Filamentous Fungal Keratitis in Taiwan: Based on Molecular Diagnosis

Ning Hung; Lung-Kun Yeh; David Hui-Kang Ma; Hsin-Chiung Lin; Hsin-Yuan Tan; Hung-Chi Chen; Pei-Lun Sun; Ching-Hsi Hsiao

doi:10.1167/tvst.9.8.32

Filamentous Fungal Keratitis in Taiwan: Based on Molecular Diagnosis

Transl Vis Sci Technol. 2020 Jul 21;9(8):32. doi: 10.1167/tvst.9.8.32. eCollection 2020 Jul.

Authors

Ning Hung¹, Lung-Kun Yeh^{1

2}, David Hui-Kang Ma^{1

2}, Hsin-Chiung Lin^{1

2}, Hsin-Yuan Tan^{1

2}, Hung-Chi Chen^{1

2}, Pei-Lun Sun^{2

3}, Ching-Hsi Hsiao^{1

2}

Affiliations

¹ Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.

Abstract

Purpose: To analyze the epidemiological pattern, demographics, risk factors, and treatment outcomes of filamentous fungal keratitis at a tertiary hospital in Taiwan.

Methods: We recruited 65 patients (65 eyes) with culture-proven filamentous fungal keratitis who received diagnosis and treatment at Chang Gung Memorial Hospital between 2015 and 2018. All isolates were examined through conventional morphological identification and subjected to molecular identification with internal transcribed spacer sequencing. Data on patient demographics, predisposing factors, and treatment outcomes were collected.

Results: In total, filamentous fungi belonged to 16 genera were identified. Fusarium spp. (29 cases [44.6%]) was the most commonly isolated organism overall, followed by Colletotrichum spp. and Purpureocillium linacinum (seven cases [10.8% for each]), and Aspergillus spp. (six cases [9.2%]). Some fungi that have not been regarded as human pathogens were also identified, such as Paracremonium and Phellinum. Among 52 (80%) patients with predisposing factors, 30 (46.2%) had trauma. The ulcers of 33 (50.8%) patients resolved with medical treatment only. Additionally, six patients (9.2%) had corneal perforation, and nine patients (13.9%) required therapeutic/destructive surgical interventions including therapeutic penetrating keratoplasty (seven patients) or evisceration (two patients). Only 16 patients (24.6%) had final visual acuity of 20/40 or better.

Conclusions: Through molecular diagnosis, a high diversity of fungal pathogens was revealed along with an increasing incidence of Colletotrichumspp. and Purpureocilliumspp. in Taiwan. The most common risk factor for filamentous fungal keratitis was trauma. The visual outcomes were guarded.

Translational relevance: The molecular diagnosis provides insight into accurate identification, which affects the epidemiology and diversity of pathogens of filamentous fungal keratitis.

Keywords: colletotrichum; filamentous fungal keratitis; internal transcribed spacer sequencing; purpureocillium.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antifungal Agents / therapeutic use
Corneal Ulcer* / diagnosis
Eye Infections, Fungal* / diagnosis
Humans
Keratitis* / diagnosis
Taiwan / epidemiology

Substances

Antifungal Agents