Incidence and clinical characteristics of fungal keratitis in a Danish population from 2000 to 2013.
OBJECTIVE
Fungal keratitis is a severe sight-threatening condition. The aim of this study was to investigate the incidence and clinical characteristics of fungal keratitis patients living in a temperate climate.


METHODS
By reviewing medical records from 2000 to July 2013, patients with fungal keratitis were identified. Risk factors, clinical signs and outcome were registered.


RESULTS
Twenty-five patients were identified: 52% with Candida, 20% with Fusarium, 16% with Aspergillus and 12% with mixed filamentous fungi. A minimum incidence of fungal keratitis of 0.6 cases per million per year was estimated. Prior topical steroid treatment was commonly found in our cases (44%). Trauma including contact lens wear was associated with infection with filamentous fungi, whereas in patients with Candida infection, ocular surface disease was a prominent feature. Median time from onset of symptoms to diagnosis was 24 days. Only a few patients exhibited classical clinical features such as endothelial plaques (28%), satellite lesions (24%) and feathery edges (16%). The final visual outcome was poor with an average best-corrected logMAR of (mean, 95% CI) 0.70 (0.4-1.0). A total of 52% were treated with corneal transplantation. Patients with Candida infections had a significantly worse visual outcome.


CONCLUSIONS
We found that patients with fungal keratitis had a poor visual outcome. However, knowledge of risk factors and clinical signs leading to early treatment can improve the prognosis.
Opthalmology Department, University Hospital of Aarhus, Aarhus, Denmark.
Stine E
SE
Nielsen
Esben
E
Nielsen
Hanne Olsen
HO
Julian
Jens
J
Lindegaard
Klavs
K
Højgaard
Anders
A
Ivarsen
Jesper
J
Hjortdal
Steffen
S
Heegaard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D003718:Denmark / Q000453:epidemiology; D015353:Eye Enucleation; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005670:Fusarium / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D055815:Young Adult
D000935:Antifungal Agents
culture; epidemiology; fungal keratitis; fungus