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In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis

BACKGROUND: Clinical outcomes in fungal keratitis vary between Fusarium and Aspergillus spp, therefore distinguishing between species using morphological features such as filament branching angles, sporulation along filaments (adventitious sporulation) or dichotomous branching may be useful. In this...

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Autores principales: Chidambaram, Jaya Devi, Prajna, Namperumalsamy Venkatesh, Larke, Natasha, Macleod, David, Srikanthi, Palepu, Lanjewar, Shruti, Shah, Manisha, Lalitha, Prajna, Elakkiya, Shanmugam, Burton, Matthew J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537506/
https://www.ncbi.nlm.nih.gov/pubmed/28043985
http://dx.doi.org/10.1136/bjophthalmol-2016-309656
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author Chidambaram, Jaya Devi
Prajna, Namperumalsamy Venkatesh
Larke, Natasha
Macleod, David
Srikanthi, Palepu
Lanjewar, Shruti
Shah, Manisha
Lalitha, Prajna
Elakkiya, Shanmugam
Burton, Matthew J
author_facet Chidambaram, Jaya Devi
Prajna, Namperumalsamy Venkatesh
Larke, Natasha
Macleod, David
Srikanthi, Palepu
Lanjewar, Shruti
Shah, Manisha
Lalitha, Prajna
Elakkiya, Shanmugam
Burton, Matthew J
author_sort Chidambaram, Jaya Devi
collection PubMed
description BACKGROUND: Clinical outcomes in fungal keratitis vary between Fusarium and Aspergillus spp, therefore distinguishing between species using morphological features such as filament branching angles, sporulation along filaments (adventitious sporulation) or dichotomous branching may be useful. In this study, we assessed these three features within Heidelberg Retina Tomograph 3 in vivo confocal microscopy (IVCM) images from culture-positive Fusarium and Aspergillus spp keratitis participants. METHODS: Prospective observational cohort study in Aravind Eye Hospital (February 2011–February 2012). Eligibility criteria: age ≥18 years, stromal infiltrate ≥3 mm diameter, Fusarium or Aspergillus spp culture-positive. Exclusion criteria: previous/current herpetic keratitis, visual acuity <6/60 in fellow eye, >80% corneal thinning. IVCM was performed and images analysed for branch angle, presence/absence of adventitious sporulation or dichotomous branching by a grader masked to the microbiological diagnosis. RESULTS: 98 participants were included (106 eligible, 8 excluded as no measurable branch angles); 68 were positive for Fusarium spp, 30 for Aspergillus spp. Mean branch angle for Fusarium spp was 59.7° (95% CI 57.7° to 61.8°), and for Aspergillus spp was 63.3° (95% CI 60.8° to 65.8°), p=0.07. No adventitious sporulation was detected in Fusarium spp ulcers. Dichotomous branching was detected in 11 ulcers (7 Aspergillus spp, 4 Fusarium spp). CONCLUSIONS: There was very little difference in the branching angle of Fusarium and Aspergillus spp. Adventitious sporulation was not detected and dichotomous branching was infrequently seen. Although IVCM remains a valuable tool to detect fungal filaments in fungal keratitis, it cannot be used to distinguish Fusarium from Aspergillus spp and culture remains essential to determine fungal species.
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spelling pubmed-55375062017-08-03 In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis Chidambaram, Jaya Devi Prajna, Namperumalsamy Venkatesh Larke, Natasha Macleod, David Srikanthi, Palepu Lanjewar, Shruti Shah, Manisha Lalitha, Prajna Elakkiya, Shanmugam Burton, Matthew J Br J Ophthalmol Clinical Science BACKGROUND: Clinical outcomes in fungal keratitis vary between Fusarium and Aspergillus spp, therefore distinguishing between species using morphological features such as filament branching angles, sporulation along filaments (adventitious sporulation) or dichotomous branching may be useful. In this study, we assessed these three features within Heidelberg Retina Tomograph 3 in vivo confocal microscopy (IVCM) images from culture-positive Fusarium and Aspergillus spp keratitis participants. METHODS: Prospective observational cohort study in Aravind Eye Hospital (February 2011–February 2012). Eligibility criteria: age ≥18 years, stromal infiltrate ≥3 mm diameter, Fusarium or Aspergillus spp culture-positive. Exclusion criteria: previous/current herpetic keratitis, visual acuity <6/60 in fellow eye, >80% corneal thinning. IVCM was performed and images analysed for branch angle, presence/absence of adventitious sporulation or dichotomous branching by a grader masked to the microbiological diagnosis. RESULTS: 98 participants were included (106 eligible, 8 excluded as no measurable branch angles); 68 were positive for Fusarium spp, 30 for Aspergillus spp. Mean branch angle for Fusarium spp was 59.7° (95% CI 57.7° to 61.8°), and for Aspergillus spp was 63.3° (95% CI 60.8° to 65.8°), p=0.07. No adventitious sporulation was detected in Fusarium spp ulcers. Dichotomous branching was detected in 11 ulcers (7 Aspergillus spp, 4 Fusarium spp). CONCLUSIONS: There was very little difference in the branching angle of Fusarium and Aspergillus spp. Adventitious sporulation was not detected and dichotomous branching was infrequently seen. Although IVCM remains a valuable tool to detect fungal filaments in fungal keratitis, it cannot be used to distinguish Fusarium from Aspergillus spp and culture remains essential to determine fungal species. BMJ Publishing Group 2017-08 2017-01-02 /pmc/articles/PMC5537506/ /pubmed/28043985 http://dx.doi.org/10.1136/bjophthalmol-2016-309656 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Clinical Science
Chidambaram, Jaya Devi
Prajna, Namperumalsamy Venkatesh
Larke, Natasha
Macleod, David
Srikanthi, Palepu
Lanjewar, Shruti
Shah, Manisha
Lalitha, Prajna
Elakkiya, Shanmugam
Burton, Matthew J
In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis
title In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis
title_full In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis
title_fullStr In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis
title_full_unstemmed In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis
title_short In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis
title_sort in vivo confocal microscopy appearance of fusarium and aspergillus species in fungal keratitis
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537506/
https://www.ncbi.nlm.nih.gov/pubmed/28043985
http://dx.doi.org/10.1136/bjophthalmol-2016-309656
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