Abstract
We report two cases of Fusarium keratomycosis in which molecular analysis was used to identify two rare causative Fusarium species. A 65-year-old woman was diagnosed with Fusarium keratomycosis caused by F. equiseti, confirmed by sequencing the internal transcribed spacer (ITS) region and morphological characteristics. She was initially treated with topical corticosteroid but the keratitis did not improve. Even after aggressive antifungal treatment, there was a severe reduction of vision. In the end, the eye perforated. Our second case was a 75-year-old man who had diabetes mellitus. He developed keratitis after his cornea was injured by corn stalks. The ITS region identified the causative organism as F. verticillioides. Unlike the first case, he had good visual recovery after early antifungal therapy. Our findings demonstrate that both ITS and morphological characteristics can be used to identify the exact Fusarium species causing Fusarium keratomycosis. This allowed us to determine the sensitivity of these species to antifungal drugs that can be used to treat patients with these species of Fusarium.
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References
Alfonso EC, Cantu-Dibildox J, Munir WM, Miller D, O’Brien TP, Karp CL, et al. Insurgence of Fusarium keratitis associated with contact lens wear. Arch Ophthalmol. 2006;124:941–7.
Zapater RC, Arrechea A. Mycotic keratitis by Fusarium. A review and report of two cases. Ophthalmologica. 1975;170:1–12.
Naiker S, Odhav B. Mycotic keratitis: profile of Fusarium species and their mycotoxins. Mycoses. 2004;47:50–6.
Garg P, Gopinathan U, Choudhary K, Rao GN. Keratomycosis: clinical and microbiologic experience with dematiaceous fungi. Ophthalmology. 2000;107:574–80.
Nelson PE, Tousson TA, Murasas WFO. Fusarium species: all illustrated manual for identification. University Park: Pennsylvania State University Press; 1983.
Ferrer C, Colom F, Frasés S, Mulet E, Abad JL, Alió JL. Detection and identification of fungal pathogens by PCR and by ITS2 and 5.8S ribosomal DNA typing in ocular infections. J Clin Microbiol. 2001;39:2873–9.
O’Donnell K, Sutton DA, Rinaldi MG, Gueidan C, Crous PW, Geiser DM. Novel multilocus sequence typing scheme reveals high genetic diversity of human pathogenic members of the Fusarium incarnatum–F. equiseti and F. chlamydosporum species complexes within the United States. J Clin Microbiol. 2009;47:3851–61.
Sugiuraa Y, Barrb JR, Barrb DB, Brockb JW, Eliec CM, Uenoa Y, et al. Physiological characteristics and mycotoxins of human clinical isolates of Fusarium species. Mycol Res. 1999;103:1462–8.
Guarro J, Nucci M, Akiti T, Gené J, Barreiro MD, Gonçalves RT. Fungemia due to Fusarium sacchari in an immunosuppressed patient. J Clin Microbiol. 2000;38:419–21.
Manzouri B, Vafidis GC, Wyse RK. Pharmacotherapy of fungal eye infections. Expert Opin Pharmacother. 2001;2:1849–57.
Proença-Pina J, Ssi Yan Kai I, Bourcier T, Fabre M, Offret H, Labetoulle M. Fusarium keratitis and endophthalmitis associated with lens contact wear. Int Ophthalmol. 2010;30:103–7.
Sekhon AS, Padhye AA, Garg AK, Ahmad H, Moledina N. In vitro sensitivity of medically significant Fusarium species to various antimycotics. Chemotherapy. 1994;40:239–44.
Reuveni R. Fusarium equiseti—a new cause of cumin spice plant wilt in Israel. Plant Dis. 1982;66:498–9.
Verma J, Sridhara S, Rai D, Gangal SV. Isolation and immunobiochemical characterization of a major allergen (65 kDa) from Fusarium equiseti. Allergy. 1998;53:311–5.
Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years’ experience at a cancer center and implications for management. Blood. 1997;90:999–1008.
Wu TG, Keasler VV, Mitchell BM, Wilhelmus KR. Immunosuppression affects the severity of experimental Fusarium solani keratitis. J Infect Dis. 2004;190:192–8.
Kalavathy CM, Parmar P, Kaliamurthy J, Philip VR, Ramalingam MD, Jesudasan CA, Thomas PA. Comparison of topical itraconazole 1% with topical natamycin 5% for the treatment of filamentous fungal keratitis. Cornea. 2005;24:449–52.
Tu EY, McCartney DL, Beatty RF, Springer KL, Levy J, Edward D. Successful treatment of resistant ocular fusariosis with posaconazole (SCH-56592). Am J Ophthalmol. 2007;143:222–7.
Jurjevic Z, Wilson DM, Wilson JP, Geiser DM, Juba JH, Mubatanhema W, et al. Fusarium species of the Gibberella fujikuroi complex and fumonisin contamination of pearl millet and corn in Georgia, USA. Mycopathologia. 2005;159:401–6.
Dornbusch HJ, Buzina W, Summerbell RC, Lass-Flörl C, Lackner H, Schwinger W, et al. Fusarium verticillioides abscess of the nasal septum in an immunosuppressed child: case report and identification of the morphologically atypical fungal strain. J Clin Microbiol. 2005;43:1998–2001.
Tezcan G, Ozhak-Baysan B, Alastruey-Izquierdo A, Ogunc D, Ongut G, Yildiran ST, et al. Disseminated fusariosis caused by Fusarium verticillioides in an acute lymphoblastic leukemia patient after allogeneic hematopoietic stem cell transplantation. J Clin Microbiol. 2009;47:278–81.
Lalitha P, Shapiro BL, Srinivasan M, Prajna NV, Acharya NR, Fothergill AW, et al. Antimicrobial susceptibility of Fusarium, Aspergillus, and other filamentous fungi isolated from keratitis. Arch Ophthalmol. 2007;125:789–93.
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Mochizuki, K., Shiraki, I., Murase, H. et al. Identification and sensitivity of two rare fungal species isolated from two patients with Fusarium keratomycosis. J Infect Chemother 18, 939–944 (2012). https://doi.org/10.1007/s10156-012-0389-4
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DOI: https://doi.org/10.1007/s10156-012-0389-4