RESEARCH PAPER
A single-centre retrospective observational study of fungal keratitis in Poland with a review of findings in Europe
 
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1
Department of Ophthalmology, School of Medicine with the Division of Dentistry, Zabrze, Poland Medical University of Silesia, Katowice, Poland
2
Department of Management and Financial Science, School of Economics, Warsaw, Poland
CORRESPONDING AUTHOR
KATARZYNA EWA NOWIK   

Department of Ophthalmology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
 
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ABSTRACT
Introduction:
Fungal keratitis is a severe condition which may lead to blindness. Fungal keratitis, also known mycotic keratitis or keratomycosis, has worldwide distribution, but is more common in tropical climates compared to moderate zones. In recent years, there have been several studies suggesting an increase in the number of mycotic keratitis cases in countries with a moderate climate. There is little data available with no literature review concerning fungal keratitis in European countries.

Objective:
To analyse the causes, presentation, and clinico-pathological associations of fungal keratitis in a retrospective series of patients referred to the Department of Ophthalmology of the Railway Hospital in Katowice, south-west Poland, and comparing the findings to previously published studies in peer reviewed articles from other European countries published between 2000–2019.

Material and methods:
Data were collected using the medical records of patients with fungal keratitis. Risk factors, clinical manifestation and treatment results were analysed from 45 patients (45 eyes) with fungal keratitis treated in the Department of Ophthalmology of Railway Hospital in Katowice between January 2013 – December 2017. The factors affecting the development of infection, visual acuity at baseline and at the end of treatment, as well as treatment method selection, were analysed. Literature review was performed using the Medline, Pubmed, Embase databases and Google scholar. The inclusion criteria were peer reviewed papers published between 2000–2019 which reported data from patients with fungal keratitis in at least one European country. 11 peer reviewed articles which matched the inclusion criteria were analysed.

Results:
The mean BCVA of patients treated in the Department of Ophthalmology of the Railway Hospital in Katowice upon diagnosis was 2.3 (logMAR), compared to 1.95 (logMAR) at the end of treatment. Pearson’s chi-squared test was used to establish the final mean BCVA in eyes with keratitis caused by Candida spp. compared with keratitis caused by Filamentous spp. The reviewed articles showed poor results of treatment and diagnostic difficulties in fungal keratitis.

Conclusions:
Fungal keratitis is a significant diagnostic and therapeutic challenge and may occur in rural and urban areas. Early and accurate diagnosis followed by proper antifungal treatment can prevent blindness and improve BCVA results.

 
REFERENCES (22)
1.
Chang HY, Chodosh J. Diagnostic and therapeutic considerations in fungal keratitis. Int Ophthalmol Clin. 2011; 51: 33–42.
 
2.
Gopinathan U, Sharma S, Garg P, Rao GN. Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol. 2009; 57: 273–279.
 
3.
Lam DS, Houang E, Fan DS, Lyon D, Seal D, Wong E. Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye (Lond). 2002; 16(5): 608–18.
 
4.
Keay LJ, et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001–2007: a multicenter study. Ophthalmology. 2011; 118(5): 920–6.
 
5.
Leck AK, Thomas PA, Hagan M. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol. 2002; 86(11): 1211–1215.
 
6.
Tilak R, Singh A, Maurya OP, Chandra A, Tilak V, Gulati AK. Mycotic keratitis in India: a five-year retrospective study. J Infect Dev Ctries. 2010; 4(3): 171–4.
 
7.
Walkden A et al. Association Between Season, Temperature and Causative Organism in Microbial Keratitis in the UK. Cornea. 2018; 37(12): 1555–1560.
 
8.
Iselin KC, Baenninger PB, Schmittinger-Zirm A, Thiel MA, Kaufmann C. Fungal keratitis: A Six-Year Review at a Tertiary Referral Centre. Klin Monbl Augenheilkd. 2017; 234(4): 419–425.
 
9.
Nielsen SE, et al. Incidence and clinical characteristics of fungal keratitis in a Danish population from 2000 to 2013. Acta Ophthalmol. 2015; 93(1): 54–8.
 
10.
Tuft SJ, Tullo AB. Fungal keratitis in the United Kingdom 2003–2005. Eye (Lond). 2009; 23(6):1308–13.
 
11.
Bograd A, Seiler T, Droz S, Zimmerli S, Früh B, Tappeiner C. Bacterial and Fungal Keratitis: A Retrospective Analysis at a University Hospital in Switzerland. Klin Monbl Augenheilkd. 2019.
 
12.
Rondeau N, et al. Fungal keratitis at the Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts: retrospective study of 19 cases. J Fr Ophtalmol. 2002; 25(9): 890–6.
 
13.
Hon Shing Ong, et al. Altered Patterns of Fungal Keratitis at a London Ophthalmic Referral Hospital: An Eight-Year Retrospective Observational Study. Am J Ophthalmol. 2016; 168: 227–236.
 
14.
Farrell S, McElnea E, Moran S, Knowles S, Murphy CC. Fungal keratitis in the Republic of Ireland. Eye (Lond). 2017; 31(10): 1427–1434.
 
15.
Galarreta DJ, Tuft SJ, Ramsay A, Dart JK. Fungal keratitis in London: microbiological and clinical evaluation. Cornea. 2007; 26(9):1082–6.
 
16.
Nielsen E, Heegaard S, Prause JU, Ivarsen,A, MortensenKL, Hjortdal J. Fungal Keratitis – Improving Diagnostics by Confocal Microscopy. Case Rep Ophthalmol. 2013; 4:303–310.
 
17.
Brasnu E, et al. In vivo confocal microscopy in fungal keratitis. Br J Ophthalmol. 2007; 91: 588–591. Roth M, et al. The German keratomycosis registry: Initial results of a multicenter survey. Ophthalmologe. 2019.
 
18.
Roth M, et al. The German keratomycosis registry: Initial results of a multicenter survey. Ophthalmologe. 2019.
 
19.
Chew R, Woods ML. Epidemiology of fungal keratitis in Queensland, Australia. Clin Exp Ophthalmol. 2019; 47(1): 26–32.
 
20.
Bharathi MJ, Ramakrishnan R, Vasu S, Meenakshi R, Palaniappan R. Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol. 2003; 51(4): 315–21.
 
21.
Walther G, et al. Fusarium Keratitis in Germany. J Clin Microbiol. 2017; 55(10): 2983–2995.
 
22.
Alio JL, Abbouda A, Valle DD, Del Castillo JM, Fernandez JA.Corneal cross linking and infectious keratitis: a systematic review with a metaanalysis of reported cases. J Ophthalmi. 2013; 3(1):47.
 
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