Cause Of Fungal Keratitis Research Articles

Platelet-derived biomaterial controls aspergillus fumigatus keratitis by decreasing fungal burden: an in vivo study.

Fungal keratitis is a severe corneal infection characterized by suppurative and ulcerative lesions. Aspergillus fumigatus is a common cause of fungal keratitis. Antifungal drugs, such as natamycin, are currently the first-line treatment for fungal keratitis, but their ineffectiveness leads to blindness and perforation. Additionally, the development of fungal resistance makes treating fungal keratitis significantly more challenging. The present study used platelet-derived biomaterial (PDB) to manage A. fumigatus keratitis in the animal model. Freezing and thawing processes were used to prepare PDB, and then A. fumigatus keratitis was induced in the mice. Topical administration of PDB, natamycin, and plasma was performed; quantitative real-time PCR (qPCR) and histopathologic examination (HE) were used to assess the inhibitory effect of the mentioned compounds against fungal keratitis. The qPCR results showed that PDB significantly decreased the count of A. fumigatus compared to the control group (P-value ≤ 5). Natamycin also remarkably reduced the count of fungi in comparison to the untreated animal, but its inhibitory effect was not better than PDB (P-value > 5). The findings of HE also demonstrated that treatment with PDB and natamycin decreased the fungal loads in the corneal tissue. However, plasma did not show a significant inhibitory effect against A. fumigatus. PDB is intrinsically safe and free of any infections or allergic responses; additionally, this compound has a potential role in decreasing the burden of A. fumigatus and treating fungal keratitis. Therefore, scientists should consider PDB an applicable approach to managing fungal keratitis and an alternative to conventional antifungal agents.

Pseudonectria keratitis—emerging pathogenic fungi in the eye

BackgroundInfectious keratitis, a significant contributor to blindness, with fungal keratitis accounting for nearly half of cases, poses a formidable diagnostic and therapeutic challenge due to its delayed clinical presentation, prolonged culture times, and the limited availability of effective antifungal medications. Furthermore, infections caused by rare fungal strains warrant equal attention in the management of this condition.Case presentationA case of fungal keratitis was presented, where corneal scraping material culture yielded pink colonies. Lactophenol cotton blue staining revealed distinctive spore formation consistent with the Fusarium species. Further analysis using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) identified the causative agent as Fusarium proliferatum. However, definitive diagnosis of Pseudonectria foliicola infection was confirmed through ITS sequencing. The patient’s recovery was achieved with a combination therapy of voriconazole eye drops and itraconazole systemic treatment.ConclusionPseudonectria foliicola is a plant pathogenic bacterium that has never been reported in human infections before. Therefore, ophthalmologists should consider Pseudonectria foliicola as a possible cause of fungal keratitis, as early identification and timely treatment can help improve vision in most eyes.

Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study.

To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.

Profile of fungal keratitis in a Sub-Himalayan territory of north India

Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents.
 Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture.
 Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively.
 Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.

Could aflatoxin B1 production by Aspergillus flavus affect the severity of keratitis: an experience in two tertiary health care centers, Egypt.

To investigate the expression of AFB1 gene in isolates obtained from corneal scrapping samples from keratitis patients and to correlate the quantity of AFB1 to the severity of keratitis. An observational study was undertaken in Medical Microbiology and Immunology department, Mansoura University, Egypt, over corneal scrapping samples that were cultured aiming to isolate fungal causes of infective keratitis followed by AFB1 gene detection in Aspergillus flavus isolates by nested PCR then quantitation of the toxin by TLC. Out of 843 corneal scrapping samples collected from patients with infective keratitis, positive fungal growth was identified in 277 cases (32.9%). A. flavus was the commonest fungal agent isolated in 93 cases (33.6%). The AFB1 toxin-encoding gene was detected in 63.4% of A. flavus isolates. There was a positive correlation between the quantity of produced AFB1 toxin and the degree of severity of keratitis (P value < 0.0001*). Aspergillus flavus was the most common cause of fungal keratitis, with the AFB1 toxin-encoding gene detected in more than half of the isolates. A significant correlation between the degree of severity of keratitis and the quantity of produced AFB1 toxin was detected. Therefore, exploring presence or absence of AFB1 toxin is important for the clinicians in their diagnostic assessment and selection of proper treatment choices.

Analysis of 105 cases of fungal keratitis in Suwan Area

Objective To analyze the epidemiological characteristics and treatment of fungal keratitis in Suwan Area. Methods The clinical data of 105 eyes of 105 patients with fungal keratitis from Jan.2012 to Dec.2017 were collected. The epidemiological, distribution characteristics and therapeutic schedules were analyzed retrospectively. Results All cases were monocular disease, including 53 cases (50.5%) in the left eye and 52 cases (49.5%) in the right. There were 70 (66.7%) males, 35 (33.3%) females, and the age was≥40 years in 92 cases (87.6%). There were 59 cases (56.2%) with clear history of trauma, 16 cases (15.2%) with other causes, and 30 patients (28.5%) without obvious cause.Seven patients (6.7%) were newly diagnosed and 98 cases (93.3%) were referred by the external hospital. Of the referrals, 24 cases were given antifungal treatment, 41 cases were given antibacterial, viral, or glucosteroids therapy, and 33 cases were given unknown treatment.There were 70 positive (66.7%) fungus cultrues, among which 29 cases (41.4%) with Fusarium, 18 cases (25.7%) with Aspergillus, 5 cases (7.1%) with Penicillium and 5 cases (7.1%) with Acremoniumin, 4 cases (5.7%) with Alternaria alternata, 3 cases (4.3%) with Curvularia spp, 2 cases(2.9%) with Mucor fungus and hybrid bacterium in 4 cases (11.4%). Forty-six cases (43.8%) were improved through antifungal drug treatment, 8 cases (7.6%) were aggravated and treated with ulcers debridement, 37 cases (35.2%) had infection controled through operation of corneal debridement combined with conjunctival flap coverage. Drugs or debridement were ineffective in 10 cases (9.5%) of corneal transplants.Four cases (3.8%) with uncontrolled infection received eyeball enucleation. Conclusion The main cause of fungal keratitis in Suwan Area is trauma. The main pathogens are Fusarium and Aspergillus. Key words: Keratitis, fungal; Suwan Area; Epidemiology

Candida dubliniensis: A novel cause of fungal keratitis.

A 45-year-old female with history of contact lens wear presented with a persistent corneal ulcer that was unresponsive to topical moxifloxacin. The patient’s exam was concerning for fungal keratitis. Cultures were obtained, and the patient was started on fortified amphotericin B drops and oral voriconazole. The cultures identified Candida dubliniensis as the causative organism. The patient’s exam worsened despite treatment, and the decision was made for surgery. At the time of surgery, her cornea was found to have unexpectedly perforated. She underwent cryotherapy; tectonic penetrating keratoplasty; anterior chamber tap; intracameral voriconazole, amphotericin B, and cefuroxime; and a partial conjunctival flap. Pathology from the cornea showed GMS and PAS stains positive for fungal forms.C. dubliniensis is a yeast closely related to Candida albicans that was first described in 1995 as a cause of oral candidiasis in patients with AIDS. There are a few published cases of endophthalmitis due to C. dubliniensis in the ophthalmology literature, but to our knowledge, no cases of fungal keratitis due to this organism have been reported. C. dubliniensis is a novel cause of fungal keratitis that can be difficult to identify and treat but is felt to be less virulent than C. albicans and generally susceptible to available anti-fungal therapies.

Epidemio-Clinico-Microbiological Study of Mycotic Keratitis in North-West Region of Rajasthan

Mycotic keratitis, with its diverse clinical presentation and difficulties in treatment, makes it a challenging task for clinicians and an important object of study. The aim of present study was to determine the frequency of occurrence and epidemiological association with identification of fungal isolates from mycotic keratitis cases. This was a prospective and observational study conducted in Mycology Laboratory, Department of Microbiology, S.P. Medical College, Bikaner, on corneal scrapings and swabs of a total of 480 patients attending the Ophthalmology OPD, P.B.M. Hospital, Bikaner, during July 2005 to June 2012. Out of 480 suspected cases, 180 were found to be positive for fungus by smear/culture examination. Increased incidence was seen in the months of May to September with Aspergillus fumigatus being the most common isolate. Mycotic keratitis, though an age-old disease, still presented with challenging aspects of diagnosis and treatment. The study showed fungal keratitis is prevalent in rural parts of north-west Rajasthan, mainly found in males (age group 21-40years) with low socio-economic status (farm or factory workers). The most common cause of fungal keratitis was found to be species of Aspergillus.

Causative agents of keratomycosis in Ibadan: review of laboratory reports

Introduction: Fungi are responsible for less than 2.0 % of corneal infection around the globe. Trauma to the cornea is the leading cause of fungal keratitis especially with history of corneal trauma with vegetable or organic matter. Because of the dearth of data on the aetiological agents of Keratomycosis in this hospital, this study was aimed at finding the prevalence and fungal etiological agents responsible for this condition Ibadan, Nigeria. Methods: A retrospective review of the laboratory reports of corneal scrapings of patients that presented with signs and symptoms suggestive of Keratomycosis was carried out. The scrapings were subjected to wet preparation with 10.0 % KOH, Gram staining and Giemsa staining to rule out inclusion bodies. The diagnosis of Keratomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae and fruiting bodies under microscopy. The media with no obvious growth after 3-4 weeks of incubation were regarded as negative. Results: A total of 48 specimens from patients with suspected diagnosis of Keratomycosis were included in the analysis. The patients consisted of 42 (87.3%) males and 6 (12.5%) females. The ages at diagnosis ranged from 3 to 73 years with a mean of 36.46 years and a median of 35.5 years. The prevalence of Keratomycosis among this group of patients in this hospital was 8.4 %. Candida albicans and Fusarium spp were the fungal isolates in these patients as it occurred in 4.2 % (2/48) of them respectively. Conclusions: Corneal scarring due to trauma or infections is a major cause of monocular blindness, especially in developing countries like Nigeria. Despite the low level of Keratomycosis in this study, high index of suspicion of possible diagnosis should be giving to patients with history of trauma, tissue devitalization with topical steroids and immunocompromised immunity. Keywords: Keratomycosis, Corneal, Fusarium and Candida.

Lasiodiplodia theobromae Keratitis: A Case Report and Review of Literature

A case report and review of literature is reported of a rare case of fungal keratitis from eastern India. A 32-year-old woman with a history of vegetative trauma presented with keratitis in left eye. Microbiological examination of corneal scraping showed refractile hyphae with aseptate branching filaments and black pigmented colonies on multiple solid agar medium. Organism was identified from culture using D1/D2 region of LSU (Large Sub Unit: 28S rDNA)-based molecular technique. PCR amplified a band with a sequence that was 100% homologous with Lasiodiplodia theobromae. The organism was susceptible to amphotericin B and voriconazole and demonstrated resistance to itraconazole and fluconazole. A therapeutic keratoplasty was performed following non-responsiveness to initial topical voriconazole (2%) therapy. Recurrence in graft was controlled with topical voriconazole and intracameral amphotericin B. However, the graft failed at the end of 3months. L. theobromae is a rare cause of fungal keratitis. Management of these cases is difficult, often involving surgical procedures.

Need to suspect fungal etiology in presumed bacterial keratitis - A case report of keratitis due to &lt;i&gt;Scedosporium prolificans&lt;/i&gt;

We describe a case of keratitis with acute presentation and without any history of trauma caused by Scedosporium prolificans; a rare cause of fungal keratitis, from a tertiary care hospital. To the best of our knowledge this is the first such case reported from the region. Because of early diagnosis and prompt treatment the patient could be managed well. Keywords: Keratitis; Scedosporium prolificans; Prompt treatment DOI: 10.3126/ajms.v2i1.4058 Asian Journal of Medical Sciences 2 (2011) 28-30

Pathogenic Spectrum of Fungal Keratitis and Specific Identification ofFusarium solani

To investigate the predominant causative pathogens and epidemiologic features of fungal keratitis and establish a rapid, specific molecular method to detect fungal keratitis caused by Fusarium solani. A total of 174 patients with presumed fungal keratitis and 174 affected eyes were examined. Isolates from corneal specimens were identified according to morphologic and physiological characteristics. The primers that were designed for F. solani were tested to confirm whether they had species specificity. Multiplex PCR with universal fungal and F. solani-specific primers was performed with fungal and bacterial strains and was used to detect microorganisms in the clinical specimens. A total of 160 patients (92.0%) were diagnosed with fungal infection by either potassium hydroxide wet-mount or microbiologic culture. Fungal cultures were positive in 128 patients (73.6%) with 139 fungal isolates. Fusarium (48.2%) was the most frequently isolated genus, in which F. solani (35.2%) was the most common species, followed by the Aspergillus (18.7%) and Candida (16.6%) genera. The PCR results showed that the designed primers were species specific and suitable for specific identification of F. solani. The multiplex PCR of 3-day broth cultures could identify and distinguish F. solani from other pathogens rapidly and specifically from clinical specimens. Fusarium species, especially F. solani, were found to be the predominant cause of fungal keratitis in northeast China. The established multiplex PCR method could have potential advantages for rapid detection of F. solani. These findings might have significance for early diagnosis and treatment of fungal keratitis.

Aureobasidium Pullulans Keratitis Following Automated Lamellar Therapeutic Keratoplasty.

Aureobasidium pullulans is a rare cause of fungal keratitis. A 73-year-old man underwent Automated Lamellar Therapeutic Keratoplasty (ALTK) for healed trachomatous keratopathy in his left eye. Five days later, he developed a graft infection. Cultures from corneal scraping showed findings consistent with Aureobasidium pullulans. The keratitis failed to respond to intensive topical and systemic anti-fungal therapy. Hence, the lamellar graft was removed. Despite this, the clinical condition deteriorated and a therapeutic penetrating keratoplasty had to be carried out to salvage the eye. At 1 year follow-up, there was no recurrence of infection. Graft infection with Aureobasidium pullulans may not be amenable to topical and systemic antifungal therapy and a penetrating keratoplasty may be required for control of infection.

Disseminated Fusarium infection with brain abscesses in a lung transplant recipient

To detail a case of disseminated Fusarium infection in an immunocompromised adult. Fusarium sp. infections are an important cause of fungal keratitis in immunocompetent patients and a recent outbreak related to use of a specific type of contact lens solution made national and international newspaper headlines. While reports of disseminated infection in immunosuppressed patients have appeared over the last 30 years, few have emphasized the neuropathological aspects of this emerging pathogen. Woman with pulmonary sarcoidosis necessitating bilateral lung transplants 4 months prior to her demise who was soon readmitted with viral pneumonia. She developed targetoid skin lesions of her face and thigh; she succumbed before biopsy could be performed. Autopsy revealed systemic organ infection involving lungs, gastrointestinal tract mucosa, bilateral kidneys, and skin. Foci of acute cerebritis showed vessels occluded by hyphal, septate fungi. Fungal culture remains the gold standard for diagnosis, and culture grew Fusarium. Fusarium is resistant to standard antifungal therapies; the increasing use of antifungal medications - as either treatment or prophylaxis - may shift more infections toward unusual species such as Fusarium.

Fusarium Keratitis in Mexico

To describe the clinical characteristics, diagnosis, treatment, and visual outcome of 61 cases of Fusarium keratitis in Mexico. Retrospective, comparative study of 61 patients with clinically and culture-confirmed Fusarium keratitis, who were attended at an eye hospital in Mexico City from 1981 to 2001. Fusarium solani was the main causal agent in 83.6% of cases. Trauma history was observed in 57.4% and a history of agricultural activity in 34.4%. Signs were redness (100%), epithelial defects (98.3%), superficial corneal ulcer (95.1%), anterior chamber inflammation (91.8%), and satellite infiltrates (75.4%). In 50% of cases, the treatment was topical ketoconazole 2%; in 34.2% of cases, additional topical antifungal preparations were used. A total of 77% of patients improved and 23% worsened. Conjunctival flap was indicated in 4 of 61 patients (6.5%), and 14 of 61 patients (23%) underwent penetrating keratoplasty. Two of 61 patients were treated with tectonic keratoplasty. Evisceration surgeries were practiced in 14 of 61 patients (22.9%). The final visual acuity after medical or medical/surgical therapy, was no light perception (NLP) in 19 patients (33.33%), light perception (LP) to hand movements (HM) in 18 patients (31.57%), 20/400 to 20/200 in 1 patient (1.75%), 20/150 to 20/60 in 5 patients (8.77%), and 20/40 to 20/20 in 14 patients (24.56%). Four patients were lost to follow-up. Fusarium is the most common cause of fungal keratitis in Mexico. Most cases (43/54, 79.6%) improved with topical antifungal therapy (either monotherapy or combined). We suggest surgical therapy with conjunctival flap or penetrating keratoplasty in advanced cases, when there has been poor response to medical therapy or a very low final visual acuity.

Aqueous Humor Concentrations of Topically Administered Caspofungin in Rabbits

Background: The echinocandin caspofungin (CAS) is a novel antifungal drug with fungicidal in vitro activity against all Candida spp., which are the most frequent cause of fungal keratitis. Penetration of CAS through the cornea into the aqueous humor after topical administration was investigated. Methods: A CAS solution with a concentration of 7 mg/ml was applied onto each rabbit’s cornea. Drug application after corneal epithelium abrasion was processed in different time intervals: single application with aqueous humor sampling after 1 and 2 h. In addition, after continuous application of CAS every 30 min, aqueous humor concentrations of CAS after 1, 2 and 5 h were analyzed by liquid-chromatography tandem mass spectrometry. Results: Topical administration of CAS without corneal epithelium abrasion resulted in no detectable amounts of the drug in the aqueous humor. However, with corneal abrasion, after a single application, levels of 2.16 ± 1.57 μg/ml (n = 6) were reached after 1 h and then decreased to 1.76 ± 0.88 μg/ml (n = 2) after 2 h. After serial application every 30 min, the following intracameral levels of CAS were detected: after 1 h, 2.11 ± 1.09 μg/ml (n = 6); after 2 h, 4.94 ± 1.80 μg/ml (n = 5), and after 5 h, 3.45 ± 2.11 μg/ml (n = 6). Conclusion: In the aqueous humor, therapeutic drug levels can be reached that cover the MICs of most fungi after epithelial abrasion. To achieve a sustained high level of CAS as an effective antifungal therapy for corneal keratitis, CAS should be administered topically every 30 min after removal of the corneal epithelium.

Management of paecilomyces keratitis

Paecilomyces is a rare cause of fungal keratitis, presenting a significant challenge for diagnosis and successful treatment.

Trichophyton Fungal Keratitis

To report 5 cases of fungal keratitis caused by Trichophyton schoenleinii. Case reports. Trichophyton schoenleinii is responsible for aggressive fungal keratitis that is associated with keratolysis as a result of collagenase expression by the organism. Clinically, the organism seems to be sensitive to topical natamycin but resistant to topical amphotericin B and miconazole. Two patients achieved clinical cures with medical therapy alone, but with visual outcomes of only 20/125 and hand motions because of corneal scarring. Two patients achieved clinical cures with therapeutic penetrating keratoplasty (PKP), which remained clear and provided final visual outcomes of 20/60 and 20/200. One patient developed fungal scleritis and panophthalmitis despite 2 therapeutic PKPs and required enucleation. Trichophyton schoenleinii is a rare cause of fungal keratitis that may be associated with progressive keratolysis and perforation, scleral extension, and endophthalmitis. Therapeutic keratoplasty may be successful in achieving cure in medically unresponsive cases.

Topical Caspofungin for Treatment of Keratitis Caused by Candida albicans in a Rabbit Model

Candida albicans is the most frequent cause of fungal keratitis in temperate regions. Caspofungin has potent activity against Candida spp. in a variety of clinical settings. Little is known, however, about its activity against fungal keratitis. We compared the efficacy of topical caspofungin with that of topical amphotericin B (AMB) in a rabbit model of experimental keratomycosis. Keratitis was induced with a standardized inoculum of Candida albicans (SC 5314) placed on the debrided cornea. Twenty-four hours after infection, animals were randomly assigned to treatment with 0.15% caspofungin, 0.5% caspofungin, 0.15% AMB, and a saline control (n = 12 rabbits in each group). For the first 12 h, treatment was repeated every 30 min and, after a 12-h pause, was resumed at hourly intervals for another 12 h. The animals were examined and killed 12 h after administration of the last dose. Treatment effects were evaluated by clinical assessment, fungal culture, and histopathology. Drug treatment significantly reduced corneal fungal recovery from 3.78 log10 CFU in saline-treated animals to 2.97, 1.76, and 1.18 log10 CFU in animals treated with 0.15% caspofungin, 0.5% caspofungin, and 0.15% AMB, respectively. By histopathology, the mean hyphal density was significantly lower in the corneas of treated animals than in those of the controls; there was no difference in hyphal densities between the different treatment groups. The depth of corneal invasion was not significantly reduced by the antifungal treatments. By clinical assessment, keratitis progressed in animals treated with saline, whereas disease progression was inhibited by all drug treatment regimens. In our rabbit model, 0.5% caspofungin was as effective as 0.15% AMB for the topical treatment of Candida keratitis. The potential clinical efficacy of caspofungin awaits further investigation.

Colletotrichum keratitis

PURPOSE: To evaluate Colletotrichum keratitis and to report the risk factors and clinical course. DESIGN: Interventional case series. METHODS: In order to report the clinical course of Colletotichum keratitis, fungal keratitis cases between January 1980 and February 2001 in an institutional setting were retrospectively reviewed and 10 eyes of 9 patients with Colletotrichum keratitis were identified by positive cultures. RESULTS: Colletotrichum species were identified in 10 of 360 culture-proven fungal keratitis cases. All cases were sensitive to amphotericin B, three of the isolates showed resistance to natamycin, two isolates had intermediate sensitivity to natamycin, and one isolate was resistant to fluconazole. Natamycin 5% was used as the initial antifungal agent in eight microbiologically proven fungal keratitis cases. Two of nine patients continued the treatment with amphotericin B 0.15% after the sensitivity results were obtained. CONCLUSION: Colletotrichum is an infrequent cause of fungal keratitis. The risk factors are similar to the known fungal keratitis. Colletotrichum is resistant to natamycin in vitro; however, all our patients responded well to this treatment while resistance or intermediate sensitivity to natamycin and resistance to fluconazole was observed.