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Meta-Analysis
. 2021 Aug 26:11:698780.
doi: 10.3389/fcimb.2021.698780. eCollection 2021.

Distribution, Prevalence, and Causative Agents of Fungal Keratitis: A Systematic Review and Meta-Analysis (1990 to 2020)

Kazem Ahmadikia  1 , Sanaz Aghaei Gharehbolagh  1 , Bahareh Fallah  2 , Mahsa Naeimi Eshkaleti  1   3 , Pooneh Malekifar  4 , Saeedeh Rahsepar  2 , Muhammad I Getso  5 , Savitri Sharma  6 , Shahram Mahmoudi  7
Affiliations
Meta-Analysis

Distribution, Prevalence, and Causative Agents of Fungal Keratitis: A Systematic Review and Meta-Analysis (1990 to 2020)

Kazem Ahmadikia et al. Front Cell Infect Microbiol. .

Abstract

Objectives: This study aims to provide an overview of the prevalence, distribution, and causative agents of fungal keratitis.

Methods: All the articles with data on the prevalence of fungal keratitis among various patient groups from January 1, 1990 to May 27, 2020 were retrieved through a systematic search in PubMed, Scopus, Web of Science, and Google Scholar. Data were extracted, and the pooled estimated prevalence of fungal keratitis, yeast/mold infection, the spectrum and frequency of various causative agents, and the pooled estimated prevalence of mixed infections were calculated in general and in various countries (wherever possible) using meta-analysis.

Results: From 11,235 articles retrieved in the primary search step, 169 met the inclusion criteria. The 169 eligible articles were divided into six groups and analyzed separately. The pooled prevalence of fungal keratitis was variable with values ranging from 0.05% among postkeratoplasty patients to 43.01% among patients with a clinical suspicion of fungal keratitis. There was also a country-dependent variation in the prevalence (Paraguay: 50.1% (95% CI, 35.11, 65.00); Ireland: 1.1% (95% CI, 0.03, 6.04)). Except for postkeratoplasty cases (yeast: 51.80%), in all patient groups, molds were more common than yeasts. Although more than 50 distinct species of fungi have been found to cause fungal keratitis, Fusarium species followed by Aspergillus species were the most common causes of the disease. In general, 9.29% (95% CI, 6.52, 12.38) of fungal keratitis cases were mixed with bacterial agents.

Conclusion: The prevalence of fungal keratitis can vary dramatically depending on the patient groups and geographical origin; however, the dominant causative agents are generally similar.

Keywords: Aspergillus; Fusarium; corneal ulcer; fungal keratitis; keratomycosis; meta-analysis; yeasts.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The PRISMA flow diagram of selecting studies reporting data on the prevalence of fungal keratitis between January 1, 1990 and May 27, 2020.
Figure 2
Figure 2
The forest plot of the prevalence of fungal keratitis among patients with a clinical suspicion of microbial keratitis based on the reported articles between January 1, 1990 and May 27, 2020.
See this image and copyright information in PMC

References

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