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    In vivo confocal microscopy ineffective for Fusarium and Aspergillus differentiation


    They found no significant different between the Fusarium and Aspergillus  groups in gender, ulcer stromal infiltrate size, presence or absence of diabetes mellitus, or prior use of topical antifungals or steroids.

    They did find that participants culture positive for Aspergillus had a median age of 54 years compared with 45 years for those culture positive for Fusarium. The Aspergillus patients had a median of 7 days of symptoms, versus 5 for the Fusarium patients. Of the Aspergillus patients, 80%  presented with ulcers involving the posterior third of the cornea, compared with 54% of Fusarium patients.

    The mean branching angle for filaments of Fusarium  was 59.7° (95% confidence interval (CI) 57.7° to 61.8 °), compared to 63.3° (95% CI 60.8° to 65.8°) for Aspergillus. The difference was not statistically significant at the 5% level in univariate analysis. After adjustment for age and gender, it became significant.

    In a multivariate analysis including the depth of the ulcer as well as age and gender, the branching angle for Aspergillus was 4.8° greater than for Fusarium (95% CI 1.0° to 8.5°, P = 0.012). The researcher also found that deeper ulcers had a branching angle of 4.0° smaller than all others (95% CI -0.3° to -7.7°, P = 0.034.)

    The branching angles from all species together were not significantly affected by symptom duration, presence of diabetes mellitus, ulcer size, or prior steroid or antifungal use.

    The researchers also found prior antifungal use caused a reduction in branch angle among Fusarium  patients of 5.9°. However, there was no significant effect of antifungal use on branch angle in Aspergillus.

    The researchers detected dichotomous branching in 7 ulcers in the Aspergillus group, and only 4 in the Fusarium group (25.9% versus 6.1%). They did not find any spores.

    The findings were consistent with histopathological reports, the researchers noted. One study found that 17% of tissue biopsy specimens diagnosed as Aspergillus based on histopathological appearance were actually culture positive for a variety of non-Aspergillus organisms including Fusarium.

    A study in tissue biopsies from infected burn wounds showed that 35% of those classified by histopathology as having hyphae consistent with Aspergillus were culture positive for other organisms.

    “In summary, we have found very little difference between the hyphal branching angle in IVCM images taken from culture positive Fusarium and Aspergillus spp ulcers,” the researchers concluded.

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