Endophthalmitis caused by Fusarium : An emerging problem in patients with corneal trauma. A case series

• Published in: Revista iberoamericana de micologia Vol. 35; no. 2; pp. 92 - 96
• Main Authors: Barrios Andrés, José Luis, López-Soria, Leyre Mónica, Alastruey Izquierdo, Ana, Echevarría Ecenarro, Jaime, Feijoó Lera, Raquel, Garrido Fierro, Jesus, Cabrerizo Nuñez, Francisco Javier, Canut Blasco, Andrés
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01-04-2018
• Subjects: Aged; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Coinfection - microbiology; Combined Modality Therapy; Contact lenses; Contact Lenses, Hydrophilic; Corneal Injuries - complications; Corneal Injuries - microbiology; Corneal trauma; Drug Resistance, Multiple, Fungal; Endoftalmitis; Endophthalmitis; Endophthalmitis - drug therapy; Endophthalmitis - etiology; Endophthalmitis - microbiology; Endophthalmitis - surgery; Eye Infections, Bacterial - etiology; Eye Infections, Bacterial - microbiology; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - etiology; Eye Infections, Fungal - microbiology; Eye Infections, Fungal - surgery; Female; Fusariosis - drug therapy; Fusariosis - etiology; Fusariosis - microbiology; Fusarium; Fusarium - isolation & purification; Fusarium oxysporum; Fusarium solani; Fusarium treatment; Humans; Infectious Disease; Keratoplasty; Keratoplasty, Penetrating; Lentes de contacto; Male; Middle Aged; Mycological Typing Techniques; Queratoplastia; Species Specificity; Staphylococcal Infections - microbiology; Tratamiento de Fusarium; Traumatismo corneal; Treatment Failure; Wound Infection - drug therapy; Wound Infection - microbiology; Fusarium oxysporum; Endophthalmitis; Endoftalmitis; Fusarium treatment; Corneal trauma; Lentes de contacto; Queratoplastia; Keratoplasty; Traumatismo corneal; Contact lenses; Fusarium; Fusarium solani; Tratamiento de Fusarium
• ISSN: 1130-1406; 2173-9188
• DOI: 10.1016/j.riam.2017.09.007

Abstract Background Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium -related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. Aims The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. Methods Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum , diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. Results Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. Conclusions It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection.