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Albasheer O, Gosadi IM, Abuallut I, Khawaji FF, Almalki AJ, Muqanna AK, Otaif AA, Abdali MM, Almukhashi AM, Refaie KM. Awareness and Hygiene Practices Among Contact Lens Wearers: A Population-Based Cross-Sectional Survey. Cureus 2024; 16:e54723. [PMID: 38523955 PMCID: PMC10960920 DOI: 10.7759/cureus.54723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Background More than 150 million individuals worldwide wear contact lenses (CL) for therapeutic as well as cosmetic purposes. Researchers have linked failure to adhere to CL care instructions with outbreaks of serious eye infections. In the current study, we assess the consequences of inadequate cleanliness as well as awareness of and adherence to appropriate CL hygiene. Methods This is a cross-sectional descriptive study conducted in the Jazan region, southwest Saudi Arabia, during the period between October 2022 and April 2023. Results Out of a total of 718 participants, 391 (54.4%) were wearing CL. Of these, 318 (81.33%) CL wearers were female, while 73 (18.67%) were male. Among the CL wearers, 196 (50%) were aged 24 and younger. The overall knowledge was higher in females, with 320 (74.6%) having a high level of knowledge, compared to 195 (67.5%) males (p-value = 0.044). The level of knowledge was higher in those who had had an eye examination before using CL. Regarding practice, 202 (63.5%) females demonstrated better practices, while only 32 (43.8%) males did (p-value = 0.002). Variations in the adequacy of practice regarding CLs were identified according to the duration of CL use and the risk of suffering from eye dryness (p-values <0.05). Conclusions The participants' overall knowledge and practices were good. This should be encouraged by performing an eye examination before wearing CL and demonstrating good wearing habits in terms of hygiene behavior.
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Affiliation(s)
- Osama Albasheer
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | - Ibrahim M Gosadi
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | | | - Fouad F Khawaji
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | - Abdullah J Almalki
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | - Alhareth K Muqanna
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | | | - Mousa M Abdali
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | | | - Khaled M Refaie
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
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2
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Yi J, Sun Y, Zeng C, Kostoulias X, Qu Y. The Role of Biofilms in Contact Lens Associated Fungal Keratitis. Antibiotics (Basel) 2023; 12:1533. [PMID: 37887234 PMCID: PMC10604847 DOI: 10.3390/antibiotics12101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Biofilm formation is an important microbial strategy for fungal pathogens, such as Fusarium, Aspergillus, and Candida, to establish keratitis in patients wearing soft contact lenses. Despite the well-documented 2006 outbreak of Fusarium keratitis that eventually led to the withdrawal of the Bausch & Lomb multipurpose lens care solution ReNu with MoistureLoc ("MoistureLoc") from the global market, contact lens care systems and solutions currently available on the market do not specifically target fungal biofilms. This is partially due to the lack of recognition and understanding of important roles that fungal biofilms play in contact lens associated fungal keratitis (CLAFK). This review aims to reemphasize the link between fungal biofilms and CLAFK, and deepen our comprehension of its importance in pathogenesis and persistence of this medical device-related infection.
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Affiliation(s)
- Jipan Yi
- Department of Optometry, Zhejiang Industry & Trade Vocational College, Wenzhou 325000, China; (J.Y.); (C.Z.)
| | - Yao Sun
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC 3800, Australia; (Y.S.); (X.K.)
| | - Chenghong Zeng
- Department of Optometry, Zhejiang Industry & Trade Vocational College, Wenzhou 325000, China; (J.Y.); (C.Z.)
| | - Xenia Kostoulias
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC 3800, Australia; (Y.S.); (X.K.)
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Clayton, VIC 3000, Australia
| | - Yue Qu
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC 3800, Australia; (Y.S.); (X.K.)
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Clayton, VIC 3000, Australia
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3
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Jones L, Efron N, Bandamwar K, Barnett M, Jacobs DS, Jalbert I, Pult H, Rhee MK, Sheardown H, Shovlin JP, Stahl U, Stanila A, Tan J, Tavazzi S, Ucakhan OO, Willcox MDP, Downie LE. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf 2023; 29:175-219. [PMID: 37149139 DOI: 10.1016/j.jtos.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.
| | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kalika Bandamwar
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, USA
| | - Deborah S Jacobs
- Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Heiko Pult
- Dr Heiko Pult Optometry & Vision Research, Weinheim, Germany
| | | | - Heather Sheardown
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | - Ulli Stahl
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | | | - Jacqueline Tan
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Silvia Tavazzi
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | | | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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4
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Velásquez-Zapata V, Palacio-Rúa K, Cano LE, Gaviria-Rivera A. Assessment of genotyping markers in the molecular characterization of a population of clinical isolates of Fusarium in Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:18-30. [PMID: 35471167 PMCID: PMC9059811 DOI: 10.7705/biomedica.5869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 08/06/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Fusarium is a very heterogeneous group of fungi, difficult to classify, with a wide range of living styles, acting as saprophytes, parasites of plants, or pathogens for humans and animals. Prevalence of clinical fusariosis and lack of effective treatments have increased the interest in the precise diagnosis, which implies a molecular characterization of Fusarium populations. OBJECTIVE We compared different genotyping markers in their assessment of the genetic variability and molecular identification of clinical isolates of Fusarium. MATERIALS AND METHODS We evaluated the performance of the fingerprinting produced by two random primers: M13, which amplifies a minisatellite sequence, and (GACA)4, which corresponds to a simple repetitive DNA sequence. Using the Hunter Gaston Discriminatory Index (HGDI), an analysis of molecular variance (AMOVA), and a Mantel test, the resolution of these markers was compared to the reference sequencing-based and PCR genotyping methods. RESULTS The highest HGDI value was associated with the M13 marker followed by (GACA)4. AMOVA and the Mantel tests supported a strong correlation between the M13 classification and the reference method given by the partial sequencing of the transcription elongation factor 1-alpha (TEF1-α) and rDNA 28S. CONCLUSION The strong correlation between the M13 classification and the sequencingbased reference together with its higher resolution demonstrates its adequacy for the characterization of Fusarium populations.
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Affiliation(s)
- Valeria Velásquez-Zapata
- Program in Bioinformatics and Computational Biology, Iowa State University, Ames, IA, USA; Department of Plant Pathology and Microbiology, Iowa State University, Ames, IA, USA.
| | - Katherine Palacio-Rúa
- Laboratorio Integrado de Medicina Especializada, Facultad de Medicina, IPS Universitaria, Universidad de Antioquia, Medellín, Colombia.
| | - Luz E Cano
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas, Medellín, Colombia; Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.
| | - Adelaida Gaviria-Rivera
- Escuela de Biociencias, Facultad de Ciencias, Universidad Nacional de Colombia, Medellín, Colombia.
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Donovan C, Arenas E, Ayyala RS, Margo CE, Espana EM. Fungal keratitis: Mechanisms of infection and management strategies. Surv Ophthalmol 2021; 67:758-769. [PMID: 34425126 PMCID: PMC9206537 DOI: 10.1016/j.survophthal.2021.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 12/24/2022]
Abstract
Fungal corneal ulcers are an uncommon, yet challenging, cause of vision loss. In the United States, geographic location appears to dictate not only the incidence of fungal ulcers, but also the fungal genera most encountered. These patterns of infection can be linked to environmental factors and individual characteristics of fungal organisms. Successful management of fungal ulcers is dependent on an early diagnosis. New diagnostic modalities like confocal microscopy and polymerase chain reaction are being increasingly used to detect and identify infectious organisms. Several novel therapies, including crosslinking and light therapy, are currently being tested as alternatives to conventional antifungal medications. We explore the biology of Candida, Fusarium, and Aspergillus, the three most common genera of fungi causing corneal ulcers in the United States and discuss current treatment regimens for the management of fungal keratitis.
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Affiliation(s)
- Christopher Donovan
- Department of Ophthalmology, Cornea and External Disease Service, Morsani College of Medicine, university of South Florida, Tampa, USA
| | - Eduardo Arenas
- Departamento de Oftalmologia, Universidad Nacional de Colombia y Universidad el Bosque, Bogota, Colombia
| | - Ramesh S Ayyala
- Department of Ophthalmology, Cornea and External Disease Service, Morsani College of Medicine, university of South Florida, Tampa, USA
| | - Curtis E Margo
- Department of Ophthalmology, Cornea and External Disease Service, Morsani College of Medicine, university of South Florida, Tampa, USA; Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Edgar M Espana
- Department of Ophthalmology, Cornea and External Disease Service, Morsani College of Medicine, university of South Florida, Tampa, USA; Molecular Pharmacology and Physiology, Morsani College of Medicine, university of South Florida, Tampa, USA.
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Khoza N, Moodley T, Sokhulu S, Sotyana NO, Suliman A, Hansraj R, van Staden D. Knowledge, attitudes and practices of contact lens use in a South African adolescent population. Afr Health Sci 2020; 20:768-774. [PMID: 33163042 PMCID: PMC7609115 DOI: 10.4314/ahs.v20i2.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Contact lens usage is becoming increasingly popular amongst young people. Assessing their knowledge, attitudes and practices in relation to contact lens wear is therefore important, so that gaps in understanding or incorrect practices can be rectified to promote continued safety and success of contact lens wear. Objectives This study aimed to assess and describe the knowledge, attitudes and practices of contact lens wearers aged 18 to 30 years, in the greater Durban area of South Africa. Methods A semi-structured questionnaire was used to assess the knowledge, attitudes and practice of the participants. Results: Two hundred and forty six participants completed the survey. Young contact lens wearers in this sample generally had poor knowledge with regards to appropriate hygiene and contact lens wear complications. Despite wearers exhibiting a positive attitude with satisfactory hand hygiene and lens cleaning practices, important aspects such as lens case hygiene, storage and lens removal practices were found to be unsatisfactory. Compliance with after-care visits was also unsatisfactory. Conclusion There is a need for contact lens practitioners to educate young contact lens wearers regarding appropriate contact lens-related care, to promote long term ocular health and contact lens-related safety.
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Affiliation(s)
| | | | | | | | | | - Rekha Hansraj
- Corresponding author: Rekha Hansraj, Discipline of Optometry College of Health Sciences University of KwaZulu-Natal Private Bag X54001 Durban 4000 Tel: +27312607089 Cell: +27829284699
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Howard KC, Dennis EK, Watt DS, Garneau-Tsodikova S. A comprehensive overview of the medicinal chemistry of antifungal drugs: perspectives and promise. Chem Soc Rev 2020; 49:2426-2480. [PMID: 32140691 DOI: 10.1039/c9cs00556k] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The emergence of new fungal pathogens makes the development of new antifungal drugs a medical imperative that in recent years motivates the talents of numerous investigators across the world. Understanding not only the structural families of these drugs but also their biological targets provides a rational means for evaluating the merits and selectivity of new agents for fungal pathogens and normal cells. An equally important aspect of modern antifungal drug development takes a balanced look at the problems of drug potency and drug resistance. The future development of new antifungal agents will rest with those who employ synthetic and semisynthetic methodology as well as natural product isolation to tackle these problems and with those who possess a clear understanding of fungal cell architecture and drug resistance mechanisms. This review endeavors to provide an introduction to a growing and increasingly important literature, including coverage of the new developments in medicinal chemistry since 2015, and also endeavors to spark the curiosity of investigators who might enter this fascinatingly complex fungal landscape.
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Affiliation(s)
- Kaitlind C Howard
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY 40536-0596, USA.
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8
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Calvillo-Medina RP, Reyes-Grajeda JP, Barba-Escoto L, Bautista-Hernandez LA, Campos-Guillén J, Jones GH, Bautista-de Lucio VM. Proteome analysis of biofilm produced by a Fusarium falciforme keratitis infectious agent. Microb Pathog 2019; 130:232-241. [DOI: 10.1016/j.micpath.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/30/2018] [Accepted: 03/01/2019] [Indexed: 11/16/2022]
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Gaviria-Rivera A, Giraldo-López A, Santa-Cardona C, Cano-Restrepo L. Molecular identification of clinical isolates of Fusarium in Colombia. ACTA ACUST UNITED AC 2019; 20:94-102. [PMID: 30183891 DOI: 10.15446/rsap.v20n1.51923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/09/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Identifying Fusarium isolates from mycosis symptomatic patients through molecular techniques as PCR and sequencing. METHODS In this study, samples were taken from 101 mycosis symptomatic patients in-between 2004-2006. To determine isolates belonging to the Fusarium genus, the DNAr 28S region was amplified through PCR and specific PCR primers further confirmed their identity to the species level. Additionally, in order to confirm the identity of the species of the isolates, 75 isolates of these were analyzed by partial sequencing of the 28S rDNA and the TEF1-α gene. RESULTS The 28S rDNA portion detected all 101 isolates as belonging to Fusarium and the PCR specific primers detected 52 and 29 isolates as F. oxysporum and F. solani, respectively; 34 and 41 of these, afterwards studied by partial sequencing of the 28S rDNA and TEF1- α genes respectively, were effectively identified by the technique. CONCLUSION From all the molecular markers used to identify Fusarium isolates, the sequence of the TEF1-α gene provided the best resolution in the identification of species level; however it is possible to discriminate between F. oxysporum and F. solani isolates by PCR, in most of the cases, what is important considering the simplicity of the technique and a faster diagnosis.
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Affiliation(s)
- Adelaida Gaviria-Rivera
- AG: Ing. Agrónoma. Ph. D. Biological Sciences. Escuela de Biociencias. Facultad de Ciencias. Universidad Nacional de Colombia. Medellín, Colombia.
| | - Alejandra Giraldo-López
- AG: Bacterióloga. M. Sc. Biotecnología. Ph. D. Ciencias Médicas Básicas. Westerdijk Fungal Biodiversity Institute. Utrecht, the Netherlands.
| | | | - Luz Cano-Restrepo
- LC: Téc. Laboratorio Clínico. Lic. Bacteriología y Laboratorio Clínico. Ph. D. Ciencias. Escuela de Bacteriología y Laboratorio Clínico, Universidad de Antioquia. Medellín. Grupo de Micología Médica y Experimental, CIB-UDEA-UPB. Corporación para Investigaciones Biológicas. Escuela de Microbiología, UdeA. Escuela de la Salud, UPB. Medellín, Colombia. ;
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Contact Lens Solutions and Contact Lens Discomfort: Examining the Correlations Between Solution Components, Keratitis, and Contact Lens Discomfort. Eye Contact Lens 2018; 44:355-366. [DOI: 10.1097/icl.0000000000000458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Microbiological Investigations of ReNu Plastic Bottles and the 2004 to 2006 ReNu With MoistureLoc-Related Worldwide Fusarium Keratitis Event. Eye Contact Lens 2017; 42:147-52. [PMID: 26332133 DOI: 10.1097/icl.0000000000000175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSES The purposes of this study were to determine whether the contact lens solution RevitaLens Ocutec (containing the antimicrobial agents alexidine and polyquaternium-1) would inhibit Fusarium organisms when heated in ReNu plastic bottles; whether alexidine would inhibit Fusarium organisms when heated in non-ReNu plastic bottles; and whether an alexidine-neutralizing compound leaches from heated ReNu bottles. METHODS RevitaLens and an alexidine solution (0.00045%), previously stored in ReNu bottles at room temperature (RT) and 56°C, were incubated with 7 different Fusarium organisms. The alexidine solution was similarly stored in seven non-ReNu plastic bottles and incubated with these same organisms. To determine if an alexidine-neutralizing compound might be leaching from heated ReNu bottles, phosphate-buffered saline (PBS) was incubated at RT and 56°C in ReNu bottles, combined with alexidine, and then tested for anti-Fusarium capability. RESULTS After being heated in ReNu bottles, RevitaLens retained its anti-Fusarium capability, whereas the alexidine solution did not. The alexidine solution heated in seven non-ReNu plastic bottles retained its anti-Fusarium capability. The alexidine solution retained its anti-Fusarium capability when incubated with a PBS solution that had been heated in ReNu bottles, indicating, microbiologically, that an alexidine-neutralizing compound did not leach from the heated ReNu bottle. CONCLUSIONS Alexidine uniquely fails to inhibit Fusarium organisms when heated in a plastic ReNu bottle, but not in seven other plastic bottles, whereas the anti-Fusarium capability of RevitaLens (containing the antimicrobial agents alexidine and polyquaternium-1) is unaffected by heating in a ReNu bottle. There does not seem to be an alexidine-neutralizing compound leaching from heated ReNu bottles. An interaction between alexidine and its heated ReNu bottle may have been a critical factor in the worldwide ReNu with MoistureLoc-related Fusarium keratitis event of 2004 to 2006.
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Tupaki-Sreepurna A, Al-Hatmi AMS, Kindo AJ, Sundaram M, de Hoog GS. Multidrug-resistant Fusarium in keratitis: a clinico-mycological study of keratitis infections in Chennai, India. Mycoses 2016; 60:230-233. [PMID: 27766684 DOI: 10.1111/myc.12578] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/15/2016] [Accepted: 09/24/2016] [Indexed: 11/26/2022]
Abstract
In this study, we aimed to present the first molecular epidemiological data from Chennai, India, analyse keratitis cases that have been monitored in a university hospital during 2 years, identify the responsible Fusarium species and determine antifungal susceptibilities. A total of 10 cases of keratitis were included in the study. Fusarium isolates were identified using the second largest subunit of the RNA polymerase gene (RPB2) and the translation elongation factor 1 alpha (TEF1). Antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. The aetiological agents belonged to Fusarium solani species complex (FSSC) (n = 9) and Fusarium sambucinum species complex (FSAMSC) (n = 1), and the identified species were Fusarium keratoplasticum (n = 7), Fusarium falciforme (n = 2) and Fusarium sporotrichioides (n = 1). All strains showed multidrug resistance to azoles and caspofungin but exhibited lower minimum inhibitory concentration (MIC) to natamycin and amphotericin B. Fusarium keratoplasticum and Fusarium falciforme belonging to the Fusarium solani species complex were the major aetiological agents of Fusarium keratitis in this study. Early presentation and 5% topical natamycin was associated with better patient outcome. Preventative measures and monitoring of local epidemiological data play an important role in clinical practice.
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Affiliation(s)
- Ananya Tupaki-Sreepurna
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, India
| | - Abdullah M S Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands.,Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands.,Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman
| | - Anupma J Kindo
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, India
| | - Murugan Sundaram
- Department of Dermatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, India
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands.,Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands.,Basic Pathology Department, Federal University of Paraná State, Curitiba, Brazil.,Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Abstract
During infection, fungi frequently transition to a biofilm lifestyle, proliferating as communities of surface-adherent aggregates of cells. Phenotypically, cells in a biofilm are distinct from free-floating cells. Their high tolerance of antifungals and ability to withstand host defenses are two characteristics that foster resilience. Biofilm infections are particularly difficult to eradicate, and most available antifungals have minimal activity. Therefore, the discovery of novel compounds and innovative strategies to treat fungal biofilms is of great interest. Although many fungi have been observed to form biofilms, the most well-studied is Candida albicans. Animal models have been developed to simulate common Candida device-associated infections, including those involving vascular catheters, dentures, urinary catheters, and subcutaneous implants. Models have also reproduced the most common mucosal biofilm infections: oropharyngeal and vaginal candidiasis. These models incorporate the anatomical site, immune components, and fluid dynamics of clinical niches and have been instrumental in the study of drug resistance and investigation of novel therapies. This chapter describes the significance of fungal biofilm infections, the animal models developed for biofilm study, and how these models have contributed to the development of new strategies for the eradication of fungal biofilm infections.
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Could Histoplasma capsulatum Be Related to Healthcare-Associated Infections? BIOMED RESEARCH INTERNATIONAL 2015; 2015:982429. [PMID: 26106622 PMCID: PMC4461736 DOI: 10.1155/2015/982429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
Abstract
Healthcare-associated infections (HAI) are described in diverse settings. The main etiologic agents of HAI are bacteria (85%) and fungi (13%). Some factors increase the risk for HAI, particularly the use of medical devices; patients with severe cuts, wounds, and burns; stays in the intensive care unit, surgery, and hospital reconstruction works. Several fungal HAI are caused by Candida spp., usually from an endogenous source; however, cross-transmission via the hands of healthcare workers or contaminated devices can occur. Although other medically important fungi, such as Blastomyces dermatitidis, Paracoccidioides brasiliensis, and Histoplasma capsulatum, have never been considered nosocomial pathogens, there are some factors that point out the pros and cons for this possibility. Among these fungi, H. capsulatum infection has been linked to different medical devices and surgery implants. The filamentous form of H. capsulatum may be present in hospital settings, as this fungus adapts to different types of climates and has great dispersion ability. Although conventional pathogen identification techniques have never identified H. capsulatum in the hospital environment, molecular biology procedures could be useful in this setting. More research on H. capsulatum as a HAI etiologic agent is needed, since it causes a severe and often fatal disease in immunocompromised patients.
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Pan-antimicrobial failure of alexidine as a contact lens disinfectant when heated in Bausch & Lomb plastic containers: implications for the worldwide Fusarium keratitis epidemic of 2004 to 2006. Eye Contact Lens 2012; 38:222-6. [PMID: 22495680 DOI: 10.1097/icl.0b013e31824da9be] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE ReNu with MoistureLoc (ReNuML), containing the antimicrobial agent alexidine 0.00045%, was associated with the Fusarium keratitis epidemic of 2004 to 2006. Although a single-point source contamination was ruled out, only Fusarium organisms were reported during the outbreak. This study investigated whether the reported loss of antimicrobial effectiveness toward Fusarium of ReNuML after exposure to heat in high-density polyethylene (HDPE) plastic containers could also be demonstrated with other common fungal and bacterial agents of keratitis. METHODS A buffered solution of alexidine 0.00045% was incubated in glass and ReNu HDPE plastic containers at room temperature (RT) and 56°C for 4 weeks, serially diluted, and tested for its ability to inhibit the growth of 20 bacterial isolates, 12 non-Fusarium fungal isolates, and 7 Fusarium isolates originally involved in the keratitis epidemic. RESULTS A statistically significant loss of antimicrobial capability was seen with all fungi, all gram-positive bacteria, and all isolates of Klebsiella when alexidine 0.00045% was incubated at 56°C in ReNu HDPE containers compared with RT or glass incubation (P≤0.0001). CONCLUSIONS Heating of an alexidine solution in ReNu HDPE plastic (but not glass) containers results in the same loss of anti-Fusarium activity as reported when testing the original ReNuML solution. This loss of inhibitory activity is not specific to Fusarium and occurs with other fungi and bacteria that cause keratitis. The reasons for the lack of reports of bacterial and/or non-Fusarium fungal keratitis during the original Fusarium keratitis epidemic remain unclear at this time.
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Mukherjee PK, Chandra J, Yu C, Sun Y, Pearlman E, Ghannoum MA. Characterization of fusarium keratitis outbreak isolates: contribution of biofilms to antimicrobial resistance and pathogenesis. Invest Ophthalmol Vis Sci 2012; 53:4450-7. [PMID: 22669723 DOI: 10.1167/iovs.12-9848] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Fusarium is a major cause of microbial keratitis, and its ability to form biofilms was suggested as a contributing factor in recent outbreaks. We investigated the ability of outbreak Fusarium isolates (F. solani species complex [FSSC] and F. oxysporum species complex [FOSC]) to form biofilms in vitro and in vivo, and evaluated their antifungal susceptibilities. METHODS Biofilm formation was assessed using our in vitro contact lens model and in vivo murine model. Biofilm architecture was assessed using confocal laser scanning microscopy (CLSM). Susceptibility against amphotericin B (AmB), voriconazole (VCZ), and natamycin (NAT) was determined using the CLSI-M38-A2 method and XTT metabolic assay. RESULTS FSSC strains formed more biofilms than FOSC, in a strain- and clade-dependent manner. CLSM analyses revealed that "high biofilm forming" (HBF) strains had denser and thicker biofilms than "low biofilm forming" (LBF) strains of both species (thickness 51 vs. 41 μm for FSSC and 61 vs. 45 μm for FOSC strains, P < 0.05 for both comparisons). Fusarium biofilms exhibited species-dependent antifungal susceptibilities (e.g., FSSC biofilms AmB minimal inhibitory concentrations [MIC] ≥16 μg/mL, while NAT or VCZ MICs were 2-8 μg/mL). FSSC-infected mice had severe corneal opacification independent of biofilm thickness, while FOSC infection resulted in moderate corneal opacification. Corneal fungal burden of mice infected with HBF strains was higher than those of the LBF strains. In contrast, the reference ATCC isolate was unable to cause infection. CONCLUSIONS The ability to form biofilms is a key pathogenicity determinant of Fusarium, irrespective of the thickness of these biofilms. Further studies are warranted to explore this association in greater detail.
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Affiliation(s)
- Pranab K Mukherjee
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Short DPG, O'Donnell K, Zhang N, Juba JH, Geiser DM. Widespread occurrence of diverse human pathogenic types of the fungus Fusarium detected in plumbing drains. J Clin Microbiol 2011; 49:4264-72. [PMID: 21976755 PMCID: PMC3232942 DOI: 10.1128/jcm.05468-11] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 09/23/2011] [Indexed: 12/31/2022] Open
Abstract
It has been proposed that plumbing systems might serve as a significant environmental reservoir of human-pathogenic isolates of Fusarium. We tested this hypothesis by performing the first extensive multilocus sequence typing (MLST) survey of plumbing drain-associated Fusarium isolates and comparing the diversity observed to the known diversity of clinical Fusarium isolates. We sampled 471 drains, mostly in bathroom sinks, from 131 buildings in the United States using a swabbing method. We found that 66% of sinks and 80% of buildings surveyed yielded at least one Fusarium culture. A total of 297 isolates of Fusarium collected were subjected to MLST to identify the phylogenetic species and sequence types (STs) of these isolates. Our survey revealed that the six most common STs in sinks were identical to the six most frequently associated with human infections. We speculate that the most prevalent STs, by virtue of their ability to form and grow in biofilms, are well adapted to plumbing systems. Six major Fusarium STs were frequently isolated from plumbing drains within a broad geographic area and were identical to STs frequently associated with human infections.
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Affiliation(s)
- Dylan P G Short
- Department of Plant Pathology, Pennsylvania State University, University Park, PA 16802, USA.
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Evaluations of shorter exposures of contact lens cleaning solutions against Fusarium oxysporum species complex and Fusarium solani species complex to simulate inappropriate usage. Antimicrob Agents Chemother 2011; 55:2265-75. [PMID: 21300826 DOI: 10.1128/aac.00634-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outbreak of Fusarium keratitis in contact lens users resulted in withdrawal of ReNu with MoistureLoc solution, although the exact cause of the outbreak remains enigmatic. We evaluated current and discontinued multipurpose cleaning solutions (MPSs; MoistureLoc, Equate, MultiPlus, and OptiFree Express) against plankton- and biofilm-derived cells of Fusarium oxysporum species complex (FOSC) and F. solani species complex (FSSC). The methods included a traditional assay based on CFU counts and a novel flow cytometry (FC) assay based on percent cell subpopulation (PCS) stained with two fluorochromes (Sytox Red and 5-chloromethylfluorescein diacetate). The tests were done with the respective manufacturers' recommended cleaning regimens (240 to 360 min) and under shorter exposures (15 to 60 min) to simulate inappropriate usage by the customers. FC assay measured PCS, which was available rapidly, in 5 to 7 h, whereas 24 to 48 h was needed for CFU counts, and there was good correlation between the two methods (r2=0.97). FC assays allowed identification of injured fungal cells, which are likely to be missed with growth assays. In general, a time- and inoculum-dependent survival pattern was seen for both FOSC and FSSC cells, and biofilm-derived cells were more resistant than plankton-derived cells. MultiPlus and Equate produced 100% sterilization of fungi even under shorter exposures. However, biofilm FOSC and FSSC cells survived for up to 4 h in MoistureLoc solution and up to 6 h in OptiFree Express solution under shorter exposure times. This finding was enigmatic, as OptiFree Express is not associated with any outbreak of Fusarium keratitis. This study provides additional support for possible roles that improper lens cleaning regimens and fungal biofilms could play as predisposing factors for Fusarium keratitis.
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The Effects of Laparoscopic Adjustable Gastric Banding on Idiopathic Intracranial Hypertension. Obes Surg 2010; 21:161-6. [DOI: 10.1007/s11695-010-0307-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Debourgogne A, Gueidan C, Hennequin C, Contet-Audonneau N, de Hoog S, Machouart M. Development of a new MLST scheme for differentiation of Fusarium solani Species Complex (FSSC) isolates. J Microbiol Methods 2010; 82:319-23. [DOI: 10.1016/j.mimet.2010.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 07/05/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
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Chaturvedi V, Springer DJ, Behr MJ, Ramani R, Li X, Peck MK, Ren P, Bopp DJ, Wood B, Samsonoff WA, Butchkoski CM, Hicks AC, Stone WB, Rudd RJ, Chaturvedi S. Morphological and molecular characterizations of psychrophilic fungus Geomyces destructans from New York bats with White Nose Syndrome (WNS). PLoS One 2010; 5:e10783. [PMID: 20520731 PMCID: PMC2875398 DOI: 10.1371/journal.pone.0010783] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 04/29/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Massive die-offs of little brown bats (Myotis lucifugus) have been occurring since 2006 in hibernation sites around Albany, New York, and this problem has spread to other States in the Northeastern United States. White cottony fungal growth is seen on the snouts of affected animals, a prominent sign of White Nose Syndrome (WNS). A previous report described the involvement of the fungus Geomyces destructans in WNS, but an identical fungus was recently isolated in France from a bat that was evidently healthy. The fungus has been recovered sparsely despite plentiful availability of afflicted animals. METHODOLOGY/PRINCIPAL FINDINGS We have investigated 100 bat and environmental samples from eight affected sites in 2008. Our findings provide strong evidence for an etiologic role of G. destructans in bat WNS. (i) Direct smears from bat snouts, Periodic Acid Schiff-stained tissue sections from infected tissues, and scanning electron micrographs of bat tissues all showed fungal structures similar to those of G. destructans. (ii) G. destructans DNA was directly amplified from infected bat tissues, (iii) Isolations of G. destructans in cultures from infected bat tissues showed 100% DNA match with the fungus present in positive tissue samples. (iv) RAPD patterns for all G. destructans cultures isolated from two sites were indistinguishable. (v) The fungal isolates showed psychrophilic growth. (vi) We identified in vitro proteolytic activities suggestive of known fungal pathogenic traits in G. destructans. CONCLUSIONS/SIGNIFICANCE Further studies are needed to understand whether G. destructans WNS is a symptom or a trigger for bat mass mortality. The availability of well-characterized G. destructans strains should promote an understanding of bat-fungus relationships, and should aid in the screening of biological and chemical control agents.
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Affiliation(s)
- Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA.
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Sun Y, Chandra J, Mukherjee P, Szczotka-Flynn L, Ghannoum MA, Pearlman E. A murine model of contact lens-associated fusarium keratitis. Invest Ophthalmol Vis Sci 2009; 51:1511-6. [PMID: 19875664 DOI: 10.1167/iovs.09-4237] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Fusarium solani and F. oxysporum were the causative organisms of the 2005/2006 outbreak of contact lens-associated fungal keratitis in the United States. The present study was an investigation of the ability of F. oxysporum grown as a biofilm on silicone hydrogel contact lenses to induce keratitis. METHODS A clinical isolate of F. oxysporum was grown as a biofilm on lotrafilcon A contact lenses, and a 2-mm diameter punch was placed on the abraded corneal epithelium of either untreated or cyclophosphamide-treated C57BL/6 mice or of IL-1R1(-/-), MyD88(-/-), TLR2(-/-), or TLR4(-/-) mice. After 2 hours, the lens was removed, and corneal opacification, colony forming units (CFUs), and histopathology were evaluated. RESULTS C57BL/6 mice developed severe corneal opacification within 24 hours and resolved after four days. In contrast, corneal opacification progressed in cyclophosphamide-treated mice, and was associated with unimpaired fungal growth in the cornea, and with hyphae penetrating into the anterior chamber. The phenotype of MyD88(-/-) and IL-1R(-/-) mice was similar to that of cyclophosphamide-treated animals, with significantly impaired cellular infiltration and fungal clearance. Although TLR4(-/-) mice developed a cellular infiltrate and corneal opacification similar to C57BL/6 mice, the CFU count was significantly and consistently higher. CONCLUSIONS Fusarium grown as a biofilm on silicone hydrogel contact lenses can induce keratitis on injured corneas, with disease severity and fungal killing dependent on the innate immune response, including IL-1R1, MyD88, and TLR4.
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Affiliation(s)
- Yan Sun
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio 44106, USA
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Soft contact lens disinfection solution efficacy: clinical Fusarium isolates vs. ATCC 36031. Optom Vis Sci 2009; 86:415-9. [PMID: 19384259 DOI: 10.1097/opx.0b013e31819fa239] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the disinfecting efficacy of five soft contact lens multipurpose disinfection solutions (MPDS) against Fusarium solani clinical isolates and the ISO standard ATCC 36031 strain. METHODS Three commercially available and two recalled MPDS were tested using the ISO/CD 14,729 stand-alone test for contact lens care products against 10 ocular isolates of F. solani and the ATCC 36031 strain. The effect of filtering the fungal suspension before incubating in MPDS was also tested. An average log reduction in colony forming units at the manufacturer's minimum recommended disinfection time was determined and compared with criteria for stand-alone disinfection products for each MPDS against each strain. RESULTS No difference between filtered and unfiltered fungal suspensions was observed for the ISO standard, whereas in one MPDS the representative clinical isolate showed significantly increased resistance when unfiltered. All but one solution met the stand-alone criteria of 1.0-log reduction of colony forming units against the recommended ISO standard strain ATCC 36031. However, there was wide variation in the ability of MPDS to meet the ISO disinfection criteria when tested against clinical isolates. Among the commercially available MPDS, the two polyquaternium-based solutions showed a higher disinfecting efficacy than the biguanide-based solution. The two recalled solutions showed a lower disinfecting efficacy than the polyquaternium-based solutions. Further, the clinical isolates were significantly more resistant to disinfection than was the recommended ISO strain. CONCLUSIONS The effect of filtering the fungal suspension to remove hyphae seems to be relevant in the clinical isolate tested, but not in the ISO strain. Clinical isolates were significantly more resistant to disinfection than the recommended ISO strain in the presence of both the commercially available and the recalled MPDS. The use of clinical isolates in stand-alone disinfection testing is indicated. Because there were significant differences in increased resistance exhibited by clinical isolates and in a mixed (unfiltered) culture the use of a single laboratory strain may be insufficient to provide assurance that the disinfection solution will be effective against clinical isolates.
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Relative In Vitro Rates of Attachment and Penetration of Hydrogel Soft Contact Lenses by Haplotypes of Fusarium. Cornea 2009; 28:447-50. [DOI: 10.1097/ico.0b013e31818d33fb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jureen R, Koh TH, Wang G, Chai LYA, Tan AL, Chai T, Wong YW, Wang Y, Tambyah PA, Beuerman R, Tan D. Use of multiple methods for genotyping Fusarium during an outbreak of contact lens associated fungal keratitis in Singapore. BMC Infect Dis 2008; 8:92. [PMID: 18627616 PMCID: PMC2483985 DOI: 10.1186/1471-2334-8-92] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 07/15/2008] [Indexed: 11/17/2022] Open
Abstract
Background In Singapore, an outbreak of fungal keratitis caused by members of the Fusarium solani species complex (FSSC) was identified in March 2005 to May 2006 involving 66 patients. Epidemiological investigations have indicated that improper contact lens wear and the use of specific contact lens solutions were risk factors. Methods We assessed the genetic diversity of the isolates using AFLP, Rep-PCR, and ERIC-PCR and compared the usefulness of these typing schemes to characterize the isolates. Results AFLP was the most discriminative typing scheme and appears to group FSSC from eye infections and from other infections differently. Conclusion There was a high genomic heterogeneity among the isolates confirming that this was not a point source outbreak.
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Affiliation(s)
- Roland Jureen
- Department of Laboratory Medicine, Alexandra Hospital, Singapore.
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Ide T, Miller D, Alfonso EC, O'Brien TP. Impact of contact lens group on antifungal efficacy of multipurpose disinfecting contact lens solutions. Eye Contact Lens 2008; 34:151-9. [PMID: 18463480 DOI: 10.1097/icl.0b013e31815788a6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate and compare the in vitro effectiveness of multipurpose contact lens solutions (MPDS) to inhibit fungal colonization of Food and Drug Administration (FDA) contact lens groups. METHODS Contact lenses from FDA groups I (low water content, nonionic), II (high water content, nonionic), III (low water content, ionic), and IV (high water content, ionic) were placed in sterile contact lens cases with 2 mL of ReNu MultiPlus, ReNu with MoistureLoc, or OPTI-FREE RepleniSH. Each contact lens-multipurpose solution combination was challenged with 0.1 mL of 10(6) colony-forming units/mL of Fusarium oxysporum and incubated at room temperature. Contact lenses and aliquots from phosphate-buffered saline rinse solutions, multipurpose solutions in cases, and lens cases were sampled at 24, 48, and 72 hours, plated on Sabouraud's agar, incubated at room temperature, and observed for growth (i.e., adhesion) for 1 to 7 days. RESULTS Used multipurpose contact lens solutions met or exceeded the 1-log reduction requirement of the FDA stand-alone test. Viable fungal colonies were recovered from group II lenses after 24 hours of storage in all three multipurpose solutions. Colonization was also detected with at least one contact lens-multipurpose solution pairing from groups I, III, and IV. Fungi were not recovered from lens-solution combinations after 24 hours or from phosphate-buffered saline solutions or lens cases at any period. CONCLUSIONS Antifungal activity of contaminated multipurpose solutions may be insufficient to prevent fungal colonization of contact lens materials despite meeting or exceeding the FDA stand-alone test criteria. Colonized lens may increase the risk of fungal keratitis.
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Affiliation(s)
- Takeshi Ide
- Department of Ophthalmology, Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Ahearn DG, Zhang S, Stulting RD, Schwam BL, Simmons RB, Ward MA, Pierce GE, Crow SA. Fusarium keratitis and contact lens wear: facts and speculations. Med Mycol 2008; 46:397-410. [PMID: 18608899 DOI: 10.1080/13693780801961352] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Over the past several decades mycotic keratitis has been considered a rare sequel to hydrogel contact lens wear. In 2005--2006 an upswing in the incidence of Fusarium keratitis was associated with a disproportionate use of one multipurpose contact lens solution (MPS, ReNu with MoistureLoc, Bausch & Lomb, Rochester, NY). The MPS, as manufactured and marketed, was sterile and met regulatory guidelines for antimicrobial activity. A multivariant interaction of poor hygienic practices and the contact lens paraphernalia were associated with a mostly selective contamination in or on the lens storage case by members of the F. solani/F. oxysporum species complexes from the environment of the user. A decline of the anti-fusaria properties of the MPS in the lens case appeared related to its dissociation from drying, or dilution and the potential for sorption of antimicrobial solution components (e.g., alexidine) to various hydrogel lenses. These factors and capacities of the fusaria for rapid amplification by microcycle conidiation, production of dormant resistant cells, and potential for attachment and penetration of hydrogel lenses, were linked to the occasional selective fungal survival and growth during storage of the lens in MPS. Lack of a manual rubbing-cleaning step in the MPS disinfection process was considered a risk factor for keratitis.
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Affiliation(s)
- Donald G Ahearn
- Biology Department, Georgia State University, Atlanta, GA 30303, USA.
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Buzina W. [Health effects of indoor molds]. Wien Med Wochenschr 2008; 157:462-5. [PMID: 18030548 DOI: 10.1007/s10354-007-0459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 07/11/2007] [Indexed: 11/25/2022]
Abstract
Molds are found almost everywhere in the environment. Their airborne propagules (conidia, spores, hyphal fragments) can--under certain circumstances--cause a variety of health problems like mycotic infections, allergies, asthma, irritations or toxic syndromes.
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Affiliation(s)
- Walter Buzina
- Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Graz, Osterreich.
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Bullock JD, Warwar RE, Elder BL, Northern WI. Temperature instability of ReNu with MoistureLoc: a new theory to explain the worldwide Fusarium keratitis epidemic of 2004-2006. TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2008; 106:117-127. [PMID: 19277227 PMCID: PMC2646433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE A 2006 US Food and Drug Administration (FDA) inspection of Bausch & Lomb's (B&L's) Greenville, South Carolina, manufacturing site indicated that B&L failed to regulate storage and transport temperatures of their products. The present study investigated the effect of storage temperature on the ability of contact lens solutions to inhibit growth of Fusarium species. METHODS SIX CONTACT LENS SOLUTIONS WERE STUDIED: ReNu with MoistureLoc (ReNu ML), ReNu MultiPlus, Complete Moistureplus, AQuify, Clear Care, and OPTI-FREE RepleniSH. Two bottles of each solution were separately stored at room temperature and 60 degrees C for 4 weeks, serially diluted, then tested for their ability to inhibit growth of 11 Fusarium isolates (7 of which were associated with the keratitis epidemic). RESULTS ReNu ML demonstrated the greatest decline in efficacy after 60 degrees C storage. Clear Care and ReNu MultiPlus performed the best. Regarding the keratitis epidemic isolates only, the ReNu ML bottle stored at room temperature allowed growth in 27 of 84 combinations vs 67 of 84 combinations with the 60 degrees C stored bottle. CONCLUSIONS When exposed to prolonged temperature elevation, ReNu ML loses its in vitro fungistatic activity to a much greater extent than other products. Improper temperature control of ReNu ML may have contributed to the Fusarium keratitis epidemic of 2004-2006.
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Affiliation(s)
- John D Bullock
- Department of Ophthalmology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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Differences Among Strains of the Fusarium oxysporum-F. solani Complexes in Their Penetration of Hydrogel Contact Lenses and Subsequent Susceptibility to Multipurpose Contact Lens Disinfection Solutions. Cornea 2007; 26:1249-54. [DOI: 10.1097/ico.0b013e318148bd9a] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fusarium and Candida albicans biofilms on soft contact lenses: model development, influence of lens type, and susceptibility to lens care solutions. Antimicrob Agents Chemother 2007; 52:171-82. [PMID: 17999966 DOI: 10.1128/aac.00387-07] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fungal keratitis is commonly caused by Fusarium species and less commonly by Candida species. Recent outbreaks of Fusarium keratitis were associated with contact lens wear and with ReNu with MoistureLoc contact lens care solution, and biofilm formation on contact lens/lens cases was proposed to play a role in this outbreak. However, no in vitro model for contact lens-associated fungal biofilm has been developed. In this study, we developed and characterized in vitro models of biofilm formation on various soft contact lenses using three species of Fusarium and Candida albicans. The contact lenses tested were etafilcon A, galyfilcon A, lotrafilcon A, balafilcon A, alphafilcon A, and polymacon. Our results showed that clinical isolates of Fusarium and C. albicans formed biofilms on all types of lenses tested and that the biofilm architecture varied with the lens type. Moreover, differences in hyphal content and architecture were found between the biofilms formed by these fungi. We also found that two recently isolated keratitis-associated fusaria formed robust biofilms, while the reference ATCC 36031 strain (recommended by the International Organization for Standardization guidelines for testing of disinfectants) failed to form biofilm. Furthermore, using the developed in vitro biofilm model, we showed that phylogenetically diverse planktonic fusaria and Candida were susceptible to MoistureLoc and MultiPlus. However, Fusarium biofilms exhibited reduced susceptibility against these solutions in a species- and time-dependent manner. This in vitro model should provide a better understanding of the biology and pathogenesis of lens-related fungal keratitis.
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O'Donnell K, Sarver BAJ, Brandt M, Chang DC, Noble-Wang J, Park BJ, Sutton DA, Benjamin L, Lindsley M, Padhye A, Geiser DM, Ward TJ. Phylogenetic diversity and microsphere array-based genotyping of human pathogenic Fusaria, including isolates from the multistate contact lens-associated U.S. keratitis outbreaks of 2005 and 2006. J Clin Microbiol 2007; 45:2235-48. [PMID: 17507522 PMCID: PMC1933018 DOI: 10.1128/jcm.00533-07] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2005 and 2006, outbreaks of Fusarium keratitis associated with soft contact lens use occurred in multiple U.S. states and Puerto Rico. A case-control study conducted by the Centers for Disease Control and Prevention (CDC) showed a significant association between infections and the use of one particular brand of lens solution. To characterize the full spectrum of the causal agents involved and their potential sources, partial DNA sequences from three loci (RPB2, EF-1alpha, and nuclear ribosomal rRNA) totaling 3.48 kb were obtained from 91 corneal and 100 isolates from the patient's environment (e.g., contact lens and lens cases). We also sequenced a 1.8-kb region encoding the RNA polymerase II second largest subunit (RPB2) from 126 additional pathogenic isolates to better understand how the keratitis outbreak isolates fit within the full phylogenetic spectrum of clinically important fusaria. These analyses resulted in the most robust phylogenetic framework for Fusarium to date. In addition, RPB2 nucleotide variation within a 72-isolate panel was used to design 34 allele-specific probes to identify representatives of all medically important species complexes and 10 of the most important human pathogenic Fusarium in a single-well diagnostic assay, using flow cytometry and fluorescent microsphere technology. The multilocus data revealed that one haplotype from each of the three most common species comprised 55% of CDC's corneal and environmental isolates and that the corneal isolates comprised 29 haplotypes distributed among 16 species. The high degree of phylogenetic diversity represented among the corneal isolates is consistent with multiple sources of contamination.
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Affiliation(s)
- Kerry O'Donnell
- Microbial Genomics and Bioprocessing Research Unit, Agricultural Research Service, U.S. Department of Agriculture, 1815 North University Street, Peoria, IL 61604-3999, USA.
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