Fusarium Keratitis in Germany

Author:

Walther Grit1,Stasch Serena1,Kaerger Kerstin1,Hamprecht Axel2,Roth Mathias3,Cornely Oliver A.456,Geerling Gerd3,Mackenzie Colin R.7,Kurzai Oliver18,von Lilienfeld-Toal Marie19

Affiliation:

1. National Reference Center for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany

2. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital, Cologne, Cologne, Germany

3. Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

4. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany

5. Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany

6. German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany

7. Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine University, Düsseldorf, Germany

8. University of Würzburg, Institute for Hygiene and Microbiology, Würzburg, Germany

9. University Hospital Jena, Department of Haematology and Medical Oncology, Jena, Germany

Abstract

ABSTRACT Fusarium keratitis is a destructive eye infection that is difficult to treat and results in poor outcome. In tropical and subtropical areas, the infection is relatively common and associated with trauma or chronic eye diseases. However, in recent years, an increased incidence has been reported in temperate climate regions. At the German National Reference Center, we have observed a steady increase in case numbers since 2014. Here, we present the first German case series of eye infections with Fusarium species. We identified Fusarium isolates from the eye or eye-related material from 22 patients in 2014 and 2015. Thirteen isolates belonged to the Fusarium solani species complex (FSSC), 6 isolates belonged to the Fusarium oxysporum species complex (FOSC), and three isolates belonged to the Fusarium fujikuroi species complex (FFSC). FSSC was isolated in 13 of 15 (85%) definite infections and FOSC in 3 of 4 (75%) definite contaminations. Furthermore, diagnosis from contact lens swabs or a culture of contact lens solution turned out to be highly unreliable. FSSC isolates differed from FOSC and FFSC by a distinctly higher MIC for terbinafine. Outcome was often adverse, with 10 patients requiring keratoplasty or enucleation. The use of natamycin as the most effective agent against keratitis caused by filamentous fungi was rare in Germany, possibly due to restricted availability. Keratitis caused by Fusarium spp. (usually FSSC) appears to be a relevant clinical problem in Germany, with the use of contact lenses as the predominant risk factor. Its outcome is often adverse.

Funder

Robert-Koch-Institute

Janssen-Cilag

Amplyx

Basilea

Cidara

F2G

Matinas

Scynexis

Vical

Gilead Sciences

Astellas Pharma

Pfizer

Merck & Co., Inc. | Merck Sharp and Dohme

Celgene

Publisher

American Society for Microbiology

Subject

Microbiology (medical)

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