (FK) can be challenging to diagnose and treat. In this retrospective case series, FK cases presenting at the University of Pittsburgh Medical Center, Pennsylvania, USA, from 2015 to 2021 were reviewed for ocular risk factors, clinical presentation, management, and outcomes. Twenty-eight [...] Read more.
Fungal keratitis (FK) can be challenging to diagnose and treat. In this retrospective case series, FK cases presenting at the University of Pittsburgh Medical Center, Pennsylvania, USA, from 2015 to 2021 were reviewed for ocular risk factors, clinical presentation, management, and outcomes. Twenty-eight cases of FK were included. The median presenting age was 58.5 (18.5) years, and the median symptom duration prior to presentation was 10 (35.8) days. Predisposing ocular risk factors included contact lens use (67.9%), recent ocular trauma/abrasion (42.9%), and history of ocular surgery (42.9%). The median presenting visual acuity (VA) was 1.35 (1.72) LogMAR. About half presented with a central ulcer (42.9%), large infiltrate (6.7 (6.3) mm2), corneal thinning (50.0%), and hypopyon (32.1%). The majority of isolated fungal species were filamentous (75.0%). Most common antifungal medications included topical voriconazole (71.4%) and natamycin (53.6%) drops and oral voriconazole (64.3%). Surgical management was necessary in 32.1% of cases and enucleation in one case. Defect resolution occurred in 42.5 (47.0) days, and median final VA was 0.5 (1.84) LogMAR. Features associated with poor final visual outcomes included poor initial VA (p < 0.001) and larger defect size (p = 0.002). In conclusion, unlike prior studies in the northeast region of the USA, FK was commonly caused by filamentous fungi, and antifungal management most often consisted of topical and oral voriconazole. Full article
(This article belongs to the Special Issue Fungal Eye Infections)
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12 pages, 537 KiB  
Article
Diagnosis of Fungal Keratitis in Low-Income Countries: Evaluation of Smear Microscopy, Culture, and In Vivo Confocal Microscopy in Nepal
by Jeremy J. Hoffman, Reena Yadav, Sandip Das Sanyam, Pankaj Chaudhary, Abhishek Roshan, Sanjay Kumar Singh, Simon Arunga, Victor H. Hu, David Macleod, Astrid Leck and Matthew J. Burton
J. Fungi 2022, 8(9), 955; https://doi.org/10.3390/jof8090955 - 13 Sep 2022
Cited by 5 | Viewed by 2194
Abstract
Clinically diagnosing fungal keratitis (FK) is challenging; diagnosis can be assisted by investigations including in vivo confocal microscopy (IVCM), smear microscopy, and culture. The aim of this study was to estimate the sensitivity in detecting fungal keratitis (FK) using IVCM, smear microscopy, and [...] Read more.
Clinically diagnosing fungal keratitis (FK) is challenging; diagnosis can be assisted by investigations including in vivo confocal microscopy (IVCM), smear microscopy, and culture. The aim of this study was to estimate the sensitivity in detecting fungal keratitis (FK) using IVCM, smear microscopy, and culture in a setting with a high prevalence of FK. In this cross-sectional study nested within a prospective cohort study, consecutive microbial keratitis (MK) patients attending a tertiary-referral eye hospital in south-eastern Nepal between June 2019 and November 2020 were recruited. IVCM and corneal scrapes for smear microscopy and culture were performed using a standardised protocol. Smear microscopy was performed using potassium hydroxide (KOH), Gram stain, and calcofluor white. The primary outcomes were sensitivities with 95% confidence intervals [95% CI] for IVCM, smear microscopy and culture, and for each different microscopy stain independently, to detect FK compared to a composite referent. We enrolled 642 patients with MK; 468/642 (72.9%) were filamentous FK, 32/642 (5.0%) were bacterial keratitis and 64/642 (10.0%) were mixed bacterial-filamentous FK, with one yeast infection (0.16%). No organism was identified in 77/642 (12.0%). Smear microscopy had the highest sensitivity (90.7% [87.9–93.1%]), followed by IVCM (89.8% [86.9–92.3%]) and culture (75.7% [71.8–79.3%]). Of the three smear microscopy stains, KOH had the highest sensitivity (85.3% [81.9–88.4%]), followed by Gram stain (83.2% [79.7–86.4%]) and calcofluor white (79.1% [75.4–82.5%]). Smear microscopy and IVCM were the most sensitive tools for identifying FK in our cohort. In low-resource settings we recommend clinicians perform corneal scrapes for microscopy using KOH and Gram staining. Culture remains an important tool to diagnose bacterial infection, identify causative fungi and enable antimicrobial susceptibility testing. Full article
(This article belongs to the Special Issue Fungal Eye Infections)
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10 pages, 240 KiB  
Article
Endogenous Fungal Endophthalmitis: Causative Organisms, Treatments, and Visual Outcomes
by Kuan-Jen Chen, Ming-Hui Sun, Yen-Po Chen, Yi-Hsing Chen, Nan-Kai Wang, Laura Liu, An-Ning Chao, Wei-Chi Wu, Yih-Shiou Hwang and Chi-Chun Lai
J. Fungi 2022, 8(6), 641; https://doi.org/10.3390/jof8060641 - 16 Jun 2022
Cited by 7 | Viewed by 2020
Abstract
Endogenous fungal endophthalmitis (EFE) is a vision-threatening intraocular infection and a rare complication of fungemia. Early diagnosis and prompt aggressive treatment are crucial to avoid vision loss. We retrospectively reviewed the data of 37 patients (49 eyes) with EFE who were treated at [...] Read more.
Endogenous fungal endophthalmitis (EFE) is a vision-threatening intraocular infection and a rare complication of fungemia. Early diagnosis and prompt aggressive treatment are crucial to avoid vision loss. We retrospectively reviewed the data of 37 patients (49 eyes) with EFE who were treated at a tertiary referral hospital from January 2000 to April 2019. The most common risk factor was diabetes (24 patients; 65%), followed by recent hospitalization, urinary tract disease, liver disease, and immunosuppressive therapy. Two or more risk factors were detected in 24 patients (65%), and yeasts (29 patients; 78%) were more commonly detected than mold (8 patients; 22%). The most common fungal isolates were Candida spp. (78%), especially Candida albicans (70%). Moreover, 24 eyes in 21 patients underwent vitrectomy, and 2 eyes underwent evisceration. Retinal detachment (RD) occurred in 17 eyes (35%) in 14 patients, and eyes without RD exhibited significantly superior visual outcomes (p = 0.001). A comparison of the initial VA between the better (20/200 or better) and worse groups (worse than 20/200) revealed that better initial VA was related to a superior visual outcome (p = 0.003). Therefore, to achieve superior visual outcomes, early diagnosis and prompt treatment are necessary for patients with EFE. Full article
(This article belongs to the Special Issue Fungal Eye Infections)

Review

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11 pages, 800 KiB  
Review
The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment
by Jamal Azhari, Pedro S. Tetelbom and Ahmed B. Sallam
J. Fungi 2023, 9(12), 1147; https://doi.org/10.3390/jof9121147 - 28 Nov 2023
Cited by 1 | Viewed by 989
Abstract
Endophthalmitis refers to inflammation involving internal ocular structures, including the anterior and posterior eye segments, associated with infectious agents, most commonly bacteria and fungi. This review focuses on endophthalmitis caused by fungi. Medical and surgical management are the two main treatment modalities for [...] Read more.
Endophthalmitis refers to inflammation involving internal ocular structures, including the anterior and posterior eye segments, associated with infectious agents, most commonly bacteria and fungi. This review focuses on endophthalmitis caused by fungi. Medical and surgical management are the two main treatment modalities for fungal endophthalmitis, with medical management utilizing systemic or intravitreal antifungals. The use of systemic or intravitreal corticosteroids as an adjuvant treatment to dampen the severity of inflammation is controversial. Based on the pathobiology of fungal endophthalmitis as well as the mechanism of action of corticosteroids, it was hypothesized that corticosteroids affected the immune response against fungal infection. In vitro studies mostly carried out during the 1980s showed that dexamethasone plays a role in the suppression of phagocytosis of yeasts and demonstrated the facilitation of yeast proliferation by dexamethasone. In vivo studies analysis was compromised entirely of retrospective studies describing steroid use in fungal endophthalmitis, with the outcomes of the patients in these studies varying greatly and often being anecdotally noted, thus difficult to discern any definitive results. Given the limited clinical data and the heterogeneity of the existing studies, additional experimentation human studies with clinical trials or observations over more extended periods analyzing the effect of systemic and intravitreal corticosteroids in fungal endophthalmitis are needed before definitive conclusions can be drawn. Full article
(This article belongs to the Special Issue Fungal Eye Infections)
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19 pages, 1381 KiB  
Review
Management of Filamentous Fungal Keratitis: A Pragmatic Approach
by Jeremy J. Hoffman, Simon Arunga, Abeer H. A. Mohamed Ahmed, Victor H. Hu and Matthew J. Burton
J. Fungi 2022, 8(10), 1067; https://doi.org/10.3390/jof8101067 - 11 Oct 2022
Cited by 14 | Viewed by 2691
Abstract
Filamentous fungal infections of the cornea known as filamentous fungal keratitis (FK) are challenging to treat. Topical natamycin 5% is usually first-line treatment following the results of several landmark clinical trials. However, even when treated intensively, infections may progress to corneal perforation. Current [...] Read more.
Filamentous fungal infections of the cornea known as filamentous fungal keratitis (FK) are challenging to treat. Topical natamycin 5% is usually first-line treatment following the results of several landmark clinical trials. However, even when treated intensively, infections may progress to corneal perforation. Current topical antifungals are not always effective and are often unavailable. Alternatives topical therapies to natamycin include voriconazole, chlorhexidine, amphotericin B and econazole. Surgical therapy, typically in the form of therapeutic penetrating keratoplasty, may be required for severe cases or following corneal perforation. Alternative treatment strategies such as intrastromal or intracameral injections of antifungals may be used. However, there is often no clear treatment strategy and the evidence to guide therapy is often lacking. This review describes the different treatment options and their evidence and provides a pragmatic approach to the management of fungal keratitis, particularly for clinicians working in tropical, low-resource settings where fungal keratitis is most prevalent. Full article
(This article belongs to the Special Issue Fungal Eye Infections)
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Other

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12 pages, 4591 KiB  
Case Report
Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia
by Rachel Xuan, Sheng Chiong Hong, Tanya Trinh, Minas T. Coroneo and Constantinos Petsoglou
J. Fungi 2023, 9(5), 589; https://doi.org/10.3390/jof9050589 - 18 May 2023
Cited by 1 | Viewed by 1583
Abstract
The present article reports on the management of six different and rare cases of fungal keratitides, two of which have never been documented in previous literature. This is a case series of six patients with rare fungal keratitides managed at a quaternary eye [...] Read more.
The present article reports on the management of six different and rare cases of fungal keratitides, two of which have never been documented in previous literature. This is a case series of six patients with rare fungal keratitides managed at a quaternary eye referral unit, Sydney Eye Hospital, Australia over a period of 7 months (May to December, 2022). The order of occurrence of fungi isolated was Scedosporium apiospermum, Lomenstospora prolificans, Cladosporium spp., Paecilomyces, Syncephalastrum racemosum and Quambalaria spp. A combination of medical and surgical interventions was employed, including topical and systemic anti-fungal therapy, with one requiring therapeutic penetrating keratoplasty and another eventuating in evisceration. Two patients were successfully treated with corneal debridement and two others required pars plana vitrectomy with anterior chamber washout. It is important to remain vigilant with monitoring patient symptoms and correlating with clinical signs to guide antifungal therapy even in the context of confirmed culture and sensitivity results. Full article
(This article belongs to the Special Issue Fungal Eye Infections)
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