Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study

Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with comple...

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Autores principales:	Darren Shu Jeng Ting, Mohamed Galal, Bina Kulkarni, Mohamed S. Elalfy, Damian Lake, Samer Hamada, Dalia G. Said, Harminder S. Dua
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	<i>Candida</i> corneal infection corneal ulcer contact lens fungal infection <i>Fusarium</i> Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/20a7c70168ac4de9b1fc5dafa2b12cfa
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spelling	oai:doaj.org-article:20a7c70168ac4de9b1fc5dafa2b12cfa2021-11-25T18:06:15ZClinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study10.3390/jof71109662309-608Xhttps://doaj.org/article/20a7c70168ac4de9b1fc5dafa2b12cfa2021-11-01T00:00:00Zhttps://www.mdpi.com/2309-608X/7/11/966https://doaj.org/toc/2309-608XFungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (<i>n</i> = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with <i>Candida</i> spp. (33, 62.3%), <i>Fusarium</i> spp. (9, 17.0%), and <i>Aspergillus</i> spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all <i>p</i> < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.Darren Shu Jeng TingMohamed GalalBina KulkarniMohamed S. ElalfyDamian LakeSamer HamadaDalia G. SaidHarminder S. DuaMDPI AGarticle<i>Candida</i>corneal infectioncorneal ulcercontact lensfungal infection<i>Fusarium</i>Biology (General)QH301-705.5ENJournal of Fungi, Vol 7, Iss 966, p 966 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	<i>Candida</i> corneal infection corneal ulcer contact lens fungal infection <i>Fusarium</i> Biology (General) QH301-705.5
spellingShingle	<i>Candida</i> corneal infection corneal ulcer contact lens fungal infection <i>Fusarium</i> Biology (General) QH301-705.5 Darren Shu Jeng Ting Mohamed Galal Bina Kulkarni Mohamed S. Elalfy Damian Lake Samer Hamada Dalia G. Said Harminder S. Dua Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study
description	Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (<i>n</i> = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with <i>Candida</i> spp. (33, 62.3%), <i>Fusarium</i> spp. (9, 17.0%), and <i>Aspergillus</i> spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all <i>p</i> < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.
format	article
author	Darren Shu Jeng Ting Mohamed Galal Bina Kulkarni Mohamed S. Elalfy Damian Lake Samer Hamada Dalia G. Said Harminder S. Dua
author_facet	Darren Shu Jeng Ting Mohamed Galal Bina Kulkarni Mohamed S. Elalfy Damian Lake Samer Hamada Dalia G. Said Harminder S. Dua
author_sort	Darren Shu Jeng Ting
title	Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study
title_short	Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study
title_full	Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study
title_fullStr	Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study
title_full_unstemmed	Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study
title_sort	clinical characteristics and outcomes of fungal keratitis in the united kingdom 2011–2020: a 10-year study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/20a7c70168ac4de9b1fc5dafa2b12cfa
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Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study

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