Contact Lens-Associated Fusarium Keratitis in Switzerland

Kaufmann, C.; Frueh, B. E.; Messerli, J.; Bernauer, Wolfgang; Thiel, Michael

doi:10.1055/s-2008-1027357

Cited by 18 publications

(11 citation statements)

References 12 publications

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“…Another theory suggests disinfection efficacy is degraded by high temperature storage, especially since the balance of cases was sourced to a single production/ distribution channel 26. A lower, but significant number of cases were also seen, however, in other geographic areas, including Europe 27, 28. Interestingly, compliance with contact lens hygiene is universally, repeatably poor even among healthy controls9, 29 and cannot change at the population level to cause an outbreak, yet contact lens-related Fusarium keratitis was rare prior to the introduction of Renu with MoistureLoc to the market 9.…”

Section: Proposed Pathogenesis Of Contact-lens Related Atypical Keratmentioning

confidence: 99%

Recent Outbreaks of Atypical Contact Lens-Related Keratitis: What Have We Learned?

Joslin

2010

American Journal of Ophthalmology

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Purpose-To examine the public health implications of two recent outbreaks of atypical contact lens-related infectious keratitis.Design-A perspective based on the literature and authors' experience.Results-The contact lens-related fusarium and acanthamoeba keratitis outbreaks were both detected by dramatic rises seen in tertiary care centers in Singapore and the US, respectively. Case control studies in both outbreaks each were able to identify a strong association with the use of different contact lens disinfection solutions. Their respective recalls resulted in a steep decline of fusarium keratitis, but not of acanthamoeba keratitis. Early investigations into each solution association implicate components not directly related to their primary disinfectant, but the true pathogenesis remains unknown. However, the number of Acanthamoeba cases individually attributed to each of almost all available disinfection systems exceeds previously understood total US incidence, suggesting other risk factors. Current standards do not require demonstration of anti-acanthamoebal activity. Yet, despite the inclusion of fusarium in mandatory testing for solutions, current pre-market testing was not predictive of the outbreak.Conclusions-The two recent outbreaks of atypical contact-lens related keratitis have reinforced the value of tertiary care eye care centers in detecting early rises in rare infections and the power of adaptable, well-designed epidemiologic investigations. While fusarium keratitis has significantly declined with the recall of Renu with Moistureloc, the persistence of Acanthamoeba keratitis begs fundamental changes in contact lens hygiene practices, inclusion of acanthamoeba as a test organism and contact lens disinfectant test regimens for all contact lens-related pathogens which are verifiably reflective of end user contact lens wear complications.

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Section: Proposed Pathogenesis Of Contact-lens Related Atypical Keratmentioning

confidence: 99%

Recent Outbreaks of Atypical Contact Lens-Related Keratitis: What Have We Learned?

Joslin

2010

American Journal of Ophthalmology

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“…Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre Pilzkeratitiden: ein 6-Jahres-Rückblick an einem tertiären Hornhautzentrum Background Fungal keratitis is relatively uncommon in developed countries [1], but it appears to have become more frequent in recent years with increasing proportions of filamentous fungi and an increasing percentage of contact lens usage as a predisposing factor [2]. In an earlier Swiss multicentre review, we reported a distinct increase in contact lens-associated Fusarium keratitis that might have occurred even before the Fusarium outbreaks in 2005 and 2006, respectively [3]. Given that fungal keratitis represents a diagnostic and therapeutic challenge, it is important to be aware of the current manifestations of this sight-threatening disease.…”

mentioning

confidence: 95%

Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre

Iselin

Baenninger

Schmittinger-Zirm

et al. 2017

Klin Monatsbl Augenheilkd

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This review reports the epidemiology, laboratory results, treatment regimens and costs of fungal keratitis at a tertiary referral center in Lucerne, Switzerland. Culture-proven fungal infections between January 2010 and December 2015 were reviewed retrospectively. Seventeen patients with a mean age of 52 years were identified. Contact lens wear was the most important risk factor (n = 11) (65 % of all cases), with filamentous fungi being identified as the most common fungus type (n = 10) (91 % of all cases of contact lens-associated fungal keratitis). All non-contact lens-associated fungal infections (n = 6) (35 % of all cases) were related to Six patients (35 %) were treated on an outpatient basis; 11 cases (65 %) required hospitalisation. Systemic voriconazole was the treatment regimen prescribed most often (n = 12) (71 %), followed by topical natamycin 5 % (n = 11) (65 %). Corneal crosslinking and penetrating keratoplasty were required in 4 cases each (24 %). One case ended up in enucleation (6 %). Average costs per case were EUR 15 952 for hospitalised patients if surgical intervention was required, and EUR 7415 if no intervention was performed. Average costs for outpatients were EUR 7079. In a majority of cases, visual acuity could be improved (n = 9) (53 %) or preserved (n = 2) (12 %). Despite the relatively low incidence of culture-proven keratitis (17 cases in 6 years), a clear pattern with regard to risk factors and fungus species was noted. In the absence of a gold standard for the treatment of fungal keratitis, the combination of systemic voriconazole and topical natamycin seems to be one of the most commonly used antifungal treatment regimens. The costs of outpatient versus inpatient non-surgical treatment were approximately the same.

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“…after heating the cleaning solution ReNu with MoistureLoc (Bausch & Lomb) (9). The highest numbers of cases were noted in Hong Kong (10), Singapore (11), and the United States (12,13), but European cases also associated with the ReNu WML solution have been reported (14)(15)(16)(17). Independent of this outbreak, a general increase in fungal keratitis cases has been observed recently in countries with temperate climates, mostly due to an increase in keratitis caused by filamentous fungi (18), probably associated with the use of contact lenses.…”

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confidence: 99%

Fusarium Keratitis in Germany

et al. 2017

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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.

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Contact Lens-Associated Fusarium Keratitis in Switzerland

Abstract: Exposure to ReNu with MoistureLoc is not the only risk factor for Fusarium keratitis. In addition to antifungal therapy, an early keratoplasty with excision of the infected tissue seems mandatory to improve prognosis.

Cited by 18 publications

References 12 publications

Recent Outbreaks of Atypical Contact Lens-Related Keratitis: What Have We Learned?

Recent Outbreaks of Atypical Contact Lens-Related Keratitis: What Have We Learned?

Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre

Fusarium Keratitis in Germany

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