Abstract
IntroductionFusarium keratitis is a severe corneal infection that is usually seen in tropical and subtropical countries after a corneal trauma. In 2005–2006, an epidemic of Fusarium keratitis, occurring predominantly among contact lens wearers, was observed in several countries. Case report We describe the clinical course of a Fusarium keratitis which failed to respond to systemic and local voriconazole treatment, and experienced a progression to a severe keratitis with endophthalmitis, requiring early therapeutic keratoplasty (“à chaud”). After 8 months of follow up, the vision recovered to 20/50. Discussion After the 2005–2006 worldwide epidemics, case–control studies pointed out that a new lens care solution, ReNu with MoistureLoc® (Bausch & Lomb™), was likely responsible of numerous cases. Complementary studies underlined that this infection mostly concerned non-compliant patients, i.e., those reusing the solution several times, since this results in a decrease of the antifungal activity due to the uptake of the biguanides into the lens. ConclusionFusarium endophtalmitis can result in a devastating disease with a poor visual outcome. An initial antifungal dual therapy may control the infection. In case of failure, an early keratoplasty may be mandatory. For contact lens wearers, education on sanitary good practice is necessary to avoid new epidemics in the future.
References
Cheng KH, Leung SL, Hoekman HW et al (1999) Incidence of contact-lens-associated microbial keratitis and its related morbidity. Lancet 354:181–185. doi:10.1016/S0140-6736(98)09385-4
Schein OD, Ormerod LD, Barraquer E et al (1989) Microbiology of contact lens-related keratitis. Cornea 8:281–285. doi:10.1097/00003226-198912000-00011
Iyer SA, Tuli SS, Wagoner RC (2006) Fungal keratitis: emerging trends and treatment outcomes. Eye Contact Lens 32:267–271. doi:10.1097/01.icl.0000249595.27520.2e
Bharathi MJ, Ramakrishnan R, Meenakshi R et al (2007) Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol 14:61–69. doi:10.1080/09286580601001347
Mah-Sadorra JH, Yavuz SG, Najjar DM et al (2005) Trends in contact lens-related corneal ulcers. Cornea 24:51–58. doi:10.1097/01.ico.0000138839.29823.57
Rosa RH Jr, Miller D, Alfonso EC (1994) The changing spectrum of fungal keratitis in south Florida. Ophthalmology 101:1005–1013
Alfonso EC, Cantu-Dibildox J, Munir WM et al (2006) Insurgence of Fusarium keratitis associated with contact lens wear. Arch Ophthalmol 124:941–947. doi:10.1001/archopht.124.7.ecs60039
Bernal MD, Acharya NR, Lietman TM et al (2006) Outbreak of Fusarium keratitis in soft contact lens wearers in San Francisco. Arch Ophthalmol 124:1051–1053. doi:10.1001/archopht.124.7.ecr60006
Chang DC, Grant GB, O’donnell K et al (2006) Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 296:953–963. doi:10.1001/jama.296.8.953
Cohen EJ (2006) Fusarium keratitis associated with soft contact lens wear. Arch Ophthalmol 124:1183–1184. doi:10.1001/archopht.124.8.1183
Epstein A (2007) Recent Fusarium outbreak. Eye Contact Lens 33:54. doi:10.1097/ICL.0b013e31802e6236
Khor WB, Aung T, Saw SM et al (2006) An outbreak of Fusarium keratitis associated with contact lens wear in Singapore. JAMA 295:2867–2873. doi:10.1001/jama.295.24.2867
Rosenberg KD, Flynn HW Jr, Alfonso EC, Miller D (2006) Fusarium endophthalmitis following keratitis associated with contact lenses. Ophthalmic Surg Lasers Imaging 37:310–313
Sugar J (2006) The contact lens/fusarium “outbreak”. Am J Ophthalmol 142:146. doi:10.1016/j.ajo.2006.04.026
Levy B, Heiler D, Norton S (2006) Report on testing from an investigation of fusarium keratitis in contact lens wearers. Eye Contact Lens 32:256–261. doi:10.1097/01.icl.0000245556.46738.14
Rosenthal RA, McDonald MM, Schlitzer RL et al (1997) Loss of bactericidal activity from contact lens storage solutions. CLAO J 23:57–62
Centers for Disease Control & Prevention (CDC) (2006) Update: fusarium keratitis—United States, 2005–2006. MMWR Morb Mortal Wkly Rep 55:563–564
Rosenthal RA, Dassanayake NL, Schlitzer RL et al (2006) Biocide uptake in contact lenses and loss of fungicidal activity during storage of contact lenses. Eye Contact Lens 32:262–266. doi:10.1097/ICL.0b013e31802b413f
Marangon FB, Miller D, Giaconi JA, Alfonso EC (2004) In vitro investigation of voriconazole susceptibility for keratitis and endophthalmitis fungal pathogens. Am J Ophthalmol 137:820–825. doi:10.1016/j.ajo.2003.11.078
Hariprasad SM, Mieler WF, Holz ER et al (2004) Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol 122:42–47. doi:10.1001/archopht.122.1.42
Sponsel WE, Graybill JR, Nevarez HL, Dang D (2002) Ocular and systemic posaconazole (SCH-56592) treatment of invasive Fusarium solani keratitis and endophthalmitis. Br J Ophthalmol 86:829–830. doi:10.1136/bjo.86.7.829-a
Tu EY, McCartney DL, Beatty RF et al (2007) Successful treatment of resistant ocular fusariosis with posaconazole (SCH-56592). Am J Ophthalmol 143:222–227. doi:10.1016/j.ajo.2006.10.048
Mahmoud YA (2007) In vitro and in vivo antifungal activity of cetrimide (cetyltrimethyl ammonium bromide) against fungal keratitis caused by Fusarium solani. Mycoses 50:64–70. doi:10.1111/j.1439-0507.2006.01313.x
Lalitha P, Shapiro BL, Srinivasan M et al (2007) Antimicrobial susceptibility of Fusarium, Aspergillus, and other filamentous fungi isolated from keratitis. Arch Ophthalmol 125:789–793. doi:10.1001/archopht.125.6.789
Nelson PE, Dignani MC, Anaissie EJ (1994) Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev 7:479–504
Dursun D, Fernandez V, Miller D, Alfonso EC (2003) Advanced fusarium keratitis progressing to endophthalmitis. Cornea 22:300–303. doi:10.1097/00003226-200305000-00004
Nelson PE, Dignani MC, Anaissie EJ (1994) Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev 7:479–504
Brasnu E, Bourcier T, Dupas B et al (2007) In vivo confocal microscopy in fungal keratitis. Br J Ophthalmol 91:588–591. doi:10.1136/bjo.2006.107243
Ti SE, Scott JA, Janardhanan P, Tan DT (2007) Therapeutic keratoplasty for advanced suppurative keratitis. Am J Ophthalmol 143:755–762. doi:10.1016/j.ajo.2007.01.015
Acknowledgments
Thanks to Dr Antoine Labbe and to Miss Beatrice Dupas for imaging with the confocal microscopy HRTII (Quinze-Vingts National Center of Ophthalmology, Department of Ophthalmology III, Christophe Baudouin).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Proença-Pina, J., Ssi Yan Kai, I., Bourcier, T. et al. Fusarium keratitis and endophthalmitis associated with lens contact wear. Int Ophthalmol 30, 103–107 (2010). https://doi.org/10.1007/s10792-008-9290-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-008-9290-7