Fungal keratitis (FK) is a serious ocular infection that can result in various degrees of vision loss, including blindness. The aim of the study was to identify and retrospectively review all FK cases diagnosed between August 2012 and December 2020 at a tertiary care hospital in northern Thailand with a specific focus on epidemiologic features, including season, patient sex and age, the spectrum of pathogens, and presence of certain putative virulence factors. Of 1237 patients with corneal ulcers, 294 (23.8%) were confirmed by direct microscopic examination and/or fungal culture. For the positive cases, direct examinations of Calcofluor white (CW) stains and KOH mounts were found in 97.3% (286/294) and 76.5% (225/294), respectively (p < 0.05). Of the cases diagnosed by microscopy and culture, fungi were isolated in 152 (51.7%), with Fusarium spp. being the most frequently identified (n = 69, 45.5%) followed by dematiaceous fungi (n = 45, 29.6%) and Aspergillus spp. (n = 18, 11.8%). The incidence of FK was higher in the rainy season of July to October. The mean age was 54.4 ± 14.4 (SD) years, with a range of 9–88 years. Males (75.8%) were affected significantly more than females (24.2%) (p < 0.05). Of 294 patients, 132 (44.9%) were middle-aged adults (41–60 years) and 107 (36.4%) were older than 60 years. Trauma to the eye by soil or vegetative matter were the most common preceding factors (188/294; 64.0%). We assessed two virulence factors. First, 142 of the 152 culture-positive FK cases were due to molds, indicating that hyphal morphogenesis is extremely important in disease. We also demonstrated that fungal melanization occurs in the molds during the course of FK by applying a melanin-specific monoclonal antibody (MAb) that labeled fungal elements in corneal samples of patients, and melanin particles derived from the hyphae were also recovered after treatment of the samples with proteolytic enzymes, denaturant and hot concentrated acid. In summary, we demonstrate that northern Thailand has a high rate of FK that is influenced by season and males engaged in outside activities are at highest risk for disease. Moulds are significantly more commonly responsible for FK, in part due to their capacity to form hyphae and melanins. Future studies will examine models of fungal corneal interactions and assess additional factors of virulence, such as secreted enzymes, to more deeply decipher the pathogenesis of FK.

Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

Background/Objectives: Human pythiosis, caused by Pythium insidiosum, is associated with severe morbidity and high mortality when diagnosis is delayed. Culture-based diagnosis is time-consuming and may be insensitive in clinical specimens, highlighting the need for rapid point-of-care serodiagnostic tools. Here, we developed and clinically evaluated the Anti-Pin Antibody Test Strip, a whole-blood-compatible lateral flow immunoassay (LFIA) for detecting anti-P. insidiosum antibodies. Methods: Secretory protein antigens of P. insidiosum were prepared and conjugated to gold nanoparticles for LFIA development. Analytical performance was assessed by determining the limit of detection (LOD) using serial dilutions of pythiosis serum and by evaluating cross-reactivity with sera from patients with other infections. Interference testing examined common anticoagulants and adverse sample conditions (hemolysis, lipidemia, and icterus). Clinical performance was evaluated using 258 serum samples, comprising 48 pythiosis-positive and 210 pythiosis-negative specimens confirmed by immunoblotting and/or culture. Test results were read at 5 min. Results: The assay LOD was a serum titer of 1:1000. No cross-reactivity was observed across the tested infectious and immunologic panels, and no interference was detected from anticoagulants or adverse sample conditions. Whole-blood testing showed no red blood cell interference. In clinical evaluation, sensitivity was 100.00% (48/48), specificity was 95.24% (200/210), and accuracy was 96.12%, with a PPV of 82.76% and an NPV of 100.00%. Conclusions: The Anti-Pin Antibody Test Strip provides rapid (5 min), operationally simple serodiagnosis and may support screening/triage of suspected pythiosis, particularly where laboratory methods are limited.