Volume 16, Issue 5 (Sep-Oct 2022)                   mljgoums 2022, 16(5): 43-51 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Karimizadeh Esfahani M, najjari M, Hosseini Teshnizi S, Dolatabadi S, najafzadeh M J. Mycotic Keratitis in the Middle East: A Systematic Review and Meta-Analysis. mljgoums 2022; 16 (5) :43-51
URL: http://mlj.goums.ac.ir/article-1-1472-en.html
1- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3- Department of Biology, Hakim Sabzevari University, Sabzevar, Iran , somayeh99@gmail.com
Abstract:   (2229 Views)
Background and objectives: Mycotic keratitis is a fungal infection of the cornea that can cause blindness. Its incidence, risk factors, and the etiological agents vary worldwide and nationwide. Therefore, proper documentation of these data is essential for better disease management. In this review, we aimed to make a clear picture of this infection in the Middle East.
Methods: Data on fungal keratitis from 1986 to 2018 in the Middle East were systematically collected from five English databases (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) and four Persian databases (Magiran, Scientific Information Database, IranMedex, and Irandoc). A total of 35 studies were included in the review.
Result: The pooled prevalence of fungal keratitis in the Middle East was estimated at 26% (95% confidence interval: 19-32%; I2=98.88%, p<0.001)  using random-effect model, with considerable variation among the countries. The prevalence of fungal keratitis was highest in Egypt (36%) and Iran (34%) and lowest in Oman (9%). Aspergillus and Fusarium spp. were the most common causative agents (28%) among filamentous fungi, and Candida (13%) was the predominant yeast species causing fungal keratitis. Based on the data, fungal keratitis was more prevalent in males (39%) than in females (23%).
Conclusion: Our study is the first systematic review on mycotic keratitis among the Middle Eastern countries. These epidemiological estimates can be used by policy makers to improve treatment strategies, especially in this part of the world.
Background and objectives: Mycotic keratitis is a fungal infection of the cornea that can cause blindness. Its incidence, risk factors, and the etiological agents vary worldwide and nationwide. Therefore, proper documentation of these data is essential for better disease management. In this review, we aimed to make a clear picture of this infection in the Middle East.
Methods: Data on fungal keratitis from 1986 to 2018 in the Middle East were systematically collected from five English databases (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) and four Persian databases (Magiran, Scientific Information Database, IranMedex, and Irandoc). A total of 35 studies were included in the review.
Result: The pooled prevalence of fungal keratitis in the Middle East was estimated at 26% (95% confidence interval: 19-32%; I2=98.88%, p<0.001)  using random-effect model, with considerable variation among the countries. The prevalence of fungal keratitis was highest in Egypt (36%) and Iran (34%) and lowest in Oman (9%). Aspergillus and Fusarium spp. were the most common causative agents (28%) among filamentous fungi, and Candida (13%) was the predominant yeast species causing fungal keratitis. Based on the data, fungal keratitis was more prevalent in males (39%) than in females (23%).
Conclusion: Our study is the first systematic review on mycotic keratitis among the Middle Eastern countries. These epidemiological estimates can be used by policy makers to improve treatment strategies, especially in this part of the world.
 
Full-Text [PDF 646 kb]   (385 Downloads) |   |   Full-Text (HTML)  (532 Views)  
Research Article: Review Article | Subject: Mycology
Received: 2021/12/26 | Accepted: 2022/05/14 | Published: 2022/09/6 | ePublished: 2022/09/6

References
1. Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN. The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India. Cornea. 2002; 21(6): 555-9. [View at Publisher] [DOI:10.1097/00003226-200208000-00004] [PubMed] [Google Scholar]
2. FlorCruz NV, Peczon IV, Evans JR. Medical interventions for fungal keratitis. Cochrane Database Syst Rev. 2012 Feb 15;(2):CD004241. doi: 10.1002/14651858.CD004241.pub3. Update in: Cochrane Database Syst Rev. 2015;(4):CD004241. [View at Publisher] [DOI:10.1002/14651858.CD004241.pub3] [PubMed] [Google Scholar]
3. Jurkuna U, Behlau I, Colby K. Fungal keratitis: changing pathogens and risk factors. Cornea. 2009; 28: 638-643. [DOI:10.1097/ICO.0b013e318191695b] [PubMed] [Google Scholar]
4. Shigeyasu C, Yamada M, Nakamura N, Mizuno Y, Sato T, Yaguchi T. Keratomycosis caused by Aspergillus viridinutans: an Aspergillus fumigatus resembling mold presenting distinct clinical and antifungal susceptibility patterns. Med Mycol. 2012; 50: 525-528. [View at Publisher] [DOI:10.3109/13693786.2012.658875] [PubMed] [Google Scholar]
5. Sengupta J, Saha S, Khetan A, Ganguly A, Banerjee D. Candida fermentati: a rare yeast involved in fungal keratitis. Eye and Contact Lens. 2013; 39(4): e15-8. [View at Publisher] [DOI:10.1097/ICL.0b013e318255121f] [PubMed] [Google Scholar]
6. Nelson PE, Dignani MC, Anaissie EJ. Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev. 1994;7:479-504. [View at Publisher] [DOI:10.1128/CMR.7.4.479] [PubMed] [Google Scholar]
7. Xie L, Zhong W, Shi W, Sun S. Spectrum of fungal keratitis in north China. Ophthalmology. 2006; 113(11): 1943-1948. [View at Publisher] [DOI:10.1016/j.ophtha.2006.05.035] [PubMed] [Google Scholar]
8. Nath R, Baruah S, Saikia L, Devi B, Borthakur AK, Mahanta J. Mycotic corneal ulcers in upper Assam. Indian J Ophthalmol. 2011; 59(5): 367-71. [View at Publisher] [DOI:10.4103/0301-4738.83613] [PubMed] [Google Scholar]
9. O' Day D. Fungal keratitis. In: Pepose JS editor(s). Ocular infection and immunity. St Louis: Moseby, 1996:1048-1061.
10. O' Brien TP, Rhee P. Pharmacotherapy of fungus infections of the eye. In: Zimmerman TJ, Koonere KS, Fecthner RD, Sharir M editor(s). Textbook of ocular pharmacology. Hagerstown: Lipincott-Raven, 1997:587-607.
11. Ferrer C, Alio JL. Evaluation of molecular diagnosis in fungal keratitis. Ten years of experience. J Ophthalmic Inflamm Infect. 2011; 1: 15-22. [View at Publisher] [DOI:10.1007/s12348-011-0019-9] [PubMed] [Google Scholar]
12. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis. John Wiley & Sons; 2011 Aug 24. [View at Publisher]
13. Gower EW, Keay LJ, Oechsler RA, Iovieno A, Alfonso EC, Jones DB, et al. Trends in fungal keratitis in the United States, 2001 to 2007. Ophthalmology. 2010; 117(12): 2263-7. [View at Publisher] [DOI:10.1016/j.ophtha.2010.03.048] [PubMed] [Google Scholar]
14. Khater MM, Shehab NS, El-Badry AS. Comparison of mycotic keratitis with nonmycotic keratitis: an epidemiological study. J Ophthalmol. 2014 [View at Publisher] [DOI:10.1155/2014/254302] [Google Scholar]
15. Alkatan H, Athmanathan S, Canites CC. Incidence and microbiological profile of mycotic keratitis in a tertiary care eye hospital: a retrospective analysis. Saudi Journal of Ophthalmology. 2012; 26(2): 217-221. [View at Publisher] [DOI:10.1016/j.sjopt.2011.11.005] [PubMed] [Google Scholar]
16. Bharathi MJ, Ramakrishnan R, Vasu S, Meenakshi R, Palaniappan R. Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol. 2003; 51(4): 315-21. [View at Publisher] [DOI:10.11648/j.cmr.20150406.18] [PubMed] [Google Scholar]
17. Satpathy G, Ahmed NH, Nayak N, Tandon R, Sharma N, Agarwal T, et al. Spectrum of mycotic keratitis in north India: Sixteen years study from a tertiary care ophthalmic centre. Journal of infection and public health. 2019; 12(3): 367-371. [View at Publisher] [DOI:10.1016/j.jiph.2018.12.005] [PubMed] [Google Scholar]
18. Saad-Hussein A, El-Mofty HM, Hassanien MA. Climate change and predicted trend of fungal keratitis in Egypt. East Mediterr Health J. 2011; 17(6): 468-73. [DOI:10.26719/2011.17.6.468] [PubMed] [Google Scholar]
19. Zaki SM, Denning DW. Serious fungal infections in Egypt. Eur J Clin Microbiol Infect Dis. 2017; 36(6): 971-974. [View at Publisher] [DOI:10.1007/s10096-017-2929-4] [PubMed] [Google Scholar]
20. Erie JC, Nevitt MP, Hodge DO, Ballard DJ. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch Ophthalmol. 1993; 111(12): 1665-71 [View at Publisher] [DOI:10.1001/archopht.1993.01090120087027] [PubMed] [Google Scholar]
21. Upadhyay M, Karmacharya P, Koirala S, et al. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. Br J Ophthalmol. 2001; 85(4): 388-92 [View at Publisher] [DOI:10.1136/bjo.85.4.388] [PubMed] [Google Scholar]
22. Erdem E, Yagmur M, Boral H, et al. Aspergillus flavus keratitis: experience of a tertiary eye clinic in Turkey. Mycopathologia. 2017; 182(3-4): 379-385. [View at Publisher] [DOI:10.1007/s11046-016-0089-1] [PubMed] [Google Scholar]
23. Al‐Hatmi AM, Castro MA, De Hoog GS, et al. Epidemiology of Aspergillus species causing keratitis in Mexico. Mycoses. 2019;62(2):144-151. [View at Publisher] [DOI:10.1111/myc.12855] [PubMed] [Google Scholar]
24. Homa M, Manikandan P, Szekeres A, et al. Characterization of Aspergillus tamarii strains from human keratomycoses: molecular identification, antifungal susceptibility patterns and cyclopiazonic acid producing abilities. Frontiers in microbiology. 2019;10. [View at Publisher] [DOI:10.3389/fmicb.2019.02249] [PubMed] [Google Scholar]
25. Cuadros J, Gros-Otero J, Gallego-Angui P, et al. Aspergillus tamarii keratitis in a contact lens wearer. Medical mycology case reports. 2018;19:21-24. [View at Publisher] [DOI:10.1016/j.mmcr.2017.11.003] [PubMed] [Google Scholar]
26. Chang DC, Grant GB, O'Donnell K, Wannemuehler KA, Noble-Wang J, Rao CY, et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. Jama. 2006; 296(8): 953-963. [View at Publisher] [DOI:10.1001/jama.296.8.953] [PubMed] [Google Scholar]
27. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol. 2002; 86: 1211-1215. [View at Publisher] [DOI:10.1136/bjo.86.11.1211] [PubMed] [Google Scholar]
28. Satpathy G, Ahmed NH, Nayak N, Tandon R, Sharma N, Agarwal T, et al. Spectrum of mycotic keratitis in north India: Sixteen years study from a tertiary care ophthalmic centre. Journal of infection and public health. 2019;12(3):367-371. [View at Publisher] [DOI:10.1016/j.jiph.2018.12.005] [PubMed] [Google Scholar]
29. Abdelkader A. Cosmetic soft contact lens associated ulcerative keratitis in southern Saudi Arabia. Middle East Afr J Ophthalmol. 2014; 21(3): 232-5. [DOI:10.4103/0974-9233.134677] [PubMed] [Google Scholar]
30. Al-Yousuf N. Microbial keratitis in kingdom of bahrain: clinical and microbiology study. Middle East African journal of ophthalmology. 2009;16(1):3. [View at Publisher] [DOI:10.4103/0974-9233.48855] [PubMed] [Google Scholar]
31. Parmar P, Salman A, Kalavathy CM, Kaliamurthy J, Thomas PA, Jesudasan CA. Microbial keratitis at extremes of age. Cornea. 2006;25:153-158. [View at Publisher] [DOI:10.1097/01.ico.0000167881.78513.d9] [PubMed] [Google Scholar]
32. Ramakrishnan T, Constantinou M, Jhanji V, Vajpayee RB. Factors affecting treatment outcomes with voriconazole in cases with fungal keratitis. Cornea. 2013;32(4):445-449. [View at Publisher] [DOI:10.1097/ICO.0b013e318254a41b] [PubMed] [Google Scholar]
33. Mohd-Tahir F, Norhayati A, Siti-Raihan I, Ibrahim M. A 5-year retrospective review of fungal keratitis at hospital Universiti sains Malaysia. Interdiscip Perspect Infect Dis. 2012;2012:851-563. [View at Publisher] [DOI:10.1155/2012/851563] [PubMed] [Google Scholar]
34. Shabrawy RM, El Badawy NE, Harb AW. The incidence of fungal keratitis in Zagazig University Hospitals, Egypt and the value of direct microscopy and PCR technique in rapid diagnosis. J Microbiol Infect Dis. 2013;3(4):186-191. [View at Publisher] [DOI:10.5799/ahinjs.02.2013.04.0106] [PubMed] [Google Scholar]
35. Keay LJ, Gower EW, Iovieno A, et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study. Ophthalmology. 2011;118(5):920-926. [View at Publisher] [DOI:10.1016/j.ophtha.2010.09.011] [PubMed] [Google Scholar]
36. Al-Shakarchi FI, Hussein MA, Al-Shaibani AB. Profile of microbial keratitis at a referral center in Iraq. Al-Nahrain Journal of Science. 2015;18:141-147. [View at Publisher] [DOI:10.22401/JNUS.18.1.21] [Google Scholar]
37. Keshav BR, Zacheria G, Ideculla T, Bhat V, Joseph M. Epidemiological characteristics of corneal ulcers in South Sharqiya Region. Oman Medical Journal. 2008;23:34. [PubMed] [Google Scholar]
38. Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivakumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalm. Epidemiol. 2007;14:61-69. [View at Publisher] [DOI:10.1080/09286580601001347] [PubMed] [Google Scholar]
39. Badawi AE, Moemen D, El-Tantawy NL. Epidemiological, clinical and laboratory findings of infectious keratitis at Mansoura Ophthalmic Center, Egypt. Int J Ophthalmol. 2017;10:61. [DOI] [PubMed] [Google Scholar]
40. Khairallah SH, Byrne KA, Tabbara KF. Fungal keratitis in Saudi Arabia. Documenta ophthalmologica. 1992;79:269-276. [View at Publisher] [DOI:10.1007/BF00158257] [PubMed] [Google Scholar]
41. Houang E, Lam D, Fan D, Seal D. Microbial keratitis in Hong Kong: relationship to climate, environment and contact-lens disinfection. Trans R Soc Trop Med Hyg. 2001;95:361-367. [View at Publisher] [DOI:10.1016/S0035-9203(01)90180-4] [PubMed] [Google Scholar]
42. Yilmaz S, Ozturk I, Maden A. Microbial keratitis in West Anatolia, Turkey: a retrospective review. International Ophthalmology. 2007; 27: 261-268. [View at Publisher] [DOI:10.1007/s10792-007-9069-2] [PubMed] [Google Scholar]
43. Saad-Hussein A, El-Mofty HM, Hassanien MA. Climate change and predicted trend of fungal keratitis in Egypt. East Mediterr Health J. 2011; 17: 468-473. [View at Publisher] [DOI:10.26719/2011.17.6.468] [Google Scholar]
44. Martone G, Pichierri P, Franceschini R et al. In vivo confocal microscopy and anterior segment optical coherence tomography in a case of Alternaria keratitis. Cornea. 2011; 30: 449-453. [View at Publisher] [DOI:10.1097/ICO.0b013e3181dae1f3] [PubMed] [Google Scholar]
45. Bharathi MJ, Ramakrishnan R, Meenakshi R, Mittal S, Shivakumar C, Srinivasan M. Microbiological diagnosis of infective keratitis: comparative evaluation of direct microscopy and culture results. Br J Ophthalmol. 2006; 90: 1271-1276. [View at Publisher] [DOI:10.1136/bjo.2006.096230] [PubMed] [Google Scholar]
46. Badiee P, Alborzi A, Nejabat M. Detection of Aspergillus keratitis in ocular infections by culture and molecular method. Int Ophthalmol. 2011;31(4), 291-296. [View at Publisher] [DOI:10.1007/s10792-011-9457-5] [PubMed] [Google Scholar]
47. Moemen D, Bedir T, Awad EA, Ellayeh A. Fungal keratitis: Rapid diagnosis using methylene blue stain. Egyptian Journal of Basic and Applied Sciences. 2015; 2(4):289-294. [View at Publisher] [DOI:10.1016/j.ejbas.2015.08.001] [Google Scholar]
48. Shabrawy RM, El Badawy NE, Harb AW. The incidence of fungal keratitis in Zagazig University Hospitals, Egypt and the value of direct microscopy and PCR technique in rapid diagnosis. J Microbiol Infect Dis. 2013; 3(4): 186-191. [View at Publisher] [DOI:10.5799/ahinjs.02.2013.04.0106] [Google Scholar]
49. Thomas PA, A Teresa P, Theodore J, Geraldine P. PCR for the molecular diagnosis of mycotic keratitis. Expert rev mol diagn. 2012; 12(7): 703-718. [View at Publisher] [DOI:10.1586/erm.12.65] [PubMed] [Google Scholar]
50. Galarreta DJ, Tuft SJ, Ramsay A, Dart JK. Fungal keratitis in London: microbiological and clinical evaluation. Cornea 2007; 26(9): 1082-1086. [View at Publisher] [DOI:10.1097/ICO.0b013e318142bff3] [PubMed] [Google Scholar]
51. Chen WL, Wu CY, Hu FR, Wang IJ. Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987-2001. Am J Ophthalmol. 2004; 137: 736-743. [View at Publisher] [DOI:10.1016/j.ajo.2003.11.010] [PubMed] [Google Scholar]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2007 All Rights Reserved | Medical Laboratory Journal

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.