背景:霉菌性角膜炎(MK)代表角膜感染,镰刀菌被确定为主要原因。镰刀菌是一种常见于土壤和植物中的丝状真菌。虽然许多镰刀菌是无害的,有些会导致人类和动物的严重感染,特别是镰刀菌角膜炎,会导致严重的眼部感染,世界热带和亚热带地区单眼失明的普遍原因。由于其在眼科中的发病率和重要性,我们对临床病例进行了系统分析,通过收集临床和人口统计学数据,提高对镰刀菌角膜炎的认识.
方法:进行镰刀菌角膜炎的分析,我们浏览了PubMed数据库中的文献,Embase,丁香花,和谷歌学者发现了99篇论文,1969年3月至2023年9月,对应163例镰刀菌角膜炎。
结果:我们的分析显示,枯萎镰刀菌是主要的分离株,女性受镰刀菌角膜炎的影响不成比例。值得注意的是,隐形眼镜的使用成为一个重要的风险因素,与近一半的病例有关。诊断主要依靠文化,虽然治疗主要涉及局部纳他霉素,两性霉素B,和/或伏立康唑。令人惊讶的是,我们的研究结果表明,来自美国的病例普遍存在,这表明热带地区可能低估和低估这种真菌病。这表明必须提高警惕,特别是在农业活动丰富的欠发达地区,镰刀菌感染可能比目前报道的更为普遍。
结论:我们的研究揭示了镰刀菌角膜炎的临床复杂性,并强调需要进一步的研究和监测,以有效地解决这种视力威胁的情况。此外,及时识别和早期开始抗真菌治疗似乎与选择初始治疗本身一样重要。
BACKGROUND: Mycotic keratitis (MK) represents a corneal infection, with Fusarium species identified as the leading cause. Fusarium is a genus of filamentous fungi commonly found in soil and plants. While many Fusarium species are harmless, some can cause serious infections in humans and animals, particularly Fusarium keratitis, that can lead to severe ocular infections, prevalent cause of monocular blindness in tropical and subtropical regions of the world. Due to its incidence and importance in ophthalmology, we conducted a systematic analysis of clinical cases to increase our understanding of Fusarium keratitis by gathering clinical and demographic data.
METHODS: To conduct an analysis of Fusarium keratitis, we looked through the literature from the databases PubMed, Embase, Lilacs, and Google Scholar and found 99 papers that, between March 1969 and September 2023, corresponded to 163 cases of Fusarium keratitis.
RESULTS: Our analysis revealed the Fusarium solani species complex as the predominant isolate, with females disproportionately affected by Fusarium keratitis. Notably, contact lens usage emerged as a significant risk factor, implicated in nearly half of cases. Diagnosis primarily relied on culture, while treatment predominantly involved topical
natamycin, amphotericin B, and/or voriconazole. Surprisingly, our findings demonstrated a prevalence of cases originating from the United States, suggesting potential underreporting and underestimation of this mycosis in tropical regions. This shows the imperative for heightened vigilance, particularly in underdeveloped regions with substantial agricultural activity, where Fusarium infections may be more prevalent than currently reported.
CONCLUSIONS: Our study sheds light on the clinical complexities of Fusarium keratitis and emphasizes the need for further research and surveillance to effectively tackle this vision-threatening condition. Furthermore, a timely identification and early initiation of antifungal treatment appear to be as important as the choice of initial treatment itself.