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01-02-2020 | Original Paper

The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis

Authors: Seyed Ali Tabatabaei, Mohammad Soleimani, Seyed Mehdi Tabatabaei, Amir Houshang Beheshtnejad, Niloufar Valipour, Shahram Mahmoudi

Published in: International Ophthalmology | Issue 2/2020

Abstract

Purpose

To evaluate the usefulness of serial in vivo confocal microscopy (IVCM) examinations to measure hyphal density for monitoring the treatment success among patients with fungal keratitis, and to compare the hyphal diameter as well as branching angle as a way of differentiation between Aspergillus and Fusarium species observed in IVCM.

Study design

Prospective nonrandomized study.

Patients and methods

The study was conducted from February 2015 to September 2016. Hyphal diameter, density and branching angle measurements were performed using IVCM at admission and on a weekly basis for at least 2 weeks after the start of treatment.

Results

During the period of study, 65 patients with culture-confirmed fungal keratitis were recruited. Of them, 40 were culture-positive for Fusarium spp. and 25 patients for Aspergillus spp. Before the start of treatment, the mean branching angle did not differ between the two species and the mean hyphal diameter was statistically higher for Aspergillus spp. (p = 0.029). Two weeks after the start of treatment, the mean hyphal diameter was statistically lower (p < 0.001) in the treatment failure group. Also the hyphal density significantly decreased with successful treatment (p < 0.05).

Conclusion

Decreasing hyphal density in serial IVCMs might be used as an indicator to predict the successful response of fungal ulcers to treatment. Branching angle is not different between Aspergillus and Fusarium keratitis. The mean hyphal diameter is significantly lower in the treatment failure group.

Takezawa Y, Shiraishi A, Noda E et al (2010) Effectiveness of in vivo confocal microscopy in detecting filamentous fungi during clinical course of fungal keratitis. Cornea 29(12):1346–1352CrossRef

Chidambaram JD, Prajna NV, Larke N, Macleod D, Srikanthi P, Lanjewar S (2017) In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis. Br J Ophthalmol 101(8):1119–1123CrossRef

Iyer SA, Tuli SS, Wagoner RC (2006) Fungal keratitis: emerging trends and treatment outcomes. Eye Contact Lens 32:267–271CrossRef

Shukla PK, Kumar M, Keshava GB (2008) Mycotic keratitis: an overview of diagnosis and therapy. Mycoses 51(3):183–199CrossRef

Sun CQ, Lalitha P, Prajna NV et al (2014) Association between in vitro susceptibility to natamycin and voriconazole and clinical outcomes in fungal keratitis. Ophthalmology 121(8):1495–1500CrossRef

Mahmoudi S, Masoomi A, Ahmadikia K et al (2018) Fungal keratitis: an overview of clinical and laboratory aspects. Mycoses 61(12):916–930. https://doi.org/10.1111/myc.12822 CrossRefPubMed

Winchester K, Mathers WD, Sutphin JE (1997) Diagnosis of Aspergillus keratitis in vivo with confocal microscopy. Cornea 16(1):27–31CrossRef

Avunduk AM, Beuerman RW, Varnell ED, Kaufman HE (2003) Confocal microscopy of Aspergillus fumigatus keratitis. Br J Ophthalmol 87(4):409–410CrossRef

Brasnu E, Bourcier T, Dupas B et al (2007) In vivo confocal microscopy in fungal keratitis. Br J Ophthalmol 91(5):588–591CrossRef

10.

Lee S, Yun NR, Kim KH et al (2010) Discrepancy between histology and culture in filamentous fungal infections. Med Mycol 48(6):886–888CrossRef

11.

Schofield CM, Murray CK, Horvath EE et al (2007) Correlation of culture with histopathology in fungal burn wound colonization and infection. Burns 33(3):341–346CrossRef

12.

Thomas PA (2003) Current perspectives on ophthalmic mycoses. Clin Microbiol Rev 16(4):730–797CrossRef

13.

Zbiba W, Baba A, Bouayed E, Abdessalem N, Daldoul A (2016) A 5-year retrospective review of fungal keratitis in the region of Cap Bon. J Fr Ophtalmol 39(10):843–848CrossRef

14.

Rautaraya B, Sharma S, Kar S, Das S, Sahu SK (2011) Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. BMC Ophthalmol 11:39CrossRef

15.

Punia RS, Kundu R, Chander J, Arya SK, Handa U, Mohan H (2014) Spectrum of fungal keratitis: clinicopathologic study of 44 cases. Int J Ophthalmol 7(1):114–117PubMedPubMedCentral

16.

Prajna NV, Krishnan T, Mascarenhas J et al (2012) Predictors of outcome in fungal keratitis. Eye 26(9):1226–1231CrossRef

17.

Ray KJ, Prajna NV, Lalitha P et al (2018) The significance of repeat cultures in the treatment of severe fungal keratitis. Am J Ophthalmol 189:41–46CrossRef

Title: The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis
Authors: Seyed Ali Tabatabaei
Mohammad Soleimani
Seyed Mehdi Tabatabaei
Amir Houshang Beheshtnejad
Niloufar Valipour
Shahram Mahmoudi
Publication date: 01-02-2020
Publisher: Springer Netherlands
Published in: International Ophthalmology / Issue 2/2020
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-019-01209-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis

Abstract

Purpose

Study design

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Study design

Patients and methods

Results

Conclusion

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