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Tuft S, Stone NRH, Burton MJ, Johnson EM, Borman AM. Antifungal susceptibility profiles for fungal isolates from corneas and contact lenses in the United Kingdom. Eye (Lond) 2024; 38:529-536. [PMID: 37684376 PMCID: PMC10858215 DOI: 10.1038/s41433-023-02719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To report the identification and results of susceptibility testing for fungal isolates from the cornea or contact lens care systems. MATERIALS AND METHODS In this retrospective epidemiological study, we searched the results of fungal cultures from cornea or contact lens systems referred for identification and susceptibility testing to the United Kingdom National Mycology Reference Laboratory between October 2016 and March 2022. For each fungal isolate, we recorded the genus and species of the fungus and the minimum inhibitory concentration (MIC) to six antifungal agents available to treat corneal infection (amphotericin, econazole, itraconazole, natamycin, posaconazole, and voriconazole). RESULTS There were 600 isolates from 585 patients, comprising 374 (62%) from corneal samples and 226 from contact lenses and care systems, of which 414 (69%) isolates were moulds (filamentous fungi) and 186 (31%) were yeasts. The most frequent moulds isolated were Fusarium spp (234 isolates, 39%) and Aspergillus spp (62, 10%). The most frequent yeasts isolated were Candida spp (112, 19%), predominantly Candida parapsilosis (65, 11%) and Candida albicans (33, 6%), with 35 isolates (6%) of Meyerozyma guilliermondii. In vitro susceptibility was greatest for natamycin (347 moulds tested, mode 4 mg/L, range 0.25-64 mg/L; 98 yeasts tested, mode 4 mg/L, range 0.5-32 mg/L), with susceptibility for 94% for moulds and 99% yeasts. Of the 16 isolates interpreted as highly resistant to natamycin (MIC ≥16 mg/L), 13 were Aspergillus flavus complex. CONCLUSIONS In vitro susceptibility supports the use of natamycin for the empiric treatment of fungal keratitis in the UK.
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Affiliation(s)
- Stephen Tuft
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
| | - Neil R H Stone
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Matthew J Burton
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Elizabeth M Johnson
- UK National Mycology Reference Laboratory, UK Health Security Agency South-West, Bristol, and MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Andrew M Borman
- UK National Mycology Reference Laboratory, UK Health Security Agency South-West, Bristol, and MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
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Knutsson KA, Rama P, Tombolini B, Di Biase C, Senni C, Buffoli F, Clementi N, Tonelli M, Carletti S, Mancini N, Ferrari G, Paganoni G, Bandello F. Beauveria bassiana Keratitis: A Case Series and Review of Literature. J Clin Med 2023; 12:7601. [PMID: 38137670 PMCID: PMC10744012 DOI: 10.3390/jcm12247601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Beauveria bassiana is a filamentous fungus commonly used as an insecticide that rarely causes keratitis. METHODS Patients affected by Beauveria bassiana keratitis were retrospectively recruited at San Raffaele Hospital (Milan, Italy) between 2020 and 2022. All subjects underwent comprehensive ophthalmic evaluation, including in vivo confocal microscopy (IVCM) and microbiologic examination of corneal scrapings. Beauveria bassiana was identified using 18S rDNA targeted PCR. RESULTS Four eyes of four patients (51 ± 8.8 years old) were evaluated. The main risk factors were soft contact lens wear (75%) and trauma with vegetative matter (50%). A superficial infiltrate was displayed in the majority of patients. Three cases (75%) showed hyphae on IVCM. All patients showed clinical improvement after topical antifungal therapy, although mostly through a combination of two antifungals (75%). One patient with a deeper infection required a systemic antifungal agent after one month of topical therapy. All cases required debridement to reduce the microbial load and enhance drug penetration. All patients experienced keratitis resolution following medical treatment (average: 3.3 months). CONCLUSIONS The identification of risk factors and the early diagnosis of Beauveria bassiana keratitis are fundamental in order to avoid its penetration in the deeper corneal stromal layers. Topical antifungal drugs, possibly accompanied by ulcer debridement, may be a successful treatment if instilled from the early phases of the disease.
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Affiliation(s)
- Karl Anders Knutsson
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Paolo Rama
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (P.R.); (C.D.B.)
| | - Beatrice Tombolini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Carlo Di Biase
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (P.R.); (C.D.B.)
| | - Carlotta Senni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Fabio Buffoli
- Laboratory of Medical Microbiology and Virology, University Vita-Salute San Raffaele, 20132 Milan, Italy; (F.B.); (N.C.); (S.C.)
| | - Nicola Clementi
- Laboratory of Medical Microbiology and Virology, University Vita-Salute San Raffaele, 20132 Milan, Italy; (F.B.); (N.C.); (S.C.)
- Laboratory of Medical Microbiology and Virology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Marco Tonelli
- Laboratory of Medical Microbiology and Virology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Silvia Carletti
- Laboratory of Medical Microbiology and Virology, University Vita-Salute San Raffaele, 20132 Milan, Italy; (F.B.); (N.C.); (S.C.)
| | - Nicasio Mancini
- Laboratory of Medical Microbiology and Virology, University of Insubria, 21100 Varese, Italy;
| | - Giulio Ferrari
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Giorgio Paganoni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (B.T.); (C.S.); (G.F.); (G.P.); (F.B.)
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Maldiney T, Garcia-Hermoso D, Sitterlé E, Chassot JM, Thouvenin O, Boccara C, Blot M, Piroth L, Quenot JP, Charles PE, Aimanianda V, Podac B, Boulnois L, Dalle F, Sautour M, Bougnoux ME, Lanternier F. Dynamic full-field optical coherence tomography for live-cell imaging and growth-phase monitoring in Aspergillus fumigatus. Front Cell Infect Microbiol 2023; 13:1183340. [PMID: 37502605 PMCID: PMC10369068 DOI: 10.3389/fcimb.2023.1183340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction The diagnosis of cutaneous manifestations of deep mycoses relies on both histopathological and direct examinations. Yet, the current diagnostic criteria cannot prevent missed cases, including invasive aspergillosis, which requires the development of a novel diagnostic approach and imaging tools. We recently introduced the use of dynamic full-field optical coherence tomography (D-FF-OCT) in fungal diagnostics with a definition approaching that of conventional microscopy and the ability to return metabolic information regarding different fungal species. The present work focuses on subcellular dynamics and live-cell imaging of Aspergillus fumigatus with D-FF-OCT to follow the fungal growth stages. Methods The A. fumigatus ATCC 204305 quality-control strain was used for all imaging experiments, following incubation times varying between 24 and 72 h at 30°C in a humidified chamber on Sabouraud dextrose agar. Fungal growth was subsequently monitored with D-FF-OCT for up to 5 h at room temperature and following the pharmacological stress of either voriconazole, amphotericin B, or caspofungin gradient concentration. Results D-FF-OCT images allow not only the visualization of intracellular trafficking of vacuoles but also an evolving dynamic segmentation of conidiophores depending on the chronological development and aging of the hyphae or the effect of antifungal treatment. The same applies to conidial heads, with the most intense D-FF-OCT signal coming from vesicles, revealing a changing dynamic within a few hours only, as well as complete extinction following subsequent drying of the Sabouraud dextrose agar. Discussion These results provide additional data on the ability of D-FF-OCT to monitor some of the main life cycle processes, dynamics, and intracellular trafficking of vacuoles in A. fumigatus, with or without the effect of pharmacological stress. Such complementary metabolic information could help both clinicians and microbiologists in either mechanistic studies toward experimental mycology or the development of a potential D-FF-OCT-guided diagnosis of superficial fungal infections.
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Affiliation(s)
- Thomas Maldiney
- Department of Intensive Care Medicine, William Morey General Hospital, Chalon-sur-Saône, France
- Lipness Team, Institut national de la santé et de la recherche médicale (INSERM) Research Centre Lipides, Nutrition, Cancer - Unité mixte de recherche (LNC-UMR)1231, University of Burgundy, Dijon, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, Université Paris Cité, National Reference Centre for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Emilie Sitterlé
- Centre hospitalier universitaire (CHU) Necker Enfants Malades, Assistance publique - Hôpitaux de Paris (AP-HP), Institut Pasteur, Paris, France
| | - Jean-Marie Chassot
- Institut Langevin, École supérieure de physique et de chimie industrielles de la ville de Paris (ESPCI) Paris, Paris Sciences & Lettres (PSL) University, Centre national de la recherche scientifique (CNRS), Paris, France
| | - Olivier Thouvenin
- Institut Langevin, École supérieure de physique et de chimie industrielles de la ville de Paris (ESPCI) Paris, Paris Sciences & Lettres (PSL) University, Centre national de la recherche scientifique (CNRS), Paris, France
| | - Claude Boccara
- Institut Langevin, École supérieure de physique et de chimie industrielles de la ville de Paris (ESPCI) Paris, Paris Sciences & Lettres (PSL) University, Centre national de la recherche scientifique (CNRS), Paris, France
| | - Mathieu Blot
- Lipness Team, Institut national de la santé et de la recherche médicale (INSERM) Research Centre Lipides, Nutrition, Cancer - Unité mixte de recherche (LNC-UMR)1231, University of Burgundy, Dijon, France
- Infectious Diseases Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Lionel Piroth
- Infectious Diseases Department, Dijon Bourgogne University Hospital, Dijon, France
- Institut national de la santé et de la recherche médicale (INSERM), CIC1432, Clinical Epidemiology Unit, Dijon, France
| | - Jean-Pierre Quenot
- Lipness Team, Institut national de la santé et de la recherche médicale (INSERM) Research Centre Lipides, Nutrition, Cancer - Unité mixte de recherche (LNC-UMR)1231, University of Burgundy, Dijon, France
- Institut national de la santé et de la recherche médicale (INSERM), CIC1432, Clinical Epidemiology Unit, Dijon, France
- Department of Intensive Care Medicine, Dijon Bourgogne University Hospital, Dijon, France
| | - Pierre-Emmanuel Charles
- Lipness Team, Institut national de la santé et de la recherche médicale (INSERM) Research Centre Lipides, Nutrition, Cancer - Unité mixte de recherche (LNC-UMR)1231, University of Burgundy, Dijon, France
- Department of Intensive Care Medicine, Dijon Bourgogne University Hospital, Dijon, France
| | | | - Bianca Podac
- Medical Biology Laboratory, William Morey General Hospital, Chalon-sur-Saône, France
| | - Léa Boulnois
- Medical Biology Laboratory, William Morey General Hospital, Chalon-sur-Saône, France
| | - Frédéric Dalle
- Department of Parasitology/Mycology, Dijon Bourgogne University Hospital, Dijon, France
- Unité Mixte de Recherche Procédés Alimentaires et Microbiologiques (UMR PAM) A 02.102 Procédés Alimentaires et Microbiologiques, Univ. Bourgogne Franche-Comté, AgroSup Dijon, Dijon, France
| | - Marc Sautour
- Department of Parasitology/Mycology, Dijon Bourgogne University Hospital, Dijon, France
- Unité Mixte de Recherche Procédés Alimentaires et Microbiologiques (UMR PAM) A 02.102 Procédés Alimentaires et Microbiologiques, Univ. Bourgogne Franche-Comté, AgroSup Dijon, Dijon, France
| | - Marie-Elisabeth Bougnoux
- Centre hospitalier universitaire (CHU) Necker Enfants Malades, Assistance publique - Hôpitaux de Paris (AP-HP), Institut Pasteur, Paris, France
- Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Unité sous contrat (USC) 2019, Unité Biologie et Pathogénicité Fongiques, Paris, France
| | - Fanny Lanternier
- Institut Pasteur, Université Paris Cité, National Reference Centre for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Filamentous Fungal Keratitis in Greece: A 16-Year Nationwide Multicenter Survey. Mycopathologia 2022; 187:439-453. [PMID: 36178544 DOI: 10.1007/s11046-022-00666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
In a multicenter, prospective study of filamentous fungal keratitis in Greece, predisposing factors, etiology, treatment practices, and outcome, were determined. Corneal scrapings were collected from patients with clinical suspicion of fungal keratitis, and demographic and clinical data were recorded. Fungal identification was based on morphology, molecular methods, and matrix assisted laser desorption ionization time-of-flight mass-spectrometry. A total of 35 cases were identified in a 16-year study period. Female to male ratio was 1:1.7 and median age 48 years. Corneal injury by plant material, and soft contact lens use were the main risk factors (42.8% and 31.4%, respectively). Trauma was the leading risk factor for men (68.1%), contact lens use (61.5%) for women. Fusarium species were isolated more frequently (n = 21, 61.8%). F. solani was mostly associated with trauma, F. verticillioides and F. proliferatum with soft contact lens use. Other fungi were: Purpureocillium lilacinum (14.7%), Alternaria (11.8%), Aspergillus (8.8%), and Phoma foliaceiphila, Beauveria bassiana and Curvularia spicifera, one case each. Amphotericin B and voriconazole MIC50s against Fusarium were 2 mg/L and 4 mg/L respectively. Antifungal therapy consisted mainly of voriconazole locally or both locally and systemically, alone or in combination with liposomal AmB. Cure/improvement rate with antifungal therapy alone was 52%, keratoplasty was required in 40% of cases, and enucleation in 8%. In conclusion, filamentous fungal keratitis in Greece is rare, but with considerable morbidity. A large proportion of cases resulted in keratoplasty despite appropriate antifungal treatment.Kindly confirm the given name and family name are correctly identified for all authros.ConfirmedJournal instruction requires a city and country for affiliations; however, these are missing in affiliations 1, 3, 4, 5, 6, 13. Please verify if the provided city and country are correct and amend if necessary.All provided cities and countries are correct.
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Jeang L, Tuli SS. Therapy for contact lens-related ulcers. Curr Opin Ophthalmol 2022; 33:282-289. [PMID: 35779052 DOI: 10.1097/icu.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy. RECENT FINDINGS Topical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise. SUMMARY Contact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.
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Affiliation(s)
- Lauren Jeang
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Bakken IM, Jackson CJ, Utheim TP, Villani E, Hamrah P, Kheirkhah A, Nielsen E, Hau S, Lagali NS. The use of in vivo confocal microscopy in fungal keratitis - Progress and challenges. Ocul Surf 2022; 24:103-118. [PMID: 35278721 DOI: 10.1016/j.jtos.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 01/02/2023]
Abstract
Fungal keratitis (FK) is a serious and sight-threatening corneal infection with global reach. The need for prompt diagnosis is paramount, as a delay in initiation of treatment could lead to irreversible vision loss. Current "gold standard" diagnostic methods, namely corneal smear and culture, have limitations due to diagnostic insensitivity and their time-consuming nature. PCR is a newer, complementary method used in the diagnosis of fungal keratitis, whose results are also sample-dependent. In vivo confocal microscopy (IVCM) is a promising complementary diagnostic method of increasing importance as it allows non-invasive real-time direct visualization of potential fungal pathogens and manifesting infection directly in the patient's cornea. In numerous articles and case reports, FK diagnosis by IVCM has been evaluated, and different features, approaches, sensitivity/specificity, and limitations have been noted. Here, we provide an up-to-date, comprehensive review of the current literature and present the authors' combined recommendations for fungal identification in IVCM images, while also looking to the future of FK assessment by IVCM using artificial intelligence methods.
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Affiliation(s)
- Ingvild M Bakken
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Catherine J Jackson
- Ifocus Eye Clinic, Haugesund, Norway; Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor P Utheim
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Edoardo Villani
- Department of Clinical Science and Community Health, University of Milan, Italy; Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Pedram Hamrah
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Esben Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Scott Hau
- Department of External Disease, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Neil S Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Division of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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