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

2021 ◽  
Vol 7 (11) ◽  
pp. 966
Author(s):  
Darren Shu Jeng Ting ◽  
Mohamed Galal ◽  
Bina Kulkarni ◽  
Mohamed S. Elalfy ◽  
Damian Lake ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Unmet Need ◽  
Treatment Strategies ◽  
Healing Time ◽  
Fungal Keratitis ◽  
Ocular Infection ◽  
Candida Spp ◽  
Corneal Surgery ◽  
Surgical Interventions ◽  
Culture Positive

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 (n = 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 Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus 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 p < 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.

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

2021 ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Mohamed Galal ◽  
Bina Kulkarni ◽  
Mohamed S. Elalfy ◽  
Damian Lake ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Unmet Need ◽  
Visual Outcome ◽  
Fungal Keratitis ◽  
Ocular Infection ◽  
Candida Spp ◽  
Corneal Surgery ◽  
Surgical Interventions ◽  
Poor Visual Outcome ◽  
Culture Positive

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&rsquo;s Medical Centre, Nottingham, and Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. A total of 117 patients (n=117 eyes) with FK were included in this study. The mean age was 59.0&plusmn;19.6 years (range, 4-92 years) and 51.3% patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus 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&plusmn;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&plusmn;1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (&gt;3mm), and poor presenting CDVA (&lt;1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of &lt;1.0 logMAR) and poor corneal healing (&gt;60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p&lt;0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcome, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.

scholarly journals Clinical analysis of fungal keratitis according to prior topical steroid use: A retrospective study

2019 ◽  
Author(s):  
Chan Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Ocular Surface ◽  
Clinical Characteristics ◽  
Topical Steroid ◽  
Fungal Keratitis ◽  
Ocular Surface Disease ◽  
Ocular Infection ◽  
Steroid Use

Abstract Background: To compare the clinical characteristics and treatment outcomes of microbiologically-proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically-proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors and clinical characteristics, microbiological profiles, and treatment outcomes were compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. No significant differences were observed in mean age, sex, occupation, and baseline clinical characteristics between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048), identified fungal isolates (53.3% vs. 26.4%, p=0.014), and diagnosed by repeat microbiological tests (40.0% vs. 17.0%, p=0.020). Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.015). Regarding treatment outcomes, the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 5.95, p=0.003), prior topical steroid use (odds 3.45, p=0.034), and non-vegetable corneal trauma (odds 4.46, p=0.037). Conclusions: The PS group was more associated with previous ocular surface disease, and no significant differences were observed in the baseline clinical characteristics between the two groups. Diagnosis was more difficult and treatment results were worse in the PS group in this study. Repeat microbiological tests can be helpful in diagnosing fungal infections especially in the prior topical steroid used group. Keywords: Fungal ocular infection, Steroids, Ulcerative keratitis.

Dual stain kit for the microscopic gram classification of ocular infection bacteria

1993 ◽  
Vol 51 ◽  
pp. 248-249
Author(s):  
Jacob S. Hanker ◽  
Dale N. Holdren ◽  
Kenneth L. Cohen ◽  
Beverly L. Giammara
Keyword(s):  
Contact Lenses ◽  
Ocular Infection ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Staining ◽  
Ocular Infections ◽  
Different Types ◽  
Culture Positive ◽  
Increased Susceptibility

Keratitis and conjunctivitis (infections of the cornea or conjunctiva) are ocular infections caused by various bacteria, fungi, viruses or parasites; bacteria, however, are usually prominent. Systemic conditions such as alcoholism, diabetes, debilitating disease, AIDS and immunosuppressive therapy can lead to increased susceptibility but trauma and contact lens use are very important factors. Gram-negative bacteria are most frequently cultured in these situations and Pseudomonas aeruginosa is most usually isolated from culture-positive ulcers of patients using contact lenses. Smears for staining can be obtained with a special swab or spatula and Gram staining frequently guides choice of a therapeutic rinse prior to the report of the culture results upon which specific antibiotic therapy is based. In some cases staining of the direct smear may be diagnostic in situations where the culture will not grow. In these cases different types of stains occasionally assist in guiding therapy.

scholarly journals Therapeutic Antibodies for the Treatment of Respiratory Tract Infections—Current Overview and Perspectives

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 151
Author(s):  
Alexie Mayor ◽  
Adélaïde Chesnay ◽  
Guillaume Desoubeaux ◽  
David Ternant ◽  
Nathalie Heuzé-Vourc’h ◽  
...  
Keyword(s):  
Respiratory Tract Infections ◽  
Inflammatory Diseases ◽  
Treatment Strategies ◽  
Candida Spp ◽  
Medical Needs ◽  
Life Threatening ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Tract Infections ◽  
Unmet Medical Needs

Respiratorytract infections (RTIs) are frequent and life-threatening diseases, accounting for several millions of deaths worldwide. RTIs implicate microorganisms, including viruses (influenza virus, coronavirus, respiratory syncytial virus (RSV)), bacteria (Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus and Bacillus anthracis) and fungi (Pneumocystis spp., Aspergillus spp. and very occasionally Candida spp.). The emergence of new pathogens, like the coronavirus SARS-CoV-2, and the substantial increase in drug resistance have highlighted the critical necessity to develop novel anti-infective molecules. In this context, antibodies (Abs) are becoming increasingly important in respiratory medicine and may fulfill the unmet medical needs of RTIs. However, development of Abs for treating infectious diseases is less advanced than for cancer and inflammatory diseases. Currently, only three Abs have been marketed for RTIs, namely, against pulmonary anthrax and RSV infection, while several clinical and preclinical studies are in progress. This article gives an overview of the advances in the use of Abs for the treatment of RTIs, based on the analysis of clinical studies in this field. It describes the Ab structure, function and pharmacokinetics, and discusses the opportunities offered by the various Ab formats, Ab engineering and co-treatment strategies. Including the most recent literature, it finally highlights the strengths, weaknesses and likely future trends of a novel anti-RTI Ab armamentarium.

scholarly journals EXPRESS: Retrospective study of clinical characteristics and viral etiologies of patients with viral pneumonia in Beijing

2021 ◽  
pp. 204589402110110
Author(s):  
Xiang Zhao ◽  
Yao Meng ◽  
Duo Li ◽  
Zhaomin Feng ◽  
Weijuan Huang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Influenza A ◽  
Clinical Characteristics ◽  
Ebola Virus ◽  
Treatment Strategies ◽  
Lavage Fluid ◽  
Viral Pneumonia ◽  
Chip Technology ◽  
Viral Influenza ◽  
Simplex Virus

Aims: The virus is common in patients with viral pneumonia. However, the viral etiology and clinical features of patients with viral pneumonia in China remain unclear. The main purpose of this study was to analyze the viral causes and epidemiology of patients with viral pneumonia in Beijing, which can significantly improve the pertinence and accuracy of clinical treatment of the disease. Methods: Firstly, 1,539 respiratory specimens of pneumonia (oropharyngeal swabs, nasopharyngeal swabs, saliva samples and bronchoalveolar lavage fluid) were collected from 19 hospitals in Beijing from September 2015 to August 2018. Then, TaqMan low-density microfluidic chip technology was used to detect viral pneumonia specimens in 1,539 respiratory tract specimens of pneumonia, and determine the types of viral bacteria in them. Lastly, the analysis of demographic, clinical and etiological data of patients with viral pneumonia was performed. Results: The results showed that among the 1,539 respiratory tract specimens with pneumonia, 760 were detected as viral pneumonia specimens, with a positive rate of 49.4%. Among which, 467 were infected with mono-viral and 293 were infected with multi-viral. Influenza A virus (Flu A), mycoplasma pneumoniae (MPn), ebola virus (EBV) and herpes simplex virus type 1 (HSV-1) were the major viral components in the samples of these patients. Furthermore, these viral species were significantly associated with sample sources, onset season and certain clinical characteristics. Discussion: Our findings may provide corresponding treatment strategies for viral pneumonia patients infected with specific viruses.

scholarly journals Fungal Keratitis in Northern Thailand: Spectrum of Agents, Risk Factors and Putative Virulence Factors

2021 ◽  
Vol 7 (6) ◽  
pp. 475
Author(s):  
Siriporn Chongkae ◽  
Sirida Youngchim ◽  
Joshua D. Nosanchuk ◽  
Angkana Laliam ◽  
Chulaluck Tangmonkongvoragul ◽  
...  
Keyword(s):  
Virulence Factors ◽  
Vision Loss ◽  
Proteolytic Enzymes ◽  
Tertiary Care ◽  
Fungal Keratitis ◽  
High Rate ◽  
Ocular Infection ◽  
Fungal Culture ◽  
Care Hospital ◽  
Northern Thailand

Fungal keratitis (FK) is a serious ocular infection that can result in various degrees of vision loss, including blindness. The aim of the study was to identify and retrospectively review all FK cases diagnosed between August 2012 and December 2020 at a tertiary care hospital in northern Thailand with a specific focus on epidemiologic features, including season, patient sex and age, the spectrum of pathogens, and presence of certain putative virulence factors. Of 1237 patients with corneal ulcers, 294 (23.8%) were confirmed by direct microscopic examination and/or fungal culture. For the positive cases, direct examinations of Calcofluor white (CW) stains and KOH mounts were found in 97.3% (286/294) and 76.5% (225/294), respectively (p < 0.05). Of the cases diagnosed by microscopy and culture, fungi were isolated in 152 (51.7%), with Fusarium spp. being the most frequently identified (n = 69, 45.5%) followed by dematiaceous fungi (n = 45, 29.6%) and Aspergillus spp. (n = 18, 11.8%). The incidence of FK was higher in the rainy season of July to October. The mean age was 54.4 ± 14.4 (SD) years, with a range of 9–88 years. Males (75.8%) were affected significantly more than females (24.2%) (p < 0.05). Of 294 patients, 132 (44.9%) were middle-aged adults (41–60 years) and 107 (36.4%) were older than 60 years. Trauma to the eye by soil or vegetative matter were the most common preceding factors (188/294; 64.0%). We assessed two virulence factors. First, 142 of the 152 culture-positive FK cases were due to molds, indicating that hyphal morphogenesis is extremely important in disease. We also demonstrated that fungal melanization occurs in the molds during the course of FK by applying a melanin-specific monoclonal antibody (MAb) that labeled fungal elements in corneal samples of patients, and melanin particles derived from the hyphae were also recovered after treatment of the samples with proteolytic enzymes, denaturant and hot concentrated acid. In summary, we demonstrate that northern Thailand has a high rate of FK that is influenced by season and males engaged in outside activities are at highest risk for disease. Moulds are significantly more commonly responsible for FK, in part due to their capacity to form hyphae and melanins. Future studies will examine models of fungal corneal interactions and assess additional factors of virulence, such as secreted enzymes, to more deeply decipher the pathogenesis of FK.

Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

2021 ◽  
Vol 23 (3) ◽  
pp. 157-164
Author(s):  
Valery V. Semenov ◽  
Sofya А. Prudyeva ◽  
Alexander A. Kurygin
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Treatment Strategies ◽  
Repeated Administration ◽  
Early Postoperative Period ◽  
Diagnosis And Treatment ◽  
Wound Therapy ◽  
Active Growth ◽  
Surgical Interventions ◽  
Ventral Hernias

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

CLINICAL CHARACTERISTICS AND EVALUATION OF THE EFFECTIVE TREATMENT OF CUTANEOUS WARTS BY ELECTROSURGERY

2020 ◽  
pp. 25-29
Author(s):  
Anh Mai Ba Hoang ◽  
Duan Nguyen Duy ◽  
Cat Mai Thi Cam ◽  
Nga Le Thi Thuy ◽  
Phuong Nguyen Thi Thanh ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Wide Distribution ◽  
Healing Time ◽  
Common Disease ◽  
Clinical Form ◽  
Plantar Wart ◽  
Dermatology Clinic ◽  
Cutaneous Wart ◽  
Cutaneous Warts ◽  
Single Lesion

Background: Cutaneous wart is a common disease caused by the infection of Human Papillomavirus, this disease has diverse clinical characteristics and many different treatments. We conducted this study to evaluate the clinical features and the efficacy electrosurgery treatment. Methods: A total 75 patients was diagnosed with cutaneous wart and treated by electrosurgery method at Dermatology Clinic of Hue University of Medicine and Pharmacy Hospital. Results: The age has a wide distribution. The female/male ratio was nearly egal. Most patients had a single lesion. Plantar wart was predominate with 63.3%. After the procedure, 90.8% of patients had mild and moderate pain. The rate of post-operative bleeding was high 85.3%. In the first week, the dried wound was 64.2%. The average healing time was about 4 weeks. The infection rate was 11%. Conclusion: The most common clinical form was plantar wart; electrosurgery had many advantages but some disadvantages in wound healing related to heat damage. Keywords: cutaneous wart, electrosurgery, HPV.

scholarly journals Clinical Characteristics and Outcomes of Rare Fungal Keratitis Caused by Verticillium dahliae

2021 ◽  
Author(s):  
Qing Huang ◽  
Wenlu Zhang ◽  
Yu Sun ◽  
Xiaofeng Li ◽  
Xiaoyu Zhang ◽  
...  
Keyword(s):  
Verticillium Dahliae ◽  
Clinical Characteristics ◽  
Corneal Ulcer ◽  
Antifungal Susceptibility ◽  
Corneal Thickness ◽  
Fungal Keratitis ◽  
Lamellar Keratoplasty ◽  
Internal Transcribed Spacer Region ◽  
In Vitro Antifungal Susceptibility

Abstract PurposeTo observe clinical characteristics and treatment outcomes of fungal keratitis cause by Verticillium dahliae. MethodsClinical data of 7 patients diagnosed as fungal keratitis cause by V. dahliae were retrospectively analyzed. The clinical manifestations, mycology, in vitro antifungal susceptibility, treatment regimens and prognoses of the patients were evaluated. ResultsAll 7 patients were farm worker, of which 5 cases were caused by plant trauma. The corneal ulcer had a round shape and a relatively limited range with the diameters mainly in the range of 2-7 mm. The stromal infiltration was mild, and had no pseudopodia, mossiness or endothelial plaques. Intact hyphaes were detected in corneal scrapings and confocal microscopy, isolates were identified by morphology and by sequencing the internal transcribed spacer region of ribosomal DNA. In vitro antifungal susceptibility testing showed that the most sensitive antifungal drug was Amphotericin B. In the 6 patients with an ulcer less than 2/3 of the corneal thickness, the ulcer healed after 18 days of antifungal treatment only in one eye. The other five patients underwent corneal ulcer debridement or conjunctival flap covering surgery. The remaining one patient with ulcer depth more than 2/3 of the corneal thickness underwent lamellar keratoplasty. ConclusionFungal keratitis caused by V. dahliae has typical signs of a mild inflammatory response, and is not sensitive to antifungal drugs. It is recommended that patients undergo corneal ulcer debridement as soon as possible to promote rapid healing of the ulcers.

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