title: Fungal keratitis: changing pathogens and risk factors.
abstract: OBJECTIVE
  To describe changes in demographics and pathogens for fungal keratitis cases diagnosed at the Massachusetts Eye and Ear Infirmary.
  
  
  METHODS
  Patient demographics, clinical and laboratory findings, treatment and outcomes of 46 cases of culture-proven fungal keratitis diagnosed from January 2004 through November 2007 were compared with 23 cases of fungal keratitis previously collected over a similar period from January 1999 through November 2002.
  
  
  RESULTS
  During 2004-2007, the rate of fungal keratitis was 1.0 cases per month, an increase from the baseline rate of 0.5 cases per month during 1999-2002. The proportion of cases caused by filamentous fungi increased from 30% (1999-2002) to 65% (2004-2007) (P = 0.01). Soft contact lens wear accounted for 41% of fungal keratitis cases in 2004-2007, as compared with 17% in 1999-2002. The majority of patients (70%) received oral antifungal treatment in addition to topical amphotericin B and natamycin. Seventeen patients (40%) required therapeutic keratoplasty. Patients with a history of corneal transplant had the highest rate of therapeutic keratoplasties (67%) and had the poorest visual outcome (40% counting fingers or less). In the contact lens group, 94% of patients maintained vision of at least 20/40 and only 12% required surgery to control the infection.
  
  
  CONCLUSIONS
  There has been an increase in fungal keratitis in the Boston area and a change in the causative pathogens and risk factors for infection. Filamentous fungi now account for the majority of fungal keratitis cases, whereas yeasts were the predominant pathogen in the past. Soft contact lens wear is currently the most common risk factor for development of fungal keratitis.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
authors.forename: Ula
authors.initials: U
authors.lastname: Jurkunas
authors.forename: Irmgard
authors.initials: I
authors.lastname: Behlau
authors.forename: Kathryn
authors.initials: K
authors.lastname: Colby
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000528:Alternaria; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects; D001900:Boston / Q000453:epidemiology; D002177:Candidiasis; D015331:Cohort Studies; D003261:Contact Lenses / Q000009:adverse effects; D016039:Corneal Transplantation / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005670:Fusarium; D006801:Humans; D015994:Incidence; D007634:Keratitis / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D010866:Natamycin / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D010866:Natamycin