Review article Filamentous fungal infections of the cornea: a global overview of epidemiology and drug sensitivity L aszl  o Kredics, 1 Venkatapathy Narendran, 2 Coimbatore Subramanian Shobana, 3 Csaba V agv € olgyi, 1,4 Palanisamy Manikandan 2,5 and Indo-Hungarian Fungal Keratitis Working Group a 1 Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary, 2 Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India, 3 Department of Microbiology, PSG College of Arts & Science, Coimbatore, Tamil Nadu, India, 4 Botany and Microbiology Department, King Saud University, Riyadh, Kingdom of Saudi Arabia and 5 Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Kingdom of Saudi Arabia Summary Fungal keratitis is a serious suppurative, usually ulcerative corneal infection which may result in blindness or reduced vision. Epidemiological studies indicate that the occurrence of fungal keratitis is higher in warm, humid regions with agricultural economy. The most frequent filamentous fungal genera among the causal agents are Fusarium, Aspergillus and Curvularia. A more successful therapy of fungal keratitis relies on precise identification of the pathogen to the species level using molecular tools. As the sequence analysis of the internal transcribed spacer (ITS) region of the ribosomal RNA gene cluster (rDNA) is not discriminative enough to reveal a species- level diagnosis for several filamentous fungal species highly relevant in keratitis infections, analysis of other loci is also required for an exact diagnosis. Molecular identifications may also reveal the involvement of fungal species which were not previously reported from corneal infections. The routinely applied chemotherapy of fungal keratitis is based on the topical and systemic administration of polyenes and azole compounds. Antifungal susceptibility testing of the causal agents is of special importance due to the emergence and spread of resistance. Testing the applicability of further available antifungals and screening for new, potential compounds for the therapy of fungal keratitis are of highlighted interest. Key words: Eye infections, keratitis, Aspergillus, Fusarium, Curvularia, epidemiology, molecular identification, antifungal susceptibility. Introduction Fungal keratitis – or mycotic keratitis, keratomycosis – is becoming a frequent and serious suppurative, usually ulcerative corneal infection which may result in reduced vision or blindness. 1 Especially during the past few decades, the incidence of fungal keratitis has increased by several times, and hundreds of reports covering epidemiology, clinical data, case descriptions and research results appeared in the literature – par- ticularly from developing countries. Although yeast infections occur more frequently in mild climates, fila- mentous fungal aetiology is more common in tropical regions where it accounts for more than 50% of all corneal ulcers. 2,3 The epidemiological pattern of fungal keratitis varies widely throughout the world and even between regions of the same country. 4,5 Since the first report of fungal keratitis diagnosed in a farmer, 6 peo- ple involved in soil-related work such as agriculture Correspondence: L. Kredics, Department of Microbiology, Faculty of Science and Informatics, University of Szeged, K€ oz ep fasor 52, H-6726, Szeged, Hungary. Tel.: +36 62 544 516. Fax: +36 62 544 823. E-mail: kredics@bio.u-szeged.hu a Indo-Hungarian Fungal Keratitis (IHFK) Working Group authors are listed in the Appendix. Submitted for publication 21 December 2014 Revised 27 January 2015 Accepted for publication 13 February 2015 © 2015 Blackwell Verlag GmbH doi:10.1111/myc.12306 mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases