Spectrum of infection of fungal keratitis: analysis of 654 cases

Abstract

To investigate the spectrum of infection and epidemiological features of fungal keratitis (FK). The demographic data, risk factors, clinical features, laboratory findings, and treatment strategies of 654 patients with FK in Qingdao area, 396 males and 258 females, aged 44.9 +/- 12.5 (7 - 80), hospitalized January 1999 - September 2004 were collected and analyzed. FK patients accounted for 61.9% of the patients hospitalized for infectious keratitis. The ratio between the FK male and female patients was 1.5:1. The age distribution was as follows: 31.0% of the patients were aged 41 - 50, 26.5% of them were aged 31 - 40, 21.1% aged 51 - 60, 9.3% aged 61 - 70, etc. 89.9% of the FK patients were peasants. Corneal trauma was the most common risk factor (51.4%), especially injury by plant mater (25.7%). The incidence of FK was higher in the harvest seasons (autumn and winter) and showed a tendency to increase year by year. The positive rate of direct microscopic examination of potassium hydroxide (KOH) wet mounts was 88.7%. Most of the isolated fungi were Fusarium species (73.3%). followed by Aspergillus species (12.1%). Surgical intervention was performed on 604 eyes (92.4%), including therapeutic penetrating keratoplasty (66.0%, 399 cases) and therapeutic lamellar keratoplasty (29.3%, 177 cases). Global integrity was preserved in 626 cases (95.7%). Fusarium species are the most predominant pathogens of FK in Qingdao area. Rapid, simple, and high specific, direct microscopic examination of KOH wet mounts is worth spreading. Corneal transplantation remains the most effective approach to cure severe FK and is proposed to be performed at the early stage of FK.