1
|
Ling JYM, Yeung SN, Chan CC, Trinh T, Antaki F, Harissi-Dagher M, Sivachandran N, Fava M, Légaré MÈ, Iovieno A. Trends and Clinical Outcomes of Fungal Keratitis in Canada: A 20-year Retrospective Multicentre Study. Am J Ophthalmol 2024; 265:147-155. [PMID: 38642698 DOI: 10.1016/j.ajo.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE An increase in fungal and particularly filamentous keratitis has been observed in many geographic areas, mostly in contact lens wearers. This study seeks to characterize long-term trends in fungal keratitis in a continental climate area to provide guidance for diagnosis and treatment. DESIGN Retrospective multicentric case series. METHODS Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included. Charts were reviewed for patient demographics, risk factors, visual acuity, and treatments undertaken. RESULTS A total of 138 patients were identified: 75 had yeast keratitis while 63 had filamentous keratitis. Patients with yeast keratitis had more ocular surface disease (79% vs 28%) while patients with filamentous keratitis wore more refractive contact lenses (78% vs 19%). Candida species accounted for 96% of all yeast identified, while Aspergillus (32%) and Fusarium (26%) were the most common filamentous fungi species. The mean duration of treatment was 81 ± 96 days. Patients with yeast keratitis did not have significantly improved visual acuity with medical treatment (1.8 ± 1 LogMAR to 1.9 ± 1.5 LogMAR, P = .9980), in contrast to patients with filamentous keratitis (1.4 ± 1.2 LogMAR to 1.1 ± 1.3 LogMAR, P = .0093). CONCLUSIONS Fungal keratitis is increasing in incidence, with contact lenses emerging as one of the leading risk factors. Significant differences in the risk factors and visual outcomes exist between yeast keratitis and filamentous keratitis which may guide diagnosis and treatment.
Collapse
Affiliation(s)
- Jennifer Y M Ling
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia N Yeung
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences (C.C., T.T.), University of Toronto, Toronto, Ontario, Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences (C.C., T.T.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (T.T.), Sydney Eye Hospital, Sydney, Australia
| | - Fares Antaki
- Department of Ophthalmology (F.A., M.H.), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology (F.A., M.H.), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Nirojini Sivachandran
- Division of Ophthalmology (N.S., M.F.), McMaster University, Hamilton, Ontario, Canada
| | - Mark Fava
- Division of Ophthalmology (N.S., M.F.), McMaster University, Hamilton, Ontario, Canada
| | - Marie-Ève Légaré
- Centre Universitaire d'Ophtalmologie - CHU de Québec (M.L.), Université Laval, Québec City, Québec, Canada
| | - Alfonso Iovieno
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
2
|
Gao N, Ju X, Jiao X, Qi Y, Tian Y, Jiang S, Niu Z, Zhao S, Yang R. Breaking Down the Barriers of Drug Resistance and Corneal Permeability with Chitosan-Poly(ethylene glycol)-LK 13 Peptide Conjugate to Combat Fungal Keratitis. ACS Infect Dis 2024; 10:2950-2960. [PMID: 38990785 DOI: 10.1021/acsinfecdis.4c00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Fungal keratitis (FK) is a leading cause of preventable blindness and eye loss. The poor antifungal activity, increased drug resistance, limited corneal permeability, and unsatisfactory biosafety of conventional antifungal eye drops are among the majority of the challenges that need to be addressed for currently available antifungal drugs. Herein, this study proposes an effective strategy that employs chitosan-poly(ethylene glycol)-LK13 peptide conjugate (CPL) in the treatment of FK. Nanoassembly CPL can permeate the lipophilic corneal epithelium in the transcellular route, and its hydrophilicity surface is a feature to drive its permeability through hydrophilic stroma. When encountering fungal cell membrane, CPL dissembles and exposes the antimicrobial peptide (LK13) to destroy fungal cell membranes, the minimum inhibitory concentration values of CPL against Fusarium solani (F. solani) are always not to exceed 8 μg peptide/mL before and after drug resistance induction. In a rat model of Fusarium keratitis, CPL demonstrates superior therapeutic efficacy than commercially available natamycin ophthalmic suspension. This study provides more theoretical and experimental supports for the application of CPL in the treatment of FK.
Collapse
Affiliation(s)
- Ning Gao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiaoyan Ju
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiting Jiao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yuanyuan Qi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Ye Tian
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Shidong Jiang
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Zhongwei Niu
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Ruibo Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| |
Collapse
|
3
|
Nayel AA, Hamdy NA, Massoud TH, Mohamed NM. A comparison of antimicrobial regimen outcomes and antibiogram development in microbial keratitis: a prospective cohort study in Alexandria, Egypt. Graefes Arch Clin Exp Ophthalmol 2024; 262:1865-1882. [PMID: 38240778 PMCID: PMC11106157 DOI: 10.1007/s00417-023-06362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance in microbial keratitis has not been previously explored in Alexandria. We aim to recommend effective therapies through identification of etiological agents, determination of antimicrobial susceptibilities, and comparing outcomes of empiric topical antimicrobials. METHODS In this 2022 prospective cohort conducted in Alexandria Main University Hospital cornea clinic, antimicrobial susceptibilities of isolated microorganisms from corneal scrapings were detected and antibiograms were developed. Bacterial (BK), fungal (FK), or mixed fungal/bacterial keratitis (MFBK) patients on empiric regimens were compared for ulcer healing, time-to-epithelialization, best-corrected visual acuity, interventions, and complications. RESULTS The prevalent microorganisms in 93 positive-cultures were coagulase-negative staphylococci (CoNS, 30.1%), Pseudomonas aeruginosa (14%), and Aspergillus spp. (12.9%). CoNS were susceptible to vancomycin (VAN, 100%) and moxifloxacin (MOX, 90.9%). Gram-negative bacteria showed more susceptibility to gatifloxacin (90.9%) than MOX (57.1%), and to gentamicin (GEN, 44.4%) than ceftazidime (CAZ, 11.8%). Methicillin-resistance reached 23.9% among Gram-positive bacteria. Fungi exhibited 10% resistance to voriconazole (VRC). Percentages of healed ulcers in 49 BK patients using GEN + VAN, CAZ + VAN and MOX were 85.7%, 44.4%, and 64.5%, respectively (p = 0.259). Their median time-to-epithelialization reached 21, 30, and 30 days, respectively (log-rank p = 0.020). In 51 FK patients, more ulcers (88.9%) healed with natamycin (NT) + VRC combination compared to VRC (39.1%) or NT (52.6%) (p = 0.036). Their median time-to-epithelialization was 65, 60, and 22 days, respectively (log-rank p < 0.001). The VRC group required more interventions (60.9%) than NT + VRC-treated group (11.1%) (p = 0.018). In 23 MFBK patients, none healed using NT + CAZ + VAN, while 50% healed using VRC + CAZ + VAN (p = 0.052). Regimens had comparable visual outcomes and complications. CONCLUSION Based on the higher detected susceptibility, we recommend empiric MOX in suspected Gram-positive BK, gatifloxacin in Gram-negative BK, and GEN + VAN in severe BK. Due to better outcomes, we recommend NT + VRC in severe FK. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT05655689. Registered December 19, 2022- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05655689?cond=NCT05655689.&draw=2&rank=1.
Collapse
Affiliation(s)
- Amira A Nayel
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Noha A Hamdy
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | - Tamer H Massoud
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nelly M Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| |
Collapse
|
4
|
García-Lorente M, Aguilar-Valdez I, García-Albisua AM, de la Torre-González CE, Cruz-Cervantes JA, Rocha-de-Lossada C, de Wit-Carter G. Phaeoacremonium parasiticum keratitis: An atypical fungal organism. J Fr Ophtalmol 2024; 47:103915. [PMID: 37625999 DOI: 10.1016/j.jfo.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 08/27/2023]
Affiliation(s)
- M García-Lorente
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Street Vicente García Torres 46, San Lucas, Coyoacán, 04030 Ciudad de México, CDMX, Spain.
| | - I Aguilar-Valdez
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Street Vicente García Torres 46, San Lucas, Coyoacán, 04030 Ciudad de México, CDMX, Spain
| | - A M García-Albisua
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Street Vicente García Torres 46, San Lucas, Coyoacán, 04030 Ciudad de México, CDMX, Spain
| | - C E de la Torre-González
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Street Vicente García Torres 46, San Lucas, Coyoacán, 04030 Ciudad de México, CDMX, Spain
| | - J A Cruz-Cervantes
- Microbiology Department, Asociación Para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Street Vicente García Torres 46, San Lucas, Coyoacán, 04030 Ciudad de México, CDMX, Spain
| | - C Rocha-de-Lossada
- Ophthalmology Department, Qvision, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Regional University Hospital of Málaga, Málaga, Spain; Ophthalmology area Doctor Fedriani, Surgery Department, University of Sevilla, Sevilla, Spain
| | - G de Wit-Carter
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Street Vicente García Torres 46, San Lucas, Coyoacán, 04030 Ciudad de México, CDMX, Spain
| |
Collapse
|
5
|
Tuft S, Stone NRH, Burton MJ, Johnson EM, Borman AM. Antifungal susceptibility profiles for fungal isolates from corneas and contact lenses in the United Kingdom. Eye (Lond) 2024; 38:529-536. [PMID: 37684376 PMCID: PMC10858215 DOI: 10.1038/s41433-023-02719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To report the identification and results of susceptibility testing for fungal isolates from the cornea or contact lens care systems. MATERIALS AND METHODS In this retrospective epidemiological study, we searched the results of fungal cultures from cornea or contact lens systems referred for identification and susceptibility testing to the United Kingdom National Mycology Reference Laboratory between October 2016 and March 2022. For each fungal isolate, we recorded the genus and species of the fungus and the minimum inhibitory concentration (MIC) to six antifungal agents available to treat corneal infection (amphotericin, econazole, itraconazole, natamycin, posaconazole, and voriconazole). RESULTS There were 600 isolates from 585 patients, comprising 374 (62%) from corneal samples and 226 from contact lenses and care systems, of which 414 (69%) isolates were moulds (filamentous fungi) and 186 (31%) were yeasts. The most frequent moulds isolated were Fusarium spp (234 isolates, 39%) and Aspergillus spp (62, 10%). The most frequent yeasts isolated were Candida spp (112, 19%), predominantly Candida parapsilosis (65, 11%) and Candida albicans (33, 6%), with 35 isolates (6%) of Meyerozyma guilliermondii. In vitro susceptibility was greatest for natamycin (347 moulds tested, mode 4 mg/L, range 0.25-64 mg/L; 98 yeasts tested, mode 4 mg/L, range 0.5-32 mg/L), with susceptibility for 94% for moulds and 99% yeasts. Of the 16 isolates interpreted as highly resistant to natamycin (MIC ≥16 mg/L), 13 were Aspergillus flavus complex. CONCLUSIONS In vitro susceptibility supports the use of natamycin for the empiric treatment of fungal keratitis in the UK.
Collapse
Affiliation(s)
- Stephen Tuft
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
| | - Neil R H Stone
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Matthew J Burton
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Elizabeth M Johnson
- UK National Mycology Reference Laboratory, UK Health Security Agency South-West, Bristol, and MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Andrew M Borman
- UK National Mycology Reference Laboratory, UK Health Security Agency South-West, Bristol, and MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| |
Collapse
|
6
|
Yolin Angel PASR, Jeyakumar P, Jasmin Suriya AR, Sheena A, Karuppiah P, Periyasami G, Stalin A, Murugan K. Topical antifungal keratitis therapeutic potential of Clitoria ternatea Linn. flower extract: phytochemical profiling, in silico modelling, and in vitro biological activity assessment. Front Microbiol 2024; 15:1343988. [PMID: 38328419 PMCID: PMC10849212 DOI: 10.3389/fmicb.2024.1343988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Fungal keratitis (FK) poses a severe threat to vision, potentially leading to blindness if not promptly addressed. Clitoria ternatea flower extracts have a history of use in Ayurvedic and Indian traditional medicines, particularly for treating eye ailments. This study investigates the antifungal and antibiofilm effects of Clitoria ternatea flower extracts on the FK clinical isolate Coniochaeta hoffmannii. Structural details and key compound identification were analysed through FTIR and GC-MS. Methods The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of Clitoria ternatea flower extracts were determined using broth dilution and well plate techniques. Biofilm inhibitory activity was assessed through microscopic evaluation, while anti-irritant and cytotoxic properties were evaluated using CAE-EI and MTT assays. Through GC-MS and FT-IR analysis the compounds dissolved in the extract and their functional group were studied, and their toxicity screening and pharmacokinetic prediction were conducted in silico. Subsequently, compounds with high corneal permeability were further identified, and molecular docking and simulation studies at 150 ns were used to investigate their interactions with fungal virulence factors and human inflammatory proteins. Results and Discussion At a concentration of 250 µg/mL, the Clitoria ternatea flower extract displayed effective biofilm inhibition. MIC and MFC values were determined as 500 and 1000 µg/mL, respectively. CAE-EI and MTT assays indicated no significant irritant and cytotoxic effects up to a concentration of 3 mg/mL. Compounds like 9,9-dimethoxybicyclo[3.3.1]nonane-2,4-dione showed high corneal permeability with strong and stable interactions with fungal virulence cellobiose dehydrogenase, endo β 1,4 xylanase, and glucanase, as well as corneal inflammation-associated human TNF-α and Interleukin IL-1b protein targets. The findings indicate that extracts from C. ternatea flowers could be formulated for an effective and safe alternative for developing new topical FK therapeutics.
Collapse
Affiliation(s)
| | - Palanisamy Jeyakumar
- Biofilm and Bioprocess Laboratory, Department of Biotechnology, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India
| | - Arul Raj Jasmin Suriya
- Biofilm and Bioprocess Laboratory, Department of Biotechnology, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India
| | - Aliyas Sheena
- Biofilm and Bioprocess Laboratory, Department of Biotechnology, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India
| | - Ponmurugan Karuppiah
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | | | - Antony Stalin
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, Chengdu, China
| | - Kasi Murugan
- Biofilm and Bioprocess Laboratory, Department of Biotechnology, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India
| |
Collapse
|
7
|
Xuan R, Hong SC, Trinh T, Coroneo MT, Petsoglou C. Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia. J Fungi (Basel) 2023; 9:jof9050589. [PMID: 37233300 DOI: 10.3390/jof9050589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
The present article reports on the management of six different and rare cases of fungal keratitides, two of which have never been documented in previous literature. This is a case series of six patients with rare fungal keratitides managed at a quaternary eye referral unit, Sydney Eye Hospital, Australia over a period of 7 months (May to December, 2022). The order of occurrence of fungi isolated was Scedosporium apiospermum, Lomenstospora prolificans, Cladosporium spp., Paecilomyces, Syncephalastrum racemosum and Quambalaria spp. A combination of medical and surgical interventions was employed, including topical and systemic anti-fungal therapy, with one requiring therapeutic penetrating keratoplasty and another eventuating in evisceration. Two patients were successfully treated with corneal debridement and two others required pars plana vitrectomy with anterior chamber washout. It is important to remain vigilant with monitoring patient symptoms and correlating with clinical signs to guide antifungal therapy even in the context of confirmed culture and sensitivity results.
Collapse
Affiliation(s)
- Rachel Xuan
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
- Save Sight Institute, University of Sydney, Sydney, NSW 2000, Australia
| | - Sheng Chiong Hong
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Tanya Trinh
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia
- School of Medicine, University of New South Wales, Kensington, Sydney, NSW 2033, Australia
| | - Constantinos Petsoglou
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
- Save Sight Institute, University of Sydney, Sydney, NSW 2000, Australia
| |
Collapse
|
8
|
Yi W, Gu L, Wang Y, Lin J, Zhang L, Wang Q, Diao W, Qi Y, Chi M, Yin M, Li C, Zhao G. Benzyl isothiocyanate improves the prognosis of Aspergillus fumigatus keratitis by reducing fungal load and inhibiting Mincle signal pathway. Front Microbiol 2023; 14:1119568. [PMID: 36876115 PMCID: PMC9978348 DOI: 10.3389/fmicb.2023.1119568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Aspergillus fumigatus keratitis is a potential blinding disease associated with A. fumigatus invasion and excessive inflammatory response. Benzyl isothiocyanate (BITC) is a secondary metabolite with broad antibacterial and anti-inflammatory activity extracted from cruciferous species. However, the role of BITC in A. fumigatus keratitis has not been discovered yet. This study aims to explore the antifungal and anti-inflammatory effects and mechanisms of BITC in A. fumigatus keratitis. Our results provided evidences that BITC exerted antifungal effects against A. fumigatus by damaging cell membranes, mitochondria, adhesion, and biofilms in a concentration-dependent manner. In vivo, fungal load and inflammatory response including inflammatory cell infiltration and pro-inflammatory cytokine expression were reduced in BITC-treated A. fumigatus keratitis. Additionally, BITC significantly decreased Mincle, IL-1β, TNF-α, and IL-6 expression in RAW264.7 cells that stimulated by A. fumigatus or Mincle ligand trehalose-6,6-dibehenate. In summary, BITC possessed fungicidal activities and could improve the prognosis of A. fumigatus keratitis by reducing fungal load and inhibiting the inflammatory response mediated by Mincle.
Collapse
Affiliation(s)
- Wendan Yi
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingwen Gu
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Lin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lina Zhang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weilin Diao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yinghe Qi
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Menghui Chi
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min Yin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cui Li
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guiqiu Zhao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
9
|
Huang Y, Yu J, Peng Q. Fungal keratitis treated with a combination of traditional Chinese medicine and Western medicine: A case report. Medicine (Baltimore) 2022; 101:e31976. [PMID: 36482581 PMCID: PMC9726375 DOI: 10.1097/md.0000000000031976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Currently, the primary treatments for fungal keratitis (FK) are drugs and surgery. However, drug treatment has low efficacy and many side effects, and surgical treatment is costly. Therefore, it is critical to develop a new method of FK treatment. This report describes a 56-year-old male patient with FK who was treated with a combination of traditional Chinese medicine (TCM) and Western medicine with noticeable results and few side effects. PATIENT CONCERNS The main symptoms were blurred vision in the right eye and pain. On the corneal surface, a large area of ulcer with a turbid margin was visible, along with an oral ulcer. Additionally, the patient was afraid of corneal transplantation due to financial constraints. DIAGNOSES The case was diagnosed as FK. In vivo confocal microscopy is the first choice for the diagnosis of this condition. Corneal ulcer was infiltrated with numerous inflammatory cells and dendritic fungal hyphae, as determined by in vivo confocal microscopy. INTERVENTIONS Early in his illness, the patient was treated with only Western medicine, which resulted in poor outcomes and severe adverse reactions. Corneal transplantation was recommended by the first hospital. The patient was later transferred to our hospital for treatment with TCM decoction. OUTCOMES After 21 days of treatment, the corneal ulcer of the patient became shallower, his vision improved, and his discomfort disappeared. Due to financial concerns, the patient and his family requested early discharge, so no follow-up disease information was obtained. However, when analyzing the disease development process in the hospital, the combination of TCM and Western medicine had obvious effects and a high level of safety. LESSONS This case report shows that TCM is safe and effective in the treatment of FK and is worthy of promotion. However, in practice, we found that TCM is better for patients with early FK, so early diagnosis of FK is crucial.
Collapse
Affiliation(s)
- Yu Huang
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Juan Yu
- Hunan University of Chinese Medicine, Changsha, Hunan, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Qinghua Peng
- Hunan University of Chinese Medicine, Changsha, Hunan, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
- *Correspondence: Qinghua Peng, Hunan University of Chinese Medicine, No. 300, Xueshi Road, Yuelu District 410208, Changsha, China (e-mail: )
| |
Collapse
|