Etiologia e Perfil Epidemiológico das Ceratites Fúngicas no Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais

Abstract

Objective: To investigate the etiology and epidemiological profile of fungal keratitis (FK) in a referral center in the state of Minas Gerais. Design: Longitudinal retrospective study Methods: We reviewed the medical records of patients with laboratory-proven fungal keratitis at Hospital São Geraldo/HC-UFMG from January 2015 to December 2020. Results: 114 patients were included. Of these, 81.6% were male, with a mean age of 47.3 years and 79.2% came from rural areas. In 60% of the cases, admission was between the months of May and September. The main predisposing factor was ocular trauma, recorded in 59.1% of the patients, and in 41.3% of these, trauma occurred with vegetable matter. In addition, 40.1% had systemic diseases, 15% had other eye diseases, 13.2% had a history of previous ocular surgeries, and 2.7% were contact lens wearers. At presentation, 56.4% of the patients had visual acuity (VA) > 2.0 (LogMAR), 37.2% had hypopyon, 34.6% displayed stromal infiltrate greater than 5 mm and 15% had ocular perforation. Filamentous fungi were the most prevalent (103/114 cases; 90.3%), with Fusarium being the most frequent genus among filamentous fungi (72/103; 70%), followed by Aspergillus (20/103; 19, 4%). Of the yeast-like fungi, we had 11 cases of Candida sp. (9.6%), being seven cases of Candida albicans (63.7%), one of Candida parapsilosis (9.1%) and three cases without identification of the species (27.3%). Of the 114 patients, 102 (89.5%) received topical antifungal treatment; pimaricin was used in 96 (94.1%) eyes and amphotericin B in 50 eyes (49%). Systemic antifungal was used by 88/113 patients (77.9%). Therapeutic corneal transplantation was required in 54/113 patients (47.8%). There was recurrence of fungal infection in the transplanted graft in 12 eyes (22.2%), at an average of 13 days after transplantation. Ocular complications of CF were observed in 56/111 patients (50.5%). Healing time averaged 40 days (median: 36.5 days). Immediately after healing, VA was > 2.0 (LogMAR) in 58 patients (61.1%). On multivariate logistic regression analysis, significant risk factors (p<0.05) for occurrence of perforation and/or need for therapeutic corneal transplantation were corneal infiltrate size > 5 mm at greatest extent and initial AV (LogMAR) > 2.0. Conclusions: This is largest investigation on the etiological and epidemiological profiles of fungal keratitis in the state of Minas Gerais, Brazil. FK was predominant in young adult men from rural areas, most frequently during period of high agricultural activity in the state, with the main risk factor being ocular trauma with vegetable matter. Fusarium sp. followed by Aspergillus sp. were the predominant pathogens implicated in FK in the region studied. Keywords: Fungal keratitis. Corneal infection. Epidemiology. Etiology. Corneal transplant.