Güney Anadolu Üçüncül Göz Sağlığı Merkezinde Fungal Keratit Olgularının Demografik, Epidemiyolojik ve Etiyolojik Özellikleri

Yıl 2022, Cilt: 44 Sayı: 5, 707 - 714, 29.09.2022

Ayse İdil Çakmak , Meryem Çetin , Yasemin Öz , Necip Kara

https://doi.org/10.20515/otd.1085275

Öz

Güney Anadolu Doğu Akdeniz kıyısında yer alan üçüncü basamak göz sağlığı merkezimizde fungal keratit olgularının demografik, epidemiyolojik ve etiyolojik özelliklerini değerlendirmek. Mayıs 2017'den Mayıs 2019'a kadar görülen, kültürle kanıtlanmış tüm mantar keratitleri retrospektif olarak değerlendirildi. Olguların demografik özellikleri, predispozan faktörleri, ilişkili sistemik ve oküler özellikleri ve mikrobiyolojik analiz sonuçları incelendi. Fungal keratitli 15 olgunun ortalama yaşı 46±7 yıl (19-77 yıl arasında) idi ve erkek/kadın oranı 4:1 idi. Vakaların çoğunluğunu tarım işçileri veya çiftçiler oluşturuyordu (%73). Etyoloji ağırlıklı olarak çevre kaynaklı travmaydı (%93.3). Toplam 39 mikrobiyal pozitif kornea kültüründe 15 gözde (%38.5) mantar üremesi tespit edildi. Fusarium sp. dahil tüm vakalardan filamentöz mantarlar sorumlu olup 8 gözde (%53.3) Fusarium türleri ve 7 gözde (%46.7) Aspergillus türleri saptandı. Fusarium türleri F. Aquaeductus, F. Chlamydosporum, F. oxysporum ve F. solani olmak üzere 4 gözde; Aspergillus türleri ise 3 gözde A. niger ve A. flavus olarak belirlendi. İki gözde bakteriyel ve fungal koenfeksiyon gösterildi (Gram (+) beta hemolitik streptokokla beraber Aspergillus türü; Pseudomonas orzyihabitans ile beraber Fusarium türü). Güney Anadolu'nun Doğu Akdeniz kıyılarında karşılaşılan fungal keratit vakalarının özelliklerini belirleyen bu çalışmanın sonuçları, bu bölgede yaşayan hastaların hastalığın erken teşhisinde ve zamanında ve uygun ampirik tedavisinin başlanmasında faydalı olabilir.

Anahtar Kelimeler

Fungal keratiti, oküler mikrobiyoloji, filamentöz mantarlar, fusarium, aspergillus

Destekleyen Kurum

Hatay Mustafa Kemal University Tayfur Ata Sökmen Medical School

Proje Numarası

ethics committee approval date-decision number: 23/05/2019-10

Teşekkür

Eskişehir Osmangazi Üniversitesi Oftalmoloji Anabilim Dalı öğretim üyesi Sayın Prof. Dr. Nilgün Yıldırım'a hastaya yaklaşım , fungal keratit tanısı ve tedavisi açısından bilgilerini paylaşmasından ve desteklerinden dolayı teşekkür ederiz.

Demographic, Epidemiological and Etiological Characteristics of Fungal Keratitis Cases in Southern Anatolia Tertiary Eye Care Center

Öz

To evaluate the demographic, epidemiological and etiological characterisitics of fungal keratitis cases in our tertiary eye care center located in the Eastern Mediterraen coast of South Anatolia.A retrospective review of all culture-proven fungal keratitis seen from May 2017 to May 2019 was performed. The demographic features, predisposing factors, associated systemic and ocular characteristics, and microbiological analysis results of cases were evaluated. The mean age of 15 cases with fungal keratitis was 46±7 years (range: 19-77 years) with a male-to-female ratio of 4:1. The majority of the occupations of the cases were agricultural workers or farmers (73%). The etiology was predominantly trauma mostly with an environmental origin (93.3%). Fungal growth was detected in 15 eyes (38.5%) in a total of 39 microbial positive corneal cultures. Filamentous fungi were responsible for all cases, including Fusarium sp. in 8 eyes (53.3%) and Aspergillus sp. in 7 eyes (46.7%). Species of Fusarium were determined in 4 eyes, namely F. Aquaeductus, F. Chlamydosporum, F. oxysporum and F. solani; whereas species of Aspergillus were determined in 3 eyes, namely A. niger and A. flavus. Bacterial and fungal coinfection was shown in two eyes (Aspergillus sp. with Gram (+) beta hemolytic streptococcus; Fusarium sp. with Pseudomonas orzyihabitans). The results of this study, which determines the characteristics of fungal keratitis cases encountered in the Eastern Mediterranean coasts of Southern Anatolia may be useful in the early diagnosis of the disease, in the timely and appropriate empirical treatment of the patients living in this region.

Anahtar Kelimeler

Fungal keratitis, ocular microbiology, filamentous fungi, fusarium, aspergillus

Proje Numarası

ethics committee approval date-decision number: 23/05/2019-10

Kaynakça

• 1. Kredics L, Narendran V, Shobana CS, et al. Filamentous fungal infections of the cornea: a global overview of epidemiology and drug sensitivity. Mycoses. 2015;58:243-60.
• 2. Thomas P, Kaliamurthy J. Mycotic keratitis: epidemiology, diagnosis and management. Clin Microbiol Infect. 2013; 19:210-20.
• 3. Mahmoudi S, Masoomi A, Ahmadikia K, et al. Fungal keratitis: An overview of clinical and laboratory aspects. Mycoses. 2018;61:916-30.
• 4. Binnani A, Gupta PS, Gupta A. Epidemio-Clinico-Microbiological Study of Mycotic Keratitis in North-West Region of Rajasthan. Mycopathologia. 2018;183:717-22.
• 5. Niyaz L, Yıldırım N, Başmak H. Turkiye Klinikleri. J Ophthalmol. 2011;20:108-11.
• 6. Gopinathan U, Garg P, Fernandes M, et al. The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India. Cornea. 2002;21:555-9. 7. de Hoog GS, Guarro J, Gené J, Ahmed S, Al-Hatmi AMS, Figueras MJ & Vitale RG (2019) Atlas of Clinical Fungi, 3rd e-edition. Utrecht / Reus.
• 8. Ong HS, Fung SS, Macleod D, et al. Altered patterns of fungal keratitis at a London Ophthalmic Referral Hospital: an eight-year retrospective observational study. Am J Ophthalmol. 2016;168:227-36.
• 9. Kottek M, Grieser J, Beck C,et al. World Map of the Köppen-Geiger climate classification updated. Meteorologische Zeitschrift. 2006;15:259-63.
• 10. Semerci A, Celik AD. Reflections of animal husbandry subsidies on dairy cattle enterprises: A case study of Hatay Province-Turkey. Journal of Tekirdag Agricultural Faculty. 2017;14:92-100
• 11. Gopinathan U, Sharma S, Garg P, et al. Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol 2009;57:273-9.
• 12. Srinivasan M. Fungal keratitis. Curr Opin Ophthalmol. 2004;15:321-7.
• 13. Punia RS, Kundu R, Chander J, et al. Spectrum of fungal keratitis: clinicopathologic study of 44 cases. Int J Ophthalmol. 2014;7:114-7.
• 14. Bharathi MJ, Ramakrishnan R, Vasu S, et al. Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol. 2003;51:315-21.
• 15. Srinivasan M, Gonzales CA, George C, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol. 1997;81:965-71.
• 16. Ebadollahi-Natanzi A, Arab-Rahmatipour G, Tabatabaei SA. Prevalence of Fungal Keratitis (FK) in Patients with Corneal Ulcers in Farabi Eye Hospital, Tehran, 2011-2013. Asia Pac J Med Toxicol. 2016;5:94-7.
• 17. Ng JK, Fraunfelder FW, Winthrop KL. Review and update on the epidemiology, clinical presentation, diagnosis, and treatment of fungal keratitis. Curr Fungal Infect Rep. 2013;7:293-300
• 18. Bharathi MJ, Ramakrishnan R, Meenakshi R, et al. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic epidemiol. 2007;14:61-9.
• 19. Shah A, Sachdev A, Coggon D, et al. Geographic variations in microbial keratitis: an analysis of the peer-reviewed literature. Br J Ophthalmol. 2011;95:762-7.
• 20. Xie L, Zhong W, Shi W,et al. Spectrum of fungal keratitis in north China. Ophthalmology. 2006;113:1943-8.
• 21. Alfonso EC, Cantu-Dibildox J, Munir WM, et al. Insurgence of Fusarium keratitis associated with contact lens wear. Arch Ophthalmol. 2006;124:941-7.
• 22. Wong TY, Fong KS, Tan DT. Clinical and microbial spectrum of fungal keratitis in Singapore: a 5-year retrospective study. Int Ophthalmol. 1997;21:127-30.
• 23. Gaujoux T, Chatel MA, Chaumeil C, et al. Outbreak of contact lens-related Fusarium keratitis in France. Cornea. 2008;27:1018-21.
• 24. Ma SK, So K, Chung PH, et al. A multicountry outbreak of fungal keratitis associated with a brand of contact lens solution: the Hong Kong experience. Int J Infect Dis. 2009;13:443-8.
• 25. Rosa RH, Miller D, Alfonso EC. The changing spectrum of fungal keratitis in South Florida. Ophthalmology. 1994;101:1005-13.
• 26. Burton MJ, Pithuwa J, Okello E, et al. Microbial keratitis in East Africa: why are the outcomes so poor? Ophthalmic Epidemiol. 2011;18:158-63. 27. Sekeroğlu HT, Yar K, Damar E, et al. Cytologically Diagnosed Fungal Keratitis: Clinical Features and Treatment Results. Turk J Ophthalmol. 2010;40:255-9.
• 28. Yilmaz S, Ozturk I, Maden A. Microbial keratitis in West Anatolia, Turkey: a retrospective review. Int Ophthalmol. 2007;27:261-8.
• 29. Ritterband DC, Seedor JA, Shah MK, et al. Fungal keratitis at the New York eye and ear infirmary. Cornea. 2006;25:264-7.
• 30. Walther G, Stasch S, Kaerger K, et al. Fusarium Keratitis in Germany. J Clin Microbiol. 2017;55:2983-95.
• 31. Lalitha P, Shapiro BL, Srinivasan M, et al. Antimicrobial susceptibility of Fusarium, Aspergillus, and other filamentous fungi isolated from keratitis. Arch Ophthalmol. 2007;125:789-93.