Abstract
We report a case of a keratitis associated with a Fusarium penzigii—a Fusarium dimerum species complex (FDSC)—in a 81-year-old woman after a corneal trauma with a tree branch. At patient admittance, slit lamp biomicroscopy revealed an exuberant chemosis, an inferior corneal ulcer with an associated inflammatory infiltrate, a central corneal abscess, bullous keratopathy and posterior synechiae. Corneal scrapes were obtained for identification of bacteria and fungi, and the patient started antibiotic treatment on empirical basis. Few days later, the situation worsened with the development of hypopyon. By that time, Fusarium was identified in cultures obtained from corneal scrapes and the patient started topical amphotericin B 0.15 %. Upon the morphological identification of the Fusarium as a FDSC, and since there was no clinical improvement, the treatment with amphotericin B was suspended and the patient started voriconazole 10 mg/ml, eye drops, hourly and voriconazole 200 mg iv, every 12 h for 1 month. The hypopyon resolved and the inflammatory infiltrate improved, but the abscess persisted at the last follow-up visit. The molecular identification revealed that the FDSC was a F. penzigii.
References
Weiner G. Confronting corneal ulcers. Eyenet. 2012;44–52.
Ho JW, Fernandez MM, Rebong RA, Carlson AN, Kim T, Afshari NA. Microbiological profiles of fungal keratitis: a 10-year study at a tertiary referral center. J Ophthalmic Inflam Infect. 2016;6:5.
Thomas PA. Current perspectives on ophthalmic mycoses current perspectives on ophthalmic mycoses. Clin Microbiol Rev. 2003;16:730–97.
Dalmon C, Porco TC, Lietman TM, Venkatesh Prajna N, Prajna L, Das MR, et al. The clinical differentiation of bacterial and fungal keratitis: a photographic survey. Investig Ophthalmol Vis Sci. 2012;53:1787–91.
Florcruz NV, Peczon IV, Evans JR. Medical interventions for fungal keratitis. Cochrane Database Syst Ver. 2012;2:CD004241.
Azor M, Gené J, Cano J, Manikandan P, Venkatapathy N, Guarro J. Less-frequent Fusarium species of clinical interest: correlation between morphological and molecular identification and antifungal susceptibility. J Clin Microbiol. 2009;47:1463–8.
Hassan AS, Al-Hatmi AMS, Shobana CS, van Diepeningen AD, Kredics L, Vágvölgyi C, et al. Antifungal susceptibility and phylogeny of opportunistic members of the genus Fusarium causing human keratomycosis in South India. Med Mycol. 2016;54:287–94.
Al-Hatmi AMS, Meis JF, de Hoog GS. Fusarium: molecular diversity and intrinsic drug resistance. PLoS Pathog. 2016;12:e1005464.
Ansari Z, Miller D, Galor A. Current thoughts in fungal keratitis: diagnosis and treatment. Curr Fungal Infect Rep. 2013;7:209–18.
van Diepeningen AD, Al-Hatmi AMS, Brankovics B, de Hoog GS. Taxonomy and clinical spectra of fusarium species: where do we stand in 2014? Curr Clin Microbiol Rep. 2014;1:10–8.
Oechsler RA, Feilmeier MR, Ledee DR, Miller D, Diaz MR, Fini ME, et al. Utility of molecular sequence analysis of the its rrna region for identification of fusarium spp. from ocular sources. Investig Ophthalmol Vis Sci. 2009;50:2230–6.
Balajee SA, Borman AM, Brandt ME, Cano J, Cuenca-Estrella M, Dannaoui E, et al. Sequence-based identification of aspergillus, fusarium, and mucorales species in the clinical mycology laboratory: where are we and where should we go from here? J Clin Microbiol. 2009;47:877–84.
Schroers H-J, O’Donnell K, Lamprecht SC, Kammeyer PL, Johnson S, Sutton DA, et al. Taxonomy and phylogeny of the Fusarium dimerum species group. Mycologia. 2009;101:44–70.
Vismer HF, Marasas WFO, Rheeder JP, Joubert JJ. Fusarium dimerum as a cause of human eye infections. Med Mycol. 2002;40:399–406.
Kanafani ZA, Perfect JR. Resistance to antifungal agents: mechanisms and clinical impact. Clin Infect Dis. 2008;46:120–8.
Alastruey-Izquierdo A, Cuenca-Estrella M, Monzón A, Mellado E, Rodríguez-Tudela JL. Antifungal susceptibility profile of clinical Fusarium spp. isolates identified by molecular methods. J Antimicrob Chemother. 2008;61:805–9.
Mascarenhas J, Lalitha P, Prajna NV, Srinivasan M, Das M, D’Silva SS, et al. Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features. Am J Ophthalmol. 2014;157:56–62.
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do Carmo, A., Costa, E., Marques, M. et al. Fusarium dimerum Species Complex (Fusarium penzigii) Keratitis After Corneal Trauma. Mycopathologia 181, 879–884 (2016). https://doi.org/10.1007/s11046-016-0060-1
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DOI: https://doi.org/10.1007/s11046-016-0060-1