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Eduardo C. Alfonso - One of the best experts on this subject based on the ideXlab platform.
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New horizons in one of ophthalmology’s challenges: Fungal Keratitis
Expert Review of Ophthalmology, 2020Co-Authors: Bozorgmehr Pouyeh, Anat Galor, Darlene Miller, Eduardo C. AlfonsoAbstract:Fungal Keratitis is a serious ophthalmic condition that requires prolonged medical treatment, often combined with surgical intervention. The prognosis of Fungal Keratitis is guarded, especially in developing countries where it primarily affects young active males of working class with limited access to medical care. In this article, every effort has been made to appraise and concisely present significant advances in the diagnosis and treatment of Fungal Keratitis in recent years, and to introduce new perspectives and ideas that may be helpful in decreasing the burden of Fungal Keratitis.
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Management of Fungal Keratitis: Topical or Systemic therapy?
Vision Pan-America The Pan-American Journal of Ophthalmology, 2014Co-Authors: Darlene Miller, Eduardo C. AlfonsoAbstract:Currently, there are no level one evidence-based studies comparing systemic vs topical therapy for the management of Fungal Keratitis. Information on systemic efficacy alone or in combination with topical use is rare. Selection of the most appropriate antiFungal for Fungal Keratitis remains a challenge, hindered by the diverse clinical presentation in Fungal Keratitis, delay in clinical and laboratory diagnosis, limited supply of effective antiFungals, lack of ocular pharmacological profiles for current antiFungals, nonstandard dosing intervals/routes of administrations, expanding list of causative agents, geographic diversity and the emergence of resistance. Efficacy is gleamed from personal observations, clinical experience, literature reviews, or retrospective data from small or single cases studies and or chart reviews. Taken together, the level of existing evidence is insufficient to determine the role of systemic vs topical therapy for Fungal Keratitis. Topical therapy remains the standard for treatment of Fungal Keratitis. Adjunctive therapy with oral or intravenous antiFungals may be required for severe or recalcitrant ulcers. Well-powered randomized clinical trials involving diverse and common topical vs systemic therapies are needed to address this question.
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trends in Fungal Keratitis in the united states 2001 to 2007
Ophthalmology, 2010Co-Authors: Emily W Gower, Kathryn Colby, Eduardo C. Alfonso, Sonal S Tuli, Lisa Keay, Rafael A Oechsler, Alfonso Iovieno, Daniel B Jones, Seema R Patel, John A IrvineAbstract:Objective Fungal Keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium Keratitis outbreak raised questions regarding the background rate of Fusarium -related Keratitis and other Fungal Keratitis in this population. Design Retrospective, multicenter case series. Participants Six hundred ninety-five cases of Fungal Keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007. Methods Ten tertiary care centers in the United States performed a retrospective review of culture-positive Fungal Keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research. Main Outcome Measures Quarterly number of Fungal Keratitis cases and Fungal species. Results We identified 695 Fungal Keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 ( P Conclusions The quarterly number of Fusarium Fungal Keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous Fungal Keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
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Fungal Keratitis associated with non therapeutic soft contact lenses
American Journal of Ophthalmology, 2006Co-Authors: Eduardo C. Alfonso, Darlene Miller, Jorge Cantudibildox, Terrence P Obrien, Oliver D ScheinAbstract:PURPOSE: To report an increase in culture-positive contact lens-associated Fungal Keratitis. DESIGN: Retrospective, cross-sectional laboratory study. METHODS: Microbiology records of culture-positive Fungal Keratitis cases from January 2004 to December 2005 were reviewed. RESULTS: Recovery of Fungal pathogens among wearers of contact lenses increased from 26.7% (eight of 30) to 50% (18 of 36) of isolates in 2005. Fusarium species (66 of 122, 54.1%) were the most frequent Fungal pathogens. Soft contact lens wear among the Fusarium cases more than doubled (seven of 30, 23.3%, vs 17 of 36, 47.7%, P = .046) from 2004 to 2005. CONCLUSIONS: Contact lens wear may be a risk factor in Fungal Keratitis.
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the changing spectrum of Fungal Keratitis in south florida
Ophthalmology, 1994Co-Authors: Robert H Rosa, Darlene Miller, Eduardo C. AlfonsoAbstract:Purpose: To review the clinical experience with Fungal Keratitis in south Florida over a 10-year period. Methods: One hundred twenty-five cases of Fungal Keratitis were identified in the microbiology laboratory records between January 1982 and January 1992. The medical record of each patient was reviewed. Results: The most commonly associated risk factor was trauma (44%). Fungal Keratitis developed in five patients using extended wear contact lenses and one patient wearing a therapeutic bandage contact lens. Clinical features included irregular, feathery margins (62%), a dry, rough texture (47%), and satellite lesions (41 %). An initial positive culture was obtained in 90% of patients, with a majority of cultures becoming positive within 48 hours. The Fusarium sp accounted for 62% of the isolates, with Fusarium oxysporum being the most commonly isolated organism. New Fungal isolates include Candida parapsilosis, Aspergillus terreus, Candida tropicalis , and Trichosporon beigellii . Natamycin 5% suspension was the initial antiFungal agent used for 91 % of the patients, with an average duration of treatment of 38 days. Twenty-five patients were treated with oral ketoconazole for a median duration of 2 weeks, in addition to topical antiFungal therapy. Thirty-four patients (27%) required a penetrating keratoplasty. Six patients had recurrence of Fungal Keratitis after penetrating keratoplasty. Conclusions: Trauma, including contact lens wear, is the most commonly associated risk factor. The Fungal organisms can be readily identified in culture. F. oxysporum is the most common organism, with new isolates identified. The mainstay of therapy is topical natamycin with the increasing use of imidazoles.
Kathryn Colby - One of the best experts on this subject based on the ideXlab platform.
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trends in Fungal Keratitis in the united states 2001 to 2007
Ophthalmology, 2010Co-Authors: Emily W Gower, Kathryn Colby, Eduardo C. Alfonso, Sonal S Tuli, Lisa Keay, Rafael A Oechsler, Alfonso Iovieno, Daniel B Jones, Seema R Patel, John A IrvineAbstract:Objective Fungal Keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium Keratitis outbreak raised questions regarding the background rate of Fusarium -related Keratitis and other Fungal Keratitis in this population. Design Retrospective, multicenter case series. Participants Six hundred ninety-five cases of Fungal Keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007. Methods Ten tertiary care centers in the United States performed a retrospective review of culture-positive Fungal Keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research. Main Outcome Measures Quarterly number of Fungal Keratitis cases and Fungal species. Results We identified 695 Fungal Keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 ( P Conclusions The quarterly number of Fusarium Fungal Keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous Fungal Keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
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Fungal Keratitis changing pathogens and risk factors
Cornea, 2009Co-Authors: Ula V Jurkunas, Irmgard Behlau, Kathryn ColbyAbstract:Purpose:To describe changes in demographics and pathogens for Fungal Keratitis cases diagnosed at the Massachusetts Eye and Ear Infirmary.Methods:Patient demographics, clinical and laboratory findings, treatment and outcomes of 46 cases of culture-proven Fungal Keratitis diagnosed from January 2004
Prajna Lalitha - One of the best experts on this subject based on the ideXlab platform.
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Human Corneal MicroRNA Expression Profile in Fungal Keratitis
Investigative Ophthalmology & Visual Science, 2015Co-Authors: Hemadevi Boomiraj, Vidyarani Mohankumar, Prajna Lalitha, Bharanidharan DevarajanAbstract:PURPOSE: MicroRNAs (miRNAs) are small, stable, noncoding RNA molecules with regulatory function and marked tissue specificity that posttranscriptionally regulate gene expression. However, their role in Fungal Keratitis remains unknown. The purpose of this study was to identify the miRNA profile and its regulatory role in Fungal Keratitis. METHODS: Normal donor (n = 3) and Fungal Keratitis (n = 5) corneas were pooled separately, and small RNA deep sequencing was performed using a sequencing platform. A bioinformatics approach was applied to identify differentially-expressed miRNAs and their targets, and select miRNAs were validated by real-time quantitative PCR (qPCR). The regulatory functions of miRNAs were predicted by combining miRNA target genes and pathway analysis. The mRNA expression levels of select target genes were further analyzed by qPCR. RESULTS: By deep sequencing, 75 miRNAs were identified as differentially expressed with fold change greater than 2 and probability score greater than 0.9 in Fungal Keratitis corneas. The highly dysregulated miRNAs (miR-511-5p, miR-142-3p, miR-155-5p, and miR-451a) may regulate wound healing as they were predicted to specifically target wound inflammatory genes. Moreover, the increased expression of miR-451a in Keratitis correlated with reduced expression of its target, macrophage migration inhibitory factor, suggesting possible regulatory functions. CONCLUSIONS: This is, to our knowledge, the first report on comprehensive human corneal miRNA expression profile in Fungal Keratitis. Several miRNAs with high expression in Fungal Keratitis point toward their potential role in regulation of pathogenesis. Further insights in understanding their role in corneal wound inflammation may help design new therapeutic strategies.
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susceptibility testing and clinical outcome in Fungal Keratitis
British Journal of Ophthalmology, 2010Co-Authors: Brett L Shapiro, Prajna Lalitha, Annette W Fothergill, Namperumalsamy Venkatesh Prajna, Muthiah Srinivasan, Amit Kabra, Jaya D Chidambaram, Nisha R Acharya, Thomas M LietmanAbstract:Fungal Keratitis causes significant morbidity, especially in tropical climates, and is notoriously difficult to manage. The choice of antiFungal agent for Fungal Keratitis remains largely empirical, with no consensus on the role of susceptibility testing in guiding therapy. Studies suggest that susceptibility and outcome may be associated in systemic Fungal infections with some dimorphic fungi,1 but this correlation may not exist for filamentous fungi or in ocular disease because of frequent topical dosing and high drug concentration. Given the availability of new topical medications, tailoring antiFungal therapy based on microbial sensitivity is important.2 Here, we assess whether Fungal susceptibility testing correlates with clinical outcomes in cases of Fungal Keratitis. This study was a retrospective case review of consecutive patients with culture proven Fungal Keratitis presenting to the Aravind Eye Hospital cornea clinic between March and July 2004. Of 98 consecutive patients, minimum inhibitory concentration (MIC) data was available for 90.3 Eighty-one corresponding charts were available, and 54 charts had follow-up of at least 3 weeks to allow determination of healing. All cases were …
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risk factors for treatment outcome in Fungal Keratitis
Ophthalmology, 2006Co-Authors: Prajna Lalitha, Namperumalsamy Venkatesh Prajna, Amit Kabra, Kannan Mahadevan, Muthaiah SrinivasanAbstract:Purpose To identify risk factors at diagnosis that can serve as prognostic indicators of primary treatment failure in cases of Fungal Keratitis. Design Prospective, nonrandomized, interventional, comparative study. Participants A total of 115 consecutive patients with Fungal Keratitis treated at one center during a 6-month period. Methods Patients with a microscopic corneal ulcer smear that was positive for fungus were enrolled and treated with 5% natamycin monotherapy according to the protocol of the hospital. Treatment responses were assessed at the end of 4 weeks. The prognostic indicators were used in a Poisson model for multiple regression analysis to estimate the relative risk of the main prognostic variables. Main Outcome Measures Response of the ulcer to treatment. Results Of the 115 patients analyzed in the study, 52 (45.2%) were treatment successes, 27 (23.5%) had slow-healing ulcers, and 36 (31.3%) were refractory to primary treatment. Multivariate analysis showed that the predictors of treatment failure were ulcers that exceeded 14 mm 2 ( P = 0.009), the presence of hypopyon ( P = 0.003), and identification of Aspergillus ( P = 0.003). Conclusion In patients with Fungal Keratitis treated with 5% natamycin monotherapy, larger ulcer size and infection with Aspergillus were predictors of a poor outcome.
Kirti Singh - One of the best experts on this subject based on the ideXlab platform.
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spectrum of Fungal Keratitis in north india
Cornea, 2005Co-Authors: Anuradha Chowdhary, Kirti SinghAbstract:Purpose:To report the epidemiologic features and laboratory results of 191 consecutive cases of Fungal Keratitis presenting to a tertiary level superspecialty teaching hospital of North India.Methods:A prospective hospital-based study was carried out on 485 consecutive patients presenting with corne
Christophe Baudouin - One of the best experts on this subject based on the ideXlab platform.
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Expression of cytokines in aqueous humor from Fungal Keratitis patients.
BMC Ophthalmology, 2018Co-Authors: Y Zhang, Christophe Baudouin, Qingfeng Liang, A Labbe, Qingxian LuAbstract:Although a series of reports on corneal Fungal infection have been published, studies on pathogenic mechanisms and inflammation-associated cytokines remain limited. In this study, aqueous humor samples from Fungal Keratitis patients were collected to examine cytokine patterns and cellular profile for the pathogenesis of Fungal Keratitis. The aqueous humor samples were collected from ten patients with advanced stage Fungal Keratitis. Eight aqueous humor samples from patients with keratoconus or corneal dystrophy were taken as control. Approximately 100 μl to 300 μl of aqueous humor in each case were obtained for examination. The aqueous humor samples were centrifuged and the cells were stained and examined under optical microscope. Bacterial and Fungal cultures were performed on the aqueous humor and corneal buttons of all patients. Cytokines related to inflammation including IL-1β, IL-6, IL-8, IL-10, TNF-α, and IFN-γ were examined using multiplex bead-based Luminex liquid protein array systems. Fungus infection was confirmed in these ten patients by smear stains and/or Fungal cultures. Bacterial and Fungal cultures revealed negative results in all aqueous humor specimens. Polymorphonuclear leukocytes were the predominant infiltrating cells in the aqueous humor of Fungal Keratitis. At the advanced stages of Fungal Keratitis, the levels of IL-1β, IL-6, IL-8, and IFN-γ in the aqueous humor were significantly increased when compared with control (p
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expression of cytokines in aqueous humor from Fungal Keratitis patients
BMC Ophthalmology, 2018Co-Authors: Y Zhang, Christophe Baudouin, Qingfeng Liang, A Labbe, Qingxian LuAbstract:Although a series of reports on corneal Fungal infection have been published, studies on pathogenic mechanisms and inflammation-associated cytokines remain limited. In this study, aqueous humor samples from Fungal Keratitis patients were collected to examine cytokine patterns and cellular profile for the pathogenesis of Fungal Keratitis. The aqueous humor samples were collected from ten patients with advanced stage Fungal Keratitis. Eight aqueous humor samples from patients with keratoconus or corneal dystrophy were taken as control. Approximately 100 μl to 300 μl of aqueous humor in each case were obtained for examination. The aqueous humor samples were centrifuged and the cells were stained and examined under optical microscope. Bacterial and Fungal cultures were performed on the aqueous humor and corneal buttons of all patients. Cytokines related to inflammation including IL-1β, IL-6, IL-8, IL-10, TNF-α, and IFN-γ were examined using multiplex bead-based Luminex liquid protein array systems. Fungus infection was confirmed in these ten patients by smear stains and/or Fungal cultures. Bacterial and Fungal cultures revealed negative results in all aqueous humor specimens. Polymorphonuclear leukocytes were the predominant infiltrating cells in the aqueous humor of Fungal Keratitis. At the advanced stages of Fungal Keratitis, the levels of IL-1β, IL-6, IL-8, and IFN-γ in the aqueous humor were significantly increased when compared with control (p<0.01). The levels of IL-10 and TNF-α also showed an ascending trend but with no statistical significance. High concentration of IL-1β, IL-6, IL-8, and IFN-γ in the aqueous humor was associated with Fungal Keratitis.
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in vivo confocal microscopy in Fungal Keratitis
British Journal of Ophthalmology, 2007Co-Authors: Emmanuelle Brasnu, T Bourcier, Benedicte Dupas, Sandrine Degorge, Thibault Rodallec, L Laroche, V Borderie, Christophe BaudouinAbstract:BACKGROUND: Fungal Keratitis is a major blinding eye disease found throughout the world, particularly in developing countries. Given the recent increase in Fusarium Keratitis infections in contact lens wearers owing to contact lens solutions, a warning was recently issued by the Food and Drug Administration, making it a public health concern in developed countries. OBJECTIVE: To show the advantages of in vivo confocal microscopy imaging using the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) in the early diagnosis of Fungal Keratitis. METHODS: HRTII-RCM confocal microscopy was performed on five patients presenting with Fungal Keratitis and on three donor corneas contaminated with Fusarium solani, Aspergillus fumigatus and Candida albicans. RESULTS: Direct microscopic evaluation of corneal smears and culture revealed the presence of F solani in four cases and C albicans in one case. HRTII-RCM examination of the infected patients and contaminated donor corneas revealed numerous high-contrast elements resembling Fusarium, Aspergillus hyphae or Candida pseudofilaments in the anterior stroma. CONCLUSION: HRTII-RCM in vivo confocal microscopy is a new, non-invasive and rapid technique for the early diagnosis of Fungal Keratitis, showing high-resolution images resembling Fungal structures in the early phase of the disease.
