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Filamentous Fungal Keratitis in Greece: A 16-Year Nationwide Multicenter Survey

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Abstract

In a multicenter, prospective study of filamentous fungal keratitis in Greece, predisposing factors, etiology, treatment practices, and outcome, were determined. Corneal scrapings were collected from patients with clinical suspicion of fungal keratitis, and demographic and clinical data were recorded. Fungal identification was based on morphology, molecular methods, and matrix assisted laser desorption ionization time-of-flight mass-spectrometry. A total of 35 cases were identified in a 16-year study period. Female to male ratio was 1:1.7 and median age 48 years. Corneal injury by plant material, and soft contact lens use were the main risk factors (42.8% and 31.4%, respectively). Trauma was the leading risk factor for men (68.1%), contact lens use (61.5%) for women. Fusarium species were isolated more frequently (n = 21, 61.8%). F. solani was mostly associated with trauma, F. verticillioides and F. proliferatum with soft contact lens use. Other fungi were: Purpureocillium lilacinum (14.7%), Alternaria (11.8%), Aspergillus (8.8%), and Phoma foliaceiphila, Beauveria bassiana and Curvularia spicifera, one case each. Amphotericin B and voriconazole MIC50s against Fusarium were 2 mg/L and 4 mg/L respectively. Antifungal therapy consisted mainly of voriconazole locally or both locally and systemically, alone or in combination with liposomal AmB. Cure/improvement rate with antifungal therapy alone was 52%, keratoplasty was required in 40% of cases, and enucleation in 8%. In conclusion, filamentous fungal keratitis in Greece is rare, but with considerable morbidity. A large proportion of cases resulted in keratoplasty despite appropriate antifungal treatment.

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Acknowledgements

We are grateful to Prof. Anna Maria Tortorano, University of Milan, Dr. Anne van Diepeningen and Bert Gerrits van den Ende, Westerdijk Fungal Biodiversity Institute, Utrect, the Netherlands, for their valuable contribution to the molecular identification of our strains. We would also like to thank Mrs Theodora Koliou (Department of Microbiology, Medical School, National and Kapodistrian University of Athens) for her excellent technical assistance with MALDI TOF.

Funding

The study was partially financed by a grant from Gilead Sciences Hellas Μ.EPE (ASKLEPIOS Programme, 2013).

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Authors and Affiliations

  1. Infectious Diseases Research Laboratory/4th Department of Internal Medicine, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece

    Alexandra Mpakosi, Anastasia Antoniadou, Georgios Petrikkos & Maria Drogari-Apiranthitou

  2. General Hospital of Nikaia “Agios Panteleimon”, Piraeus, Greece

    Alexandra Mpakosi

  3. Clinical Microbiology Laboratory, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Maria Siopi & Joseph Meletiadis

  4. Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Georgia Vrioni

  5. Clinical Microbiology Laboratory, General Hospital of Athens “Georgios Gennimatas”, Athens, Greece

    Maria Orfanidou, Eleni Vagiakou & Eleni Petrou

  6. Department of Clinical Microbiology, Evangelismos General Hospital, Athens, Greece

    Athina Argyropoulou

  7. Laboratory of Microbiology, University Hospital of Patras, Patras, Greece

    Myrto Christofidou

  8. Athens Eye Hospital, Glyfada, Greece

    Maria Kostoula

  9. Agioi Anargyroi General Oncological Hospital of Kifissia, Kifissia, Greece

    Stamatina Golegou

  10. Department of Microbiology, General Hospital of Nea Ionia ‘Konstantopouleio-Patission’, Athens, Greece

    Evangelia Platsouka

  11. Hygeia General Hospital, Athens, Greece

    Eleni Papadogeorgaki

  12. 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece

    Irini Chatziralli & Panagiotis Theodossiadis

  13. School of Medicine, European University, Nicosia, Cyprus

    Georgios Petrikkos

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Contributions

AM collected data, performed diagnostic tests, and wrote the first draft. MD-A and GP conceived, designed, and supervised the study. MS provided data and performed diagnostic tests. MD-A analyzed data and edited the manuscript. JM, MS, MC, IC, AA, EP, GV and GP, reviewed and commented on previous versions of the manuscript. All authors provided data and approved the final manuscript.

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Correspondence to Maria Drogari-Apiranthitou.

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The study has been approved by the Ethics Committee and Scientific Council of Attikon University Hospital (14/4/2014).

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Mpakosi, A., Siopi, M., Vrioni, G. et al. Filamentous Fungal Keratitis in Greece: A 16-Year Nationwide Multicenter Survey. Mycopathologia 187, 439–453 (2022). https://doi.org/10.1007/s11046-022-00666-1

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