title: In vivo confocal microscopy appearance ofFusariumandAspergillusspecies in fungal keratitis.
abstract: Clinical outcomes in fungal keratitis vary betweenFusariumandAspergillusspp, therefore distinguishing between species using morphological features such as filament branching angles, sporulation along filaments (adventitious sporulation) or dichotomous branching may be useful. In this study, we assessed these three features within Heidelberg Retina Tomograph 3 in vivo confocal microscopy (IVCM) images from culture-positiveFusariumandAspergillusspp keratitis participants.
  
  
  
  Prospective observational cohort study in Aravind Eye Hospital (February 2011-February 2012). Eligibility criteria: age ≥18 years, stromal infiltrate ≥3 mm diameter,FusariumorAspergillusspp culture-positive.
  
  
  
  previous/current herpetic keratitis, visual acuity <6/60 in fellow eye, >80% corneal thinning. IVCM was performed and images analysed for branch angle, presence/absence of adventitious sporulation or dichotomous branching by a grader masked to the microbiological diagnosis.
  
  
  
  98 participants were included (106 eligible, 8 excluded as no measurable branch angles); 68 were positive forFusariumspp, 30 forAspergillusspp. Mean branch angle forFusariumspp was 59.7° (95% CI 57.7° to 61.8°), and forAspergillusspp was 63.3° (95% CI 60.8° to 65.8°), p=0.07. No adventitious sporulation was detected inFusariumspp ulcers. Dichotomous branching was detected in 11 ulcers (7Aspergillusspp, 4Fusariumspp).
  
  
  
  There was very little difference in the branching angle ofFusariumandAspergillusspp. Adventitious sporulation was not detected and dichotomous branching was infrequently seen. Although IVCM remains a valuable tool to detect fungal filaments in fungal keratitis, it cannot be used to distinguishFusariumfromAspergillusspp and culture remains essential to determine fungal species.
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jaya Devi
authors.identifier: 0000-0001-5438-2858
authors.initials: JD
authors.lastname: Chidambaram
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.|Aravind Medical Research Foundation, Madurai, Tamil Nadu, India.
authors.forename: Namperumalsamy Venkatesh
authors.initials: NV
authors.lastname: Prajna
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Larke
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Macleod
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.
authors.forename: Palepu
authors.initials: P
authors.lastname: Srikanthi
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.
authors.forename: Shruti
authors.initials: S
authors.lastname: Lanjewar
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.|Aravind Medical Research Foundation, Madurai, Tamil Nadu, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Shah
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.|Aravind Medical Research Foundation, Madurai, Tamil Nadu, India.
authors.forename: Prajna
authors.initials: P
authors.lastname: Lalitha
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.|Aravind Medical Research Foundation, Madurai, Tamil Nadu, India.
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Elakkiya
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000000981:diagnostic imaging*; D001230:Aspergillus / Q000302:isolation & purification; D003320:Corneal Ulcer / Q000000981:diagnostic imaging / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000000981:diagnostic imaging*; D005260:Female; D005670:Fusarium / Q000302:isolation & purification; D006801:Humans; D007634:Keratitis / Q000000981:diagnostic imaging* / Q000382:microbiology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D055815:Young Adult
keywords: Cornea; Diagnostic tests/Investigation; Imaging; Infection; Microbiology