Fusarium Keratitis in Germany

• Published in: Journal of clinical microbiology Vol. 55; no. 10; pp. 2983 - 2995
• Main Authors: Walther, Grit, Stasch, Serena, Kaerger, Kerstin, Hamprecht, Axel, Roth, Mathias, Cornely, Oliver A, Geerling, Gerd, Mackenzie, Colin R, Kurzai, Oliver, von Lilienfeld-Toal, Marie
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 01-10-2017
• Subjects: Adult; Antifungal Agents - therapeutic use; Contact Lenses - microbiology; Cornea - microbiology; Endophthalmitis - drug therapy; Endophthalmitis - epidemiology; Endophthalmitis - microbiology; Female; Fusariosis - drug therapy; Fusariosis - epidemiology; Fusariosis - microbiology; Fusarium - classification; Fusarium - drug effects; Fusarium - isolation & purification; Germany - epidemiology; Humans; Keratitis - drug therapy; Keratitis - epidemiology; Keratitis - microbiology; Male; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Mycological Typing Techniques; Mycology; Naphthalenes - therapeutic use; Natamycin - therapeutic use; Terbinafine; Treatment Outcome; Fusarium; antifungal susceptibility testing; fungal keratitis; contact lens
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/JCM.00649-17

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
species. We identified
isolates from the eye or eye-related material from 22 patients in 2014 and 2015. Thirteen isolates belonged to the
species complex (FSSC), 6 isolates belonged to the
species complex (FOSC), and three isolates belonged to the
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
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.