Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal Stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.

Impact of Vegetation Restoration on Soil Fungal Community Structure in Karst Rocky Desertification Areas

In this paper,managed forest(MF)and natural forest(NF)in the Huajiang Demonstration Zone of Guanling,Guizhou were selected as research objects,and cropland(CL)was taken as control.High-throughput sequencing technology was used to study the characteristics of fungal community composition and species diversity in the surface(0-10 cm)soil of each restoration measure,in order to reveal the dominant soil fungal groups and fungal community composition in karst rocky desertification areas,which was conducive to a more comprehensive understanding of the soil conditions of different vegetation restoration measures.Research has shown that vegetation restoration significantly affected the diversity of soil fungal community,with significant increases in Sob index,Ace index,and Chao index.The vegetation restoration has significantly changed the composition of fungal community.The dominant fungi in the CL topsoil are Sordariomycetes(62.28%),Dothideomycetes(12.34%),and Eurotiomycetes(9.12%);the dominant fungi in the MF soil are Sordariomycetes(45.05%),Dothideomycetes(14.74%),and Mortierellomycetes(10.40%);the dominant fungi in the NF soil are unclassified fungal community(26.38%),Sordariomycetes(19.78%),and Agaricomycetes(13.82%).Vegetation restoration has changed the key fungal groups in the soil.Sordariomycetes,Fusarium,and Setophoma are the key dominant fungal groups in CL soil;Dioszegia is key dominant fungal group in MF soil;c_unclassified_k_Fungi,p_unclassified_k_Fungi,o_unclassified_k_Fungi,f_unclassified_k_Fungi,g_unclassified_k_Fungi,Teichospora,and Diaporthe are key dominant fungal groups in NF soil.

Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?

BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.METHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.RESULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,P<0.001).The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,P<0.001),and dialysis due to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associations between fungal infections and transplant outcomes are critical.

Advances in Drug Treatment of Fungal Keratitis

Fungal keratitis is an important cause of corneal blindness in China, accounting for 45% of infectious keratitis. The main pathogenic bacteria include yeast, filamentous bacteria and nearly 100 kinds of fungi, which are difficult to diagnose, difficult to treat and poor prognosis. When the infected fungal strains have strong virulence and poor drug sensitivity, it is easy to prolong the disease. Once the fungal infection involves the whole limbus and reaches the whole layer of the cornea, it will be followed by intraocular tissue infection such as anterior chamber, lens and vitreous body. When the infection is difficult to control and the visual function is seriously damaged, the enucleation of eye contents has to be performed, which causes irreversible harm to the patient’s appearance and physical and mental health. Therefore, in order to gain greater hope for the vision of patients with fungal keratitis, In recent years, with the continuous progress of clinical medicine and microbiological diagnostics, the treatment methods of fungal keratitis have been constantly updated. This article will briefly review the new progress in drug and surgical treatment of fungal keratitis in recent years to provide patients with better visual prognosis. .

Fungal arthritis:A challenging clinical entity

There has been an increasing incidence of fungal infections in recent years.Rarely joints are also affected by fungal infections.Mainly,these infections develop in prosthetic joints,but sometimes native joints are also involved.Candida infections are mostly reported,but patients may also develop infections secondary to non-Candida fungi,especially Aspergillus.Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy.Despite this,these infections are associated with high morbidity and mortality.This review described the clinical features,risk factors,and therapeutic interventions required to manage fungal arthritis.

Two-step strategy—conjunctival flap covering surgery combined with secondary deep anterior lamellar keratoplasty for the treatment of high-risk fungal keratitis

AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.

Response of fungal communities to afforestation and its indication for forest restoration

Soil fungi in forest ecosystems have great potential to enhance host plant growth and systemic ecological functions and services.Reforestation at Saihanba Mechanized Forest Farm,the world's largest artificial plantation,has been integral to global forest ecosystem preservation since the 1950s.To better assess the ecological effects of soil microbiology after afforestation,fungal diversity and community structure(using Illumina sequencing)from forests dominated by Larix gmelinii var.principis-rupprechtii,Pinus sylvestris var.mongolica and Picea asperata,and from grassland were surveyed.In total,4,540 operational taxonomic units(OTUs)were identified,with Mortierella and Solicoccozyma being the dominant genera of grassland soil and Inocybe,Cortinarius,Piloderma,Tomentella,Sebacina,Hygrophorus and Saitozyma dominating the plantation soil.Principle coordinate analysis(PCoA)and co-occurrence networks revealed differences in fungal structure after afforestation.Significantly,more symbiotroph guilds were dominated by ectomycorrhizal fungi in plantations under the prediction of FUNGuild.The community composition and diversity of soil fungi were significantly influenced by pH via redundancy analysis(RDA)and the Mantel test(p<0.01).This finding emphasizes that soil pH has a strong effect on the transition of fungal communities and functional taxa from grassland to plantation,providing a novel indicator for forest restoration.

Evaluation of in vitro digestibility of Aspergillus oryzae fungal biomass grown on organic residue derived‑VFAs as a promising ruminant feed supplement

Background As demand for high quality animal feed continues to raise,it becomes increasingly important to mini-mize the environmental impact of feed production.An appealing sustainable approach to provide feed fractions is to use organic residues from agro-food industry.In this regard,volatile fatty acids(VFAs)such as acetic,propionic and butyric acids,derived from bioconversion of organic residues can be used as precursors for production of micro-bial protein with ruminant feed inclusion potential.This study aims to investigate the in vitro digestibility of the Asper-gillus oryzae edible fungal biomass cultivated on VFAs-derived from anaerobic digestion of residues.The produced fungal protein biomass,along with hay clover silage and rapeseed meal were subjected to various in vitro assays using two-stage Tilley and Terry(TT),gas,and bag methods to evaluate and compare its digestibility for application in ruminant feed.Results The produced fungal biomass contained a higher crude protein(CP)(41%–49%)and rather similar neutral detergent fiber(NDF)(41%–56%)compared to rapeseed meal.The rumen in vitro dry matter digestibility(IVDMD)of the fungal biomass in the TT method ranged from 82%to 88%(statistically similar to that of the gas method(72%to 85%)).The IVDMD of fungal biomass were up to 26%and 40%greater than that of hay clover silage and rapeseed meal,respectively.The type of substrate and bag method had pronounced effect on the fermentation products(ammonium-N(NH4+-N),total gas and VFAs).Fungal biomass digestion resulted in the highest release of NH4+-N(340–540 mg/L)and the ratio of acetate to propionate ratio(3.5)among subjected substrates.Conclusion The results indicate that gas method can be used as a reliable predictor for IVDMD as well as fermenta-tion products.Furthermore,the high IVDMD and fermentation product observed for Aspergillus oryzae fungal biomass digestion,suggest that the supplementation of fungal biomass will contribute to improving the rumen digestion by providing necessary nitrogen and energy to the ruminant and microbiota.

Tomato LysM receptor kinase 4 mediates chitin-elicited fungal resistance in both leaves and fruit

Fungal infection is a major cause of crop and fruit losses.Recognition of chitin,a component of fungal cell walls,endows plants with enhanced fungal resistance.Here,we found that mutation of tomato LysM receptor kinase 4(SlLYK4)and chitin elicitor receptor kinase 1(SlCERK1)impaired chitin-induced immune responses in tomato leaves.Compared with the wild type,sllyk4 and slcerk1 mutant leaves were more susceptible to Botrytis cinerea(gray mold).SlLYK4 extracellular domain showed strong binding affinity to chitin,and the binding of SlLYK4 induced SlLYK4-SlCERK1 association.Remarkably,qRT–PCR analysis indicated that SlLYK4 was highly expressed in tomato fruit,andβ-GLUCURONIDASE(GUS)expression driven by the SlLYK4 promoter was observed in tomato fruit.Furthermore,SlLYK4 overexpression enhanced disease resistance not only in leaves but also in fruit.Our study suggests that chitin-mediated immunity plays a role in fruit,providing a possible way to reduce fungal infection-related fruit losses by enhancing the chitin-induced immune responses.

Meta-QTL analysis for mining of candidate genes and constitutive gene network development for fungal disease resistance in maize(Zea mays L.)

The development of resistant maize cultivars is the most effective and sustainable approach to combat fungal diseases.Over the last three decades,many quantitative trait loci(QTL)mapping studies reported numerous QTL for fungal disease resistance(FDR)in maize.However,different genetic backgrounds of germplasm and differing QTL analysis algorithms limit the use of identified QTL for comparative studies.The meta-QTL(MQTL)analysis is the meta-analysis of multiple QTL experiments,which entails broader allelic coverage and helps in the combined analysis of diverse QTL mapping studies revealing common genomic regions for target traits.In the present study,128(33.59%)out of 381 reported QTL(from 82 studies)for FDR could be projected on the maize genome through MQTL analysis.It revealed 38 MQTL for FDR(12 diseases)on all chromosomes except chromosome 10.Five MQTL namely 1_4,2_4,3_2,3_4,and 5_4 were linked with multiple FDR.Total of 1910 candidate genes were identified for all the MQTL regions,with protein kinase gene families,TFs,pathogenesis-related,and disease-responsive proteins directly or indirectly associated with FDR.The comparison of physical positions of marker-traits association(MTAs)from genome-wide association studies with genes underlying MQTL interval verified the presence of QTL/candidate genes for particular diseases.The linked markers to MQTL and putative candidate genes underlying identified MQTL can be further validated in the germplasm through marker screening and expression studies.The study also attempted to unravel the underlying mechanism for FDR resistance by analyzing the constitutive gene network,which will be a useful resource to understand the molecular mechanism of defense-response of a particular disease and multiple FDR in maize.

Differential expression of antimicrobial peptides in human fungal keratitis

AIM:To analyze a series of antimicrobial peptides(AMPs)in corneal tissue from individuals with fungal keratitis(FK)during the active phase of the fungus infection and after healing.METHODS:Patients undergone lamellar keratoplasty for the treatment of severe FK or corneal scar had their corneal buttons sampled.Quantitative real-time polymerase chain reaction(PCR)was used to ascertain the gene expression of human beta-defensin(HBD)-1,-2,-3,-9,S100A7,8,9,and LL-37.RESULTS:All AMPs’messenger ribonucleic acid(mRNA)expression was considerably elevated in all samples(n=12).In contrast to controls,where HBD-2,-3,and S100A7 mRNAs were expressed at very low levels,it was discovered that HBD-1,-9,S100A8,S100A9,and LL-37 were constitutively expressed in all healed samples(n=4).HBD-1,-2-3,S100A7,and LL-37 mRNAs were significantly increased in all active FK samples(n=8).The levels of HBD-9,S100A8,and S100A9 mRNAs were moderately upregulated in all active FK samples.Subgroup comparison showed that HBD-2 was significantly increased in Fusarium keratitis samples(n=5),and LL-37 mRNAs were significantly enhanced in Aspergillus keratitis samples(n=3).Whereas there was not significantly increased of HBD-1,-3,-9,S100A7,8,9 mRNA in Aspergillus keratitis samples compared with Fusarium keratitis samples.CONCLUSION:AMPs expression is increased in active FK,but not all AMPs are equally expressed.HBD-2 and LL-37 expression levels are the highest,showing some specificity of AMP expression related to FK.Human AMPs,particularly HBD-2 may play a significant role in Fusarium keratitis and LL-37 might be the key player in Aspergillus keratitis.

Fungal community structure analysis of peanut pod rot in soil in Hebei Province,China

In recent years,peanut yield and quality are more seriously affected by pod rot disease in China.However,managing this disease has proven challenging due to the wide host range of its pathogens.In this study,four soil samples were collected from fields with pod rot disease in Hebei Province,and 454 pyrosequencing was used to analyze the fungal communities structure within them.All 38490 ITS high-quality sequences were grouped into 1203 operational taxonomic units,the fungal community diversity of four soil samples was evaluated and compared using Shannon index and Simpson index.The results showed that members of Ascomycota were dominant,followed by Basidiomycota.According to the BLAST results at the species level,Guehomyces had the highest abundance,accounting for about 7.27%,followed by Alternaria,Fusarium,and Davidiella.The relative abundance of Fusarium oxysporum isolated from rotting peanuts in soil with peanut rot was higher than that in the control,indicating that Fusarium oxysporum might be one of the main pathogenic fungus of peanut rot in this area.This study delved into the broader fungal community associated with peanut pod rot,providing a theoretical foundation for preventing and treating this disease in agriculture.

Pulmonary fungal infection in a neonate with methylmalonic acidemia:A case report

BACKGROUND Methylmalonic acidemia(MMA)is characterized by non-specific symptoms such as vomiting,and feeding difficulties,along with delayed mental and physical development.However,no case of MMA combined with pulmonary fungal infection has been reported yet.CASE SUMMARY We report the case of a neonate who presented pulmonary fungal infection along with the non-specific features of MMA.Exome sequencing revealed a c.331C>T variant in exon 3 of MMACHC from the father,and a c.658-c.660delAAG variant in exon 4 from the mother,which confirmed the diagnosis of cblC type MMA combined with hyperhomocysteinemia.CONCLUSION Invasive fungal infection might occur in some infants with MMA.Therefore,early diagnosis is recommended for unexplained pulmonary infection.

Challenges of the Global COVID-19 Pandemic and Invasive Fungal Pathogens in SARS-COV-2 Associations: A Dangerous Relationship

Background: COVID-19 is a rapidly transmissible pneumonia-like illness caused by SARS-CoV-2 that out broke in China in 2019 and is currently circulating worldwide. In the current context of the SARS-CoV-2 pandemic, complications are observed in clinical settings for the treatment of severe COVID-19 disease in nosocomial settings, due to cases of fungal co-infections. Objective: To carry out a review on fungal infections associated with respiratory infections caused by COVID-19 (Sars-Cov-2) and their aggravation. Methodology: The purpose of this study is to inform the reader about the characteristics of SARS-CoV-2 and the main fungal species that are affecting patients undergoing treatment for severe COVID-19, provoking discussion of the importance of the proposed topic, in relation to co-infections by different fungal microorganisms. Result: 80 scientific studies were selected, resulting from patients with COVID-19 and most commonly observed in patients with a history of comorbidities such as diabetes mellitus, hypertension, kidney disease, severe liver disease, oncological diseases, obesity and with severe COVID-19. These data do not represent the total number of records of the disease in the world, but cases reported by researchers in their series, showing the overlapping of fungal co-infection through the compromised immune status due to the use of therapeutic drugs, dysregulation of the microbiota, age of patients and the severity itself of the severe inflammation caused by COVID-19. Conclusion: The immunosuppression caused by the infection of COVID-19 concomitant with its therapy through corticosteroid therapy and comorbidities of the patients made fungal infections more susceptible, and these interfere in the evolution of the case and in the treatment of COVID-19, being relevant to distinguish secondary infections to therapy and the best possible reconstitution of the clinical picture.

Investigation and Identification of Fungal Diseases of Kiwifruit in Qiandongnan Prefecture

[Objectives]The paper was to investigate and identify the fungal diseases of wild and red heart kiwifruit in Qiandongnan Prefecture.[Methods]The pathogenic fungi were isolated from diseased leaves and fruits of wild and red heart kiwifruit by tissue separation method.DNA sequencing was carried out by using the sequence analysis of ribosomal r DNA-ITS region,and molecular evolutionary trees were built by using MEGA 4.0 software.Finally,the pathogenic fungi were classified and identified by combining morphological observation.[Results]The main fungal diseases were anthracnose caused by Colletotrichum gloeosporioides on wild kiwifruit,fruit anthracnose caused by C.acutatum on red heart kiwifruit,leaf soft rot caused by Fusarium incarnatum on red heart kiwifruit,and brown spot caused by Alternaria alternata on red heart kiwifruit.[Conclusions]The study may provide some theoretical basis for the control of kiwifruit diseases in Qiandongnan Prefecture.

Fungal corneal ulcer after repair of an overhanging filtering bleb:A case report

BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection including in the filtering bleb itself and even endophthalmitis in some severe cases has been reported.However,corneal fungal infection after filtering bleb repair is rarely reported.CASE SUMMARY A 57-year-old Chinese man who had sensations of redness and foreign body sensations in the left eye 3 wk after repair of overhanging filtering bleb.3 wk ago,due to sensations of a foreign body in the left eye for 3 years with worsening for 3 mo.The patient was diagnosed as overhanging filtering bleb and underwent a repair of overhanging filtering bleb.Postoperative,the filtering bleb formed well and the intraocular pressure is normal.But the patient gradually develop redness,pain and a grey infiltrate of the cornea in the eye.Finally it developed into fungal corneal ulcer.Through asking the medical history,we found the patient had irregularly self-medicated for years with glucocorticoid eye drops for years to relieve the foreign body sensation in the eye caused by filtering bleb overhanging.Because the glucocorticoid eye drops he used years ago had provide normal sensation to the eye.After 3 mo of anti-fungal treatment,the inflammation was controlled.CONCLUSION In addition to avoiding the development of overhanging filtering bleb after trabeculectomy,the present case report also suggests that clinicians should pay more attention to the patient’s ocular self-medication history.Particularly in patients with a history of glaucoma or eye surgery.Because these patients may be exposed to more types of eye drops than other individuals,they may select the wrong medi-cations for long-term use,based on their previous experience.

Rhizosphere Soil Fungal Diversity and Soil Physicochemical Properties of Different Vegetations in Tundra of Changbai Mountain

By studying the diversity and community structure of rhizosphere soil fungi of different plants in the tundra on the northern slope of Changbai Mountain, it provides theoretical support for the restoration of environmental degradation and in-depth study of fungal diversity in the tundra of Changbai Mountain. High-throughput sequencing technology was used to determine the ITS1 region of fungal amplicons, so as to analyze the diversity of fungal communities in the rhizosphere soil of six plants in the tundra of Changbai Mountain, and to analyze the correlation between the environment and the diversity and richness of fungal communities in combination with relevant soil physical and chemical factors. The diversity and richness of fungal community in the rhizosphere soil of six plants in Changbai Mountain tundra were different. The Simpson and Shannon indexes of Saxifraga stolonifera Curt were the highest, and the richness of fungal community in Dryas octopetala was the highest. The analysis of fungal community composition showed that the fungal colonies in plant rhizosphere soil samples mainly belonged to Ascomycota and Basidiomycota, which were the main dominant phyla. Mortierella, Fusarium and Sordariomycetes are common fungal genera in the rhizosphere soil of six plants, but their abundances are different among different plants. Water content was negatively correlated with fungal diversity, and TP was positively correlated with fungal community diversity. There were some differences in the composition and diversity of rhizosphere soil fungal communities of six plants in Changbai Mountain tundra. Ascomycota and Basidiomycota were the main soil fungal phyla in the rhizosphere of six plants in Changbai Mountain tundra. The results could provide theoretical guidance for ecological protection of Changbai Mountain tundra.

Clinical Analysis of 137 Cases of Fungal Keratitis

Objective: To analyze the epidemiology, clinical diagnosis and treatment of fungal keratitis (FK) in hospitalized patients at the First Affiliated Hospital of Yangtze University in recent years. Methods: A retrospective investigation was conducted on the data of 137 cases of FK in our hospital from January 2019 to December 2022. The epidemiological characteristics, identification results of fungal strains, clinical treatment, and prognosis of the patients were analyzed. Results: Among the 137 FK patients, 89 were males and 48 were females, and the ratio of male to female was 1.85:1, The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The disease occurred most in autumn, winter and summer farming season (from September to December, January, May, June). 72 cases (52.6%) had a clear history of corneal injury, and 43 cases (31.4%) had a history of plant injury. Other risk factors include eye surface diseases, ophthalmic surgery, and wearing corneal contact lenses. The top three pathogens were fusarium (38.7%), aspergillus (23.3%), and alternaria (17.5%). 101 eyes showed improvement or cure after treatment with medication, 9 eyes underwent corneal stromal injection, 11 eyes were covered with conjunctival flap covering or amniotic membrane transplantation, 12 eyes were covered with corneal transplantation, and enucleation of ocular contents was performed in 4 eyes;Visual acuity was improved or maintained in 123 patients (about 89.8%). Conclusions: The incidence of FK in our hospital was mostly middle-aged and elderly men, mostly caused by corneal injury in the process of agricultural labor. The pathogens were mainly fusarium and aspergillus. The preferred treatment was medication, with severe cases requiring combined surgical treatment. Most patients can maintain or improve their vision after treatment.

Chromoblastomycosis:a tropical-subtropical fungal disease with pathognomonic features not to be neglected in a global health scenario

Chromoblastomycosis(CBM)is a fungal disease,distributed in tropical and subtropical regions,affecting mainly rural workers.It is characterized by chronic skin lesions that may vary from nodular,tumorous,verrucous or plaque type.Associated constitutional symptoms are rarely found.The histological presentation may yield a pathognomonic feature,the Medlar(sclerotic)bodies,in which a typical brown to black pigment is depicted,explaining“copper pennies”as its alias.In this article,the case of a 56-year-old woman in the countryside of Brazil is reported,whose main complaint was a chronic leg ulcer for the past 8 years.The left leg had a large,partially ulcerated plaque lesion was found.Microbiological cultures were positive for the pathogen.Histological analysis demonstrated pseudoepitheliomatous hyperplasia,lymphohistiocytic infiltrate and sclerotic bodies(“copper pennies”).CBM’s epidemiological panorama,once established uniquely by geographical distribution,is transitioning to a global health issue,influenced by immunosuppressive conditions,global warming and migration.This scenario demands CBM to be widely considered as a differential diagnosis and may represent a clinical challenge in regions whose professionals have little expertise in infectious tropical diseases.

Surgical management of fungal endophthalmitis resulting from fungal keratitis

AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.