Skip to main content
SpringerLink
Log in

Aspergillus flavus Keratitis: Experience of a Tertiary Eye Clinic in Turkey

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

We investigated the clinical and mycological characteristics of four cases of mycotic keratitis caused by Aspergillus flavus that occurred from July 2014 to May 2015 at Çukurova University Hospital, Adana, Turkey. In a 10-month period, a total of 64 corneal smear/scrapings were examined from patients with suspected mycotic keratitis. Fungal cultures were positive in six of these patients, indicating a 9.4% incidence of mycotic keratitis in this region, including four cases of A. flavus and two cases of Fusarium spp. The predisposing factors, clinical presentation, and success of the therapeutic approaches were further evaluated. For all cases, topical voriconazole was the first choice of treatment. Surgical procedures were required to control infection in 3 of the 4 cases, including intrastromal voriconazole injection for two cases and keratoplasty for one case. Predisposing factors included trauma (two cases, 50%), contact lens use (one case, 25%), and previous ocular surgery (one case, 25%). The clinical presentations also differed, including a well-limited ulcer (one case), an ulcer with an irregular feathery margin (one case), and ulcers with satellite lesions (two cases). The mean duration between the time of presentation and definitive diagnosis by culture was 14 days (8–25 days). We observed that A. flavus keratitis can present with different underlying factors and clinical conditions. A combination of antifungal therapy and supportive surgical intervention may resolve infections caused by A. flavus in the cornea.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Manikandan P, Varga J, Kocsube S, et al. Epidemiology of Aspergillus keratitis at a tertiary care eye hospital in South India and antifungal susceptibilities of the causative agents. Mycoses. 2013;56:26–33.

    Article  PubMed  Google Scholar 

  2. Thomas PA, Kaliamurthy J. Mycotic keratitis: epidemiology, diagnosis and management. Clin Microbiol Infect. 2013;19:210–20.

    Article  CAS  PubMed  Google Scholar 

  3. Jurkuna U, Behlau I, Colby K. Fungal keratitis: changing pathogens and risk factors. Cornea. 2009;28:638–43.

    Article  Google Scholar 

  4. Chen WL, Wu CY, Hu FR, et al. Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987–2001. Am J Ophthalmol. 2004;137:736–43.

    PubMed  Google Scholar 

  5. Tanure MA, Cohen EJ, Sudesh S, et al. Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea. 2000;19:307–12.

    Article  CAS  PubMed  Google Scholar 

  6. Thomas PA. Current perspectives on ophthalmic mycoses. Clin Microbiol Rev. 2003;16:730–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hedayati MT, Pasqualotto AC, Warn PA, et al. Aspergillus flavus: human pathogen, allergen and mycotoxin producer. Microbiology. 2007;153:1677–92.

    Article  CAS  PubMed  Google Scholar 

  8. Cheikhrouhou F, Makni F, Neji S, et al. Epidemiological profile of fungal keratitis in Sfax (Tunisia). J Mycol Med. 2014;24:308–12.

    Article  CAS  PubMed  Google Scholar 

  9. Al-Wathiqi F, Ahmad S, Khan Z. Molecular identification and antifungal susceptibility profile of Aspergillus flavus isolates recovered from clinical specimens in Kuwait. BMC Infect Dis. 2013;13:126.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Samson RA, Visagie CM, Houbraken J, et al. Phylogeny, identification and nomenclature of the genus Aspergillus. Stud Mycol. 2014;78:141–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gonçalves SS, Stchigel AM, Cano J, et al. In vitro antifungal susceptibility of clinically relevant species belonging to Aspergillus section Flavi. Antimicrob Agents Chemother. 2013;57:1944–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tam EW, Chen JH, Lau EC, et al. Misidentification of Aspergillus nomius and Aspergillus tamarii as Aspergillus flavus: characterization by internal transcribed spacer, β-tubulin, and calmodulin gene sequencing, metabolic fingerprinting, and matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2014;52:1153–60.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gonçalves SS, Cano JF, Stchigel AM, et al. Molecular phylogeny and phenotypic variability of clinical and environmental strains of Aspergillus flavus. Fungal Biol. 2012;116:1146–55.

    Article  PubMed  Google Scholar 

  14. Subcommittee on Antifungal Susceptibility Testing of the ESCMID. European Committee for Antimicrobial Susceptibility Testing. EUCAST Technical Note on the method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia-forming moulds. Clin Microbiol Infect. 2008;14:982–4.

    Article  Google Scholar 

  15. Iyer SA, Tuli SS, Wagoner RC. Fungal keratitis: emerging trends and treatment outcomes. Eye Contact Lens. 2006;32:267–71.

    Article  PubMed  Google Scholar 

  16. Johnson LB, Kauffman CA. Voriconazole: a new triazole antifungal agent. Clin Infect Dis. 2003;36:630–7.

    Article  CAS  PubMed  Google Scholar 

  17. Mehta H, Mehta HB, Garg P, et al. Voriconazole for the treatment of refractory Aspergillus fumigatus keratitis. Indian J Ophthalmol. 2008;56:243–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Prajna NV, Mascarenhas J, Krishnan T, et al. Comparison of natamycin and voriconazole for the treatment of fungal keratitis. Arch Ophthalmol. 2010;128:672–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sharma N, Agarwal P, Sinha R, et al. Evaluation of intrastromal voriconazole injection in recalcitrant deep fungal keratitis: case series. Br J Ophthalmol. 2011;95:1735–7.

    Article  PubMed  Google Scholar 

  20. Prakash G, Sharma N, Goel M, et al. Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis. Am J Ophthalmol. 2008;146:56–9.

    Article  PubMed  Google Scholar 

  21. Lalitha P, Prajna NV, Kabra A, et al. Risk factors for treatment outcome in fungal keratitis. Ophthalmology. 2006;113:526–30.

    Article  PubMed  Google Scholar 

  22. Martins SA, Combs JC, Noguera G, et al. Antimicrobial efficacy of riboflavin/UVA combination (365 nm) in vitro for bacterial and fungal isolates: a potential new treatment for infectious keratitis. Invest Ophthalmol Vis Sci. 2008;49:3402–8.

    Article  PubMed  Google Scholar 

  23. Iseli HP, Thiel MA, Hafezi F, et al. Ultraviolet A/riboflavin corneal cross-linking for infectious keratitis associated with corneal melts. Cornea. 2008;27:590–4.

    Article  PubMed  Google Scholar 

  24. Makdoumi K, Backman A, Mortensen J, et al. Evaluation of antibacterial efficacy of photo-activated riboflavin using ultraviolet light (UVA). Graefes Arch Clin Exp Ophthalmol. 2010;248:207–12.

    Article  CAS  PubMed  Google Scholar 

  25. Said DG, Elalfy MS, Gatzioufas Z, et al. Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for the treatment of advanced infectious keratitis with corneal melting. Ophthalmology. 2014;121:1377–82.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Seyedmojtaba Seyedmousavi

    Present address: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine, University of Çukurova, 01380, Adana, Turkey

    Elif Erdem, Meltem Yagmur & Reha Ersoz

  2. Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey

    Hazal Boral & Macit Ilkit

  3. Department of Medical Microbiology, Radboud UMC, Nijmegen, The Netherlands

    Seyedmojtaba Seyedmousavi

  4. Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran

    Seyedmojtaba Seyedmousavi

Authors
  1. Elif Erdem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meltem Yagmur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hazal Boral
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Macit Ilkit
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reha Ersoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seyedmojtaba Seyedmousavi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elif Erdem.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erdem, E., Yagmur, M., Boral, H. et al. Aspergillus flavus Keratitis: Experience of a Tertiary Eye Clinic in Turkey. Mycopathologia 182, 379–385 (2017). https://doi.org/10.1007/s11046-016-0089-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-016-0089-1

Keywords

Search

Navigation