Fusarium Keratitis in Germany

Abstract

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.

Epidemiology and Clinical Management of Fusarium keratitis in the Netherlands, 2005–2016

“…We acknowledge that our estimate is prone to bias as we lack a reliable denominator and practices of sending fungal isolates to the mycology reference laboratory might have changed over time. However, our observation is in keeping with a general increase of keratitis cases and reports of increasing fungal keratitis cases in other countries such as the USA, Denmark and Germany (Jurkunas et al, 2009;Nielsen et al, 2015;Walther et al, 2017). Furthermore, one previous study indicated that the incidence of fungal keratitis was very low before 2010 in the Netherlands (Cheng et al, 1999).…”

“…As filamentous fungi cannot penetrate intact cornea, the most common route of infection is through (micro) trauma or disruptive ocular surface disease. Several epidemiological studies indicate that the frequency of Fusarium keratitis may be increasing (Cheng et al, 1999;Stapleton et al, 2008Stapleton et al, , 2012Jurkunas et al, 2009;Nielsen et al, 2015;Walther et al, 2017). Based on a perceived increase of ocular Fusarium isolates sent to the Dutch mycology reference laboratory (Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, the Netherlands) for identification and in vitro susceptibility testing, a national survey was initiated.…”

Burden of serious fungal infections in the Netherlands

“…Interestingly, the incidence of Fusarium keratitis has been increasing over the years and 15‐25 annual cases were found in 2014 to 2016 19 . Similar trends are seen in Germany 45 . Thus, the estimated incidence of 8 may underestimate the current incidence of Fusarium keratitis.…”

Mikrobielle Keratitis, Teil 1: allgemeine Aspekte und bakterielle Keratitiden

“…Das klassische Keimspektrum KL-assoziierter Keratitiden umfasst in absteigender Häufigkeit [2,5,8,16] Zudem verfügen einige Bakterien und Pilze (z. B. Candida spp.)…”