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Localized Versus Diffuse Corneal Invasion in Fungal Keratitis: Histological Insights from Candida albicans and Fusarium falciforme

Summary

This study compared how two different fungi invade the cornea (clear part of the eye) by examining tissue samples from patients who had severe eye infections. Candida stayed in one small area while Fusarium spread throughout the entire cornea tissue. The findings suggest that different fungi behave very differently when infecting the eye, which could help doctors choose better treatments. Understanding these differences may explain why Fusarium infections are much harder to treat with medications alone.

Background

Fungal keratitis is a severe eye infection that often requires surgical intervention with poor outcomes. The depth of pathogen invasion cannot always be reliably assessed by slit lamp examination but can be accurately determined through histological analysis. Understanding species-specific invasion patterns may have important implications for treatment strategies.

Objective

To histologically analyze corneal trephinates obtained during emergency keratoplasty and compare the invasion patterns of Candida albicans and Fusarium falciforme within corneal tissue to identify pathogen-specific differences.

Results

Candida albicans demonstrated localized fungal infiltration confined to the site of entry at the endothelium, penetrating less than one-third of corneal tissue with sparse inflammatory response. Fusarium falciforme exhibited trans-corneal invasion with hyphae scattered throughout the entire stromal tissue with high density near the endothelium, indicating aggressive diffuse infiltration. Clinical slit-lamp findings did not reliably reflect the true depth of fungal invasion in either case.

Conclusion

Candida albicans and Fusarium falciforme demonstrate fundamentally different corneal invasion patterns, with Candida remaining localized and Fusarium showing aggressive diffuse stromal infiltration. These findings highlight the importance of early diagnosis and suggest that filamentous fungi possess greater intrinsic capacity for tissue invasion compared to yeasts, which may explain why Fusarium keratitis requires more aggressive surgical intervention.
  • Published in:Journal of Fungi,
  • Study Type:Case Study,
  • Source: PMID: 41003233, DOI: 10.3390/jof11090688
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