Clinical and microbiological insights on mycotic keratitis: A prospective cross-sectional study at the Research Institute of Ophthalmology | ||||
| Microbes and Infectious Diseases | ||||
| Articles in Press, Accepted Manuscript, Available Online from 26 June 2025 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mid.2025.381788.2761 | ||||
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| Authors | ||||
Doaa Mahdy El-Wakil   1; Mai Al-Kaffas 2; Shady M. Soliman3
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| 1Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt | ||||
| 2Medical Microbiology and Immunology, Research Institute of Ophthalmology, Giza, Egypt | ||||
| 3Cornea Unit, Research Institute of Ophthalmology, Giza, Egypt | ||||
| Abstract | ||||
| Background: Mycotic keratitis (MK) is a leading cause of visual impairment, particularly in developing countries. Early diagnosis and antifungal susceptibility testing (AFST) are critical for effective treatment and improving outcomes. Aim: To identify the predisposing factors and causative agents of MK and evaluate the antifungal susceptibility profiles of the isolated pathogens. Methods: In this prospective study, 193 patients clinically diagnosed with keratitis were recruited from the Cornea outpatient clinics at the Research Institute of Ophthalmology, Egypt. Corneal scrapings were collected for direct microscopy and culture. The fungal isolates were tested for antifungal susceptibility using the disk diffusion method. Results: Seventy-two cases (37.3%) were confirmed as MK by microscopy and positive culture. Aspergillus spp. were the most common isolates (91.7%), followed by Candida spp. (8.3%). Ocular trauma was the primary predisposing factor (63.9%). Males showed significantly higher rates of ocular trauma (69.6% vs. 30.4%, p = 0.010), whereas contact lens (CL) use was more common among females (59.5% vs. 40.5%, p = 0.002). Agricultural workers had higher rates of ocular trauma (67.4%, p < 0.001), whereas non-agricultural workers had higher rates of CL use (81.1%, p < 0.001). Candida infections were associated with longer disease duration than Aspergillus infections (median, 8.5 vs. 5; p = 0.009). Voriconazole showed the highest efficacy against Aspergillus (84.4%) and Candida spp. (100%) followed by amphotericin B (66.7% and 100%, respectively). Conclusion: Mycotic keratitis is highly prevalent in our region. A tailored treatment approach, guided by microbiological analysis and AFST, is crucial for effectively managing MK. | ||||
| Keywords | ||||
| Mycotic keratitis; Aspergillus; Candida; antifungal susceptibility | ||||
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