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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 types of fungi invade the cornea of the eye. Candida albicans, a yeast, stayed localized to where it entered the eye and was easier to control surgically. In contrast, Fusarium falciforme, a mold, spread aggressively throughout the entire cornea and was much harder to treat. Understanding these different invasion patterns helps explain why some fungal eye infections are more difficult to manage than others.

Background

Fungal keratitis is a serious eye infection requiring surgical intervention in approximately one-third of cases in Germany, with high rates of poor outcomes. Conservative treatment is often unsuccessful due to limited effective medications and frequent antifungal resistance. Understanding pathogen-specific invasion patterns may help inform therapeutic strategies.

Objective

This study histologically analyzes corneal trephinates from two cases of fungal keratitis to examine and compare the invasion patterns of Candida albicans and Fusarium falciforme within corneal tissue, with implications for treatment strategies.

Results

Candida albicans demonstrated localized fungal infiltration confined to the site of entry at the endothelium, penetrating only one-third of corneal tissue with limited spread to deeper stromal layers. In contrast, Fusarium falciforme showed diffuse, full-thickness corneal invasion with hyphae scattered throughout the entire stroma, particularly with high density near the endothelium. Clinical slit-lamp findings did not reliably reflect the actual depth of fungal invasion observed histologically in either case.

Conclusion

This comparative histological analysis reveals distinct invasion patterns between yeasts and filamentous fungi, with Candida infections remaining localized while Fusarium exhibits aggressive diffuse stromal infiltration. These findings highlight the importance of early accurate diagnosis and suggest that understanding species-specific invasion behavior may help refine therapeutic strategies and improve clinical outcomes in fungal keratitis.
  • Published in:Journal of Fungi,
  • Study Type:Case Report/Comparative Histological Analysis,
  • Source: PMID: 41003233, DOI: 10.3390/jof11090688
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