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Ling JYM, Yeung SN, Chan CC, Trinh T, Antaki F, Harissi-Dagher M, Sivachandran N, Fava M, Légaré MÈ, Iovieno A. Trends and Clinical Outcomes of Fungal Keratitis in Canada: A 20-year Retrospective Multicentre Study. Am J Ophthalmol 2024; 265:147-155. [PMID: 38642698 DOI: 10.1016/j.ajo.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE An increase in fungal and particularly filamentous keratitis has been observed in many geographic areas, mostly in contact lens wearers. This study seeks to characterize long-term trends in fungal keratitis in a continental climate area to provide guidance for diagnosis and treatment. DESIGN Retrospective multicentric case series. METHODS Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included. Charts were reviewed for patient demographics, risk factors, visual acuity, and treatments undertaken. RESULTS A total of 138 patients were identified: 75 had yeast keratitis while 63 had filamentous keratitis. Patients with yeast keratitis had more ocular surface disease (79% vs 28%) while patients with filamentous keratitis wore more refractive contact lenses (78% vs 19%). Candida species accounted for 96% of all yeast identified, while Aspergillus (32%) and Fusarium (26%) were the most common filamentous fungi species. The mean duration of treatment was 81 ± 96 days. Patients with yeast keratitis did not have significantly improved visual acuity with medical treatment (1.8 ± 1 LogMAR to 1.9 ± 1.5 LogMAR, P = .9980), in contrast to patients with filamentous keratitis (1.4 ± 1.2 LogMAR to 1.1 ± 1.3 LogMAR, P = .0093). CONCLUSIONS Fungal keratitis is increasing in incidence, with contact lenses emerging as one of the leading risk factors. Significant differences in the risk factors and visual outcomes exist between yeast keratitis and filamentous keratitis which may guide diagnosis and treatment.
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Affiliation(s)
- Jennifer Y M Ling
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia N Yeung
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences (C.C., T.T.), University of Toronto, Toronto, Ontario, Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences (C.C., T.T.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (T.T.), Sydney Eye Hospital, Sydney, Australia
| | - Fares Antaki
- Department of Ophthalmology (F.A., M.H.), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology (F.A., M.H.), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Nirojini Sivachandran
- Division of Ophthalmology (N.S., M.F.), McMaster University, Hamilton, Ontario, Canada
| | - Mark Fava
- Division of Ophthalmology (N.S., M.F.), McMaster University, Hamilton, Ontario, Canada
| | - Marie-Ève Légaré
- Centre Universitaire d'Ophtalmologie - CHU de Québec (M.L.), Université Laval, Québec City, Québec, Canada
| | - Alfonso Iovieno
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada.
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Huang TE, Ou JH, Hung N, Yeh LK, Ma DHK, Tan HY, Chen HC, Hung KH, Fan YC, Sun PL, Hsiao CH. Fusarium Keratitis in Taiwan: Molecular Identification, Antifungal Susceptibilities, and Clinical Features. J Fungi (Basel) 2022; 8:jof8050476. [PMID: 35628732 PMCID: PMC9144221 DOI: 10.3390/jof8050476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
We performed molecular identification and antifungal susceptibilities of pathogens and investigated clinical features of 43 culture-proven Fusarium keratitis cases from 2015–2020 in Taiwan. The pathogens were identified by sequencing of their internal transcribed spacer regions of ribosomal DNA and translation elongation factor 1α gene; their antifungal susceptibilities (to seven agents) were determined by broth microdilution method. We also collected clinical data to compare the drug susceptibilities and clinical features of Fusarium solani species complex (FSSC) isolates with those of other Fusarium species complexes (non-FSSC). The FSSC accounted for 76.7% pathogens, among which F. falciforme (32.6%) and F. keratoplasticum (27.9%) were the most common species. Among clinically used antifungal agents, amphotericin B registered the lowest minimal inhibitory concentration (MIC), and the new azoles efinaconazole, lanoconazole and luliconazole, demonstrated even lower MICs against Fusarium species. The MICs of natamycin, voriconazole, chlorhexidine, lanoconazole, and luliconazole were higher for the FSSC than the non-FSSC, but no significant differences were noted in clinical outcomes, including corneal perforation and final visual acuity. In Taiwan, the FSSC was the most common complex in Fusarium keratitis; its MICs for five tested antifungal agents were higher than those of non-FSSC, but the clinical outcomes did not differ significantly.
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Affiliation(s)
- Tsung-En Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Jie-Hao Ou
- Department of Plant Pathology, National Chung Hsing University, Taichung 402, Taiwan;
| | - Ning Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Yun-Chen Fan
- Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Pei-Lun Sun
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Correspondence: (P.-L.S.); (C.-H.H.); Tel.: +886-3-328-1200 (C.-H.H.)
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (P.-L.S.); (C.-H.H.); Tel.: +886-3-328-1200 (C.-H.H.)
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Szaliński M, Zgryźniak A, Rubisz I, Gajdzis M, Kaczmarek R, Przeździecka-Dołyk J. Fusarium Keratitis-Review of Current Treatment Possibilities. J Clin Med 2021; 10:jcm10235468. [PMID: 34884170 PMCID: PMC8658515 DOI: 10.3390/jcm10235468] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
In many parts of the world, fungi are the predominant cause of infectious keratitis; among which, Fusarium is the most commonly isolated pathogen. The clinical management of this ophthalmic emergency is challenging. Due to the retardation of the first symptoms from an injury and the inability to differentiate fungal from bacterial infections based on clinical symptoms and difficult microbial diagnostics, proper treatment, in many cases, is postponed. Moreover, therapeutical options of Fusarium keratitis remain limited. This paper summarizes the available treatment modalities of Fusarium keratitis, including antifungals and their routes of administration, antiseptics, and surgical interventions.
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Affiliation(s)
- Marek Szaliński
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Aleksandra Zgryźniak
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
- Correspondence:
| | - Izabela Rubisz
- Okulus Ophthalmology Clinic, ul. Śródmiejska 34, 62-800 Kalisz, Poland;
| | - Małgorzata Gajdzis
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
| | - Radosław Kaczmarek
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Joanna Przeździecka-Dołyk
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
- Department of Optics and Photonics, Wroclaw University of Science and Technology, Wyb. Stanisława Wyspiańskiego 27, 50-370 Wrocław, Poland
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Najafzadeh MJ, Dolatabadi S, de Hoog S, Esfahani MK, Haghani I, Aghili SR, Ghazvini RD, Rezaei-Matehkolaei A, Abastabar M, Al-Hatmi AMS. Phylogenetic Analysis of Clinically Relevant Fusarium Species in Iran. Mycopathologia 2020; 185:515-525. [PMID: 32506392 DOI: 10.1007/s11046-020-00460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/22/2020] [Indexed: 10/20/2022]
Abstract
Fungi of the genus Fusarium are well known as major plant pathogens but also cause a broad spectrum of human infections. Sixty-three clinical isolates, collected during 2014-2017, were identified using a part of the TEF1 gene as barcoding marker. Fusarium fujikuroi species complex (FFSC, n = 41, 65%) showed to be the dominant etiological agent, followed by F. solani species complex (FSSC, n = 14, 22%) and F. oxysporum species complex (FOSC, n = 7, 11%). There was one strain belonging to F. lateritium species complex (FLSC, n = 1, 1.5%). For final identification, a phylogenetic tree was constructed including the type strains of each species complex. Most cases of fusariosis were due to nail infection (n = 38, 60.3%), followed by keratitis (n = 22, 34%). Fusarium infections are difficult to be treated due to their intrinsic resistance to different azoles; however, accurate and fast identification of etiological agents may enhance management of the infection. We present the first phylogenetic study on clinical Fusarium spp. from Iran.
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Affiliation(s)
- Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Dolatabadi
- Faculty of Engineering, Sabzevar University of New Technology, Sabzevar, Iran
| | - Sybren de Hoog
- Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Mahmoud Karimizadeh Esfahani
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iman Haghani
- Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Reza Aghili
- Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roshanak Daei Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Abdullah M S Al-Hatmi
- Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. .,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands. .,Ministry of Health, Directorate General of Health Services, Ibri, Oman.
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5
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Ocular Fungi: Molecular Identification and Antifungal Susceptibility Pattern to Azoles. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.99922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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6
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Rosa PD, Sheid K, Locatelli C, Marinho D, Goldani L. Fusarium solani keratitis: role of antifungal susceptibility testing and identification to the species level for proper management. Braz J Infect Dis 2019; 23:197-199. [PMID: 31129063 PMCID: PMC9428218 DOI: 10.1016/j.bjid.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 12/02/2022] Open
Abstract
We report a patient with fungal keratitis caused by a multiresistant Fusarium solani in a tertiary care hospital located in southern Brazil. A 55-year-old man with a history of ocular trauma presented with keratitis in left eye. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, and required eye enucleation. Despite multiple topical, intraocular and systemic antifungal treatments, hyphal infiltration persisted in the corneal transplant causing continuous recurrences. The cultures of corneal biopsy scrapings were positive for Fusarium spp. The organism was identified to species level by multi-locus sequencing for translation elongation factor 1 alpha (EF-1α), and RNA polymerase II subunit (RPB2). In vitro antifungal susceptibility testing of the isolate by the broth microdilution method, according to CLSI M38-A2, disclosed susceptibility to natamycin and resistance to amphotericin B, voriconazole, itraconazole and fluconazole. Considering previous unsuccessful antifungal treatments due to multiple drug resistance, the eye was enucleated. Our case report illustrates that management of fungal keratitis remains a therapeutic challenge. Optimal treatment for F. solani infection has not yet been established and should include susceptibility testing for different antifungal agents.
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Efficacy of Luliconazole Against Broad-Range Filamentous Fungi Including Fusarium solani Species Complex Causing Fungal Keratitis. Cornea 2019; 38:238-242. [PMID: 30422866 PMCID: PMC6343950 DOI: 10.1097/ico.0000000000001812] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Fungal keratitis can be difficult to medically treat. Topical antifungals are usually applied empirically as the initial option in treating fungal keratitis. Natamycin (NAT) and/or voriconazole (VRCZ) have been widely used in the treatment of fungal keratitis. However, Fusarium solani species complex (FSSC), which are the dominant species of fungal keratitis, are resistant to VRCZ. This study investigated in vitro efficacy of luliconazole (LLCZ), a new imidazole antifungal, against FSSC and other filamentous fungi. METHODS A total of 18 Fusarium isolates and 7 others were grown on potato dextrose agar at 30 and 37°C. For Fusarium, species identification and phylogenetic tree analysis were performed based on elongation factor-1α (EF-1α) DNA sequencing. The broth microdilution method was used for antifungal susceptibility testing of 11 antifungal drugs including LLCZ. RESULTS The 18 identified Fusarium isolates belonged to FSSC (n = 13), Fusarium oxysporum species complex (FOSC; n = 2), Fusarium chlamydosporum species complex (FCSC; n = 1), Fusarium incarnatum-equiseti species complex (FIESC; n = 1), and Fusarium fujikuroi species complex (FFSC; n = 1). We further divided 13 FSSC isolates into 3 clades, FSSC5 (n = 8), FSSC3 + 4 (n = 4), and FSSC9-a (n = 1), with 8 FSSC strains growing at 37°C. LLCZ showed lowest minimum inhibitory concentrations (MICs) against all tested filamentous fungi, with a MIC90 against the Fusarium species of 0.06 μg/mL, whereas MIC90 for NAT and VRCZ were 4 and 8 μg/mL, respectively. CONCLUSIONS LLCZ has the strongest in vitro antifungal activity among all drugs used against broad-range filamentous fungi including FSSC. LLCZ may potentially be a new medical treatment option for fungal keratitis.
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Borman AM, Szekely A, Palmer MD, Fraser M, Patterson Z, Johnson EM. The burden of serious fungal disease in the UK - infections with "rare" organisms. J Infect 2018; 77:561-571. [PMID: 30391548 DOI: 10.1016/j.jinf.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Andrew M Borman
- PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom.
| | - Adrien Szekely
- PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
| | - Michael D Palmer
- PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
| | - Mark Fraser
- PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
| | - Zoe Patterson
- PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
| | - Elizabeth M Johnson
- PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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Abstract
Fusarium is an emerging human opportunistic pathogen of growing importance, especially among immunosuppressed haematology patients due to an increased incidence of disseminated infections over the past two decades. This trend is expected only to continue due to the advances in medical and surgical technologies that will prolong the lives of the severely ill, making these patients susceptible to rare opportunistic infections. Production of mycotoxins, enzymes such as proteases, angio-invasive property and an intrinsically resistant nature, makes this genus very difficult to treat. Fusarium is frequently isolated from the cornea and less commonly from nail, skin, blood, tissue, Continuous Ambulatory Peritoneal Dialysis (CAPD) fluid, urine and pleural fluid. Conventional microscopy establishes the genus, but accurate speciation requires multilocus sequence typing with housekeeping genes such as internal transcribed spacer, translation elongation factor-1α and RPB1 and 2 (largest and second largest subunits of RNA polymerase), for which expansive internet databases exist. Identifying pathogenic species is of epidemiological significance, and the treatment includes immune reconstitution by granulocyte-colony-stimulating factor, granulocyte macrophage-colony-stimulating factor and a combination of the most active species - specific antifungals, typically liposomal amphotericin-B and voriconazole. However, patient outcome is difficult to predict even with in vitro susceptibility with these drugs. Therefore, prevention methods and antifungal prophylaxis have to be taken seriously for these vulnerable patients by vigilant healthcare workers. The current available literature on PubMed and Google Scholar using search terms 'Fusarium', 'opportunistic invasive fungi' and 'invasive fusariosis' was summarised for this review.
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Affiliation(s)
- Ananya Tupaki-Sreepurna
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Dallé da Rosa P, Nunes A, Borges R, Batista B, Meneghello Fuentefria A, Goldani LZ. In vitro susceptibility and multilocus sequence typing of Fusarium isolates causing keratitis. J Mycol Med 2018; 28:482-485. [PMID: 29779647 DOI: 10.1016/j.mycmed.2018.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 01/07/2023]
Abstract
Fungal keratitis is recognized as a significant cause of ocular morbidity and blindness especially in developing countries. In this study, we aimed to present the molecular identification and susceptibility of Fusarium isolates causing fungal keratitis in a university hospital in southern Brazil. The samples were identified using the second largest subunit of the RNA polymerase gene (RPB2) and the translation elongation factor 1-alpha (TEF1), while the antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. The majority of the isolates belonged to the Fusarium solani species complex (F. solani, F. keratoplasticum and F. falciforme) and Fusarium oxysporum species complex. Antifungal susceptibility has shown that amphotericin B and natamycin were the most effective antifungals across all isolates, followed by voriconazole. Variation among Fusarium complexes in their antifungal sensitivities was observed in our study. The identification of Fusarium species from human samples is important not only from an epidemiological viewpoint, but also for choosing the appropriate antifungal agent for difficult-to-treat Fusarium infections such as keratitis.
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Affiliation(s)
- P Dallé da Rosa
- Programa de Pós-graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A Nunes
- Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - R Borges
- Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - B Batista
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A Meneghello Fuentefria
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L Z Goldani
- Programa de Pós-graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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11
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Bourcier T, Sauer A, Dory A, Denis J, Sabou M. [Fungal keratitis]. J Fr Ophtalmol 2017; 40:882-888. [PMID: 29150029 DOI: 10.1016/j.jfo.2017.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
Fungal keratitis, or keratomycoses, are corneal infections which must be considered in cases of corneal trauma, prior corneal surgery, chronic ocular surface disease, topical corticosteroids or contact lens wear. Filamentous fungi or yeasts may be involved. Presenting clinical features such as corneal infiltrates with feathery edges and/or raised surface, intact epithelium with deep stromal involvement, satellite lesions, endothelial plaques, lack of improvement with antibiotics and worsening with steroids are suggestive of fungal keratitis. Corneal scraping for laboratory examination is mandatory. Medical management with antifungal eye drops and systemic agents should be started as soon as possible. Surgical interventions are required in a significant number of cases to control the infection. The prognosis of fungal keratitis is worse than that of bacterial keratitis.
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Affiliation(s)
- T Bourcier
- Service d'ophtalmologie, Nouvel hôpital civil, EA7290, FMTS, hôpitaux universitaires, université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - A Sauer
- Service d'ophtalmologie, Nouvel hôpital civil, EA7290, FMTS, hôpitaux universitaires, université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Dory
- Service de pharmacie, Nouvel hôpital civil, FMTS, hôpitaux universitaires, université de Strasbourg, BP 426, 67091 Strasbourg, France
| | - J Denis
- Service de parasitologie - mycologie, plateau technique de microbiologie, Nouvel hôpital civil, FMTS, hôpitaux universitaires, université de Strasbourg, BP 426, 67091 Strasbourg, France
| | - M Sabou
- Service de parasitologie - mycologie, plateau technique de microbiologie, Nouvel hôpital civil, FMTS, hôpitaux universitaires, université de Strasbourg, BP 426, 67091 Strasbourg, France
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Bourcier T, Sauer A, Dory A, Denis J, Sabou M. Fungal keratitis. J Fr Ophtalmol 2017; 40:e307-e313. [DOI: 10.1016/j.jfo.2017.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/03/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
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Abstract
In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies.
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Affiliation(s)
- Anna Skiada
- 1st Department of Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Drogari-Apiranthitou
- Infectious Diseases Research Laboratory, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Maharana PK, Sharma N, Nagpal R, Jhanji V, Das S, Vajpayee RB. Recent advances in diagnosis and management of Mycotic Keratitis. Indian J Ophthalmol 2017; 64:346-57. [PMID: 27380973 PMCID: PMC4966371 DOI: 10.4103/0301-4738.185592] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mycotic keratitis is a major cause of corneal blindness, especially in tropical and subtropical countries. The prognosis is markedly worse compared to bacterial keratitis. Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. Over the last decade, considerable progress has been made to rapidly diagnose cases with mycotic keratitis and increase the efficacy of treatment. This review article discusses the recent advances in diagnosis and management of mycotic keratitis with a brief discussion on rare and emerging organisms. A MEDLINE search was carried out for articles in English language, with the keywords, mycotic keratitis, fungal keratitis, emerging or atypical fungal pathogens in mycotic keratitis, investigations in mycotic keratitis, polymerase chain reaction in mycotic keratitis, confocal microscopy, treatment of mycotic keratitis, newer therapy for mycotic keratitis. All relevant articles were included in this review. Considering the limited studies available on newer diagnostic and therapeutic modalities in mycotic keratitis, case series as well as case reports were also included if felt important.
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Affiliation(s)
- Prafulla K Maharana
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Namrata Sharma
- Cornea and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nagpal
- Department of Ophthalmology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sujata Das
- Department of Ophthalmology, L.V. Prasad Eye Institute, Bhubaneswar, India
| | - Rasik B Vajpayee
- Department of Ophthalmology, Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Australia
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Rosa PD, Heidrich D, Corrêa C, Scroferneker ML, Vettorato G, Fuentefria AM, Goldani LZ. Genetic diversity and antifungal susceptibility of Fusarium isolates in onychomycosis. Mycoses 2017; 60:616-622. [PMID: 28657120 DOI: 10.1111/myc.12638] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/30/2017] [Accepted: 05/07/2017] [Indexed: 01/31/2023]
Abstract
Fusarium species have emerged as an important human pathogen in skin disease, onychomycosis, keratitis and invasive disease. Onychomycosis caused by Fusarium spp. The infection has been increasingly described in the immunocompetent and immunosuppressed hosts. Considering onychomycosis is a difficult to treat infection, and little is known about the genetic variability and susceptibility pattern of Fusarium spp., further studies are necessary to understand the pathogenesis and better to define the appropriate antifungal treatment for this infection. Accordingly, the objective of this study was to describe the in vitro susceptibility to different antifungal agents and the genetic diversity of 35 Fusarium isolated from patients with onychomycosis. Fusarium spp. were isolated predominantly from female Caucasians, and the most frequent anatomical location was the nail of the hallux. Results revealed that 25 (71.4%) of isolates belonged to the Fusarium solani species complex, followed by 10 (28.5%) isolates from the Fusarium oxysporum species complex. Noteworthy, the authors report the first case of Neocosmospora rubicola isolated from a patient with onychomycosis. Amphotericin B was the most effective antifungal agent against the majority of isolates (60%, MIC ≤4 μg/mL), followed by voriconazole (34.2%, MIC ≤4 μg/mL). In general, Fusarium species presented MIC values >64 μg/mL for fluconazole, itraconazole and terbinafine. Accurate pathogen identification, characterisation and susceptibility testing provide a better understanding of pathogenesis of Fusarium in onychomycosis.
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Affiliation(s)
- Priscila D Rosa
- Programa de Pós-graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daiane Heidrich
- Programa de Pós-graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Corrêa
- Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Lúcia Scroferneker
- Programa de Pós-graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gerson Vettorato
- Serviço de Dermatologia, do Hospital Santa Clara, Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre M Fuentefria
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciano Z Goldani
- Programa de Pós-graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Reduced Multidrug Susceptibility Profile Is a Common Feature of Opportunistic Fusarium Species: Fusarium Multi-Drug Resistant Pattern. J Fungi (Basel) 2017; 3:jof3020018. [PMID: 29371536 PMCID: PMC5715927 DOI: 10.3390/jof3020018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/27/2017] [Accepted: 04/07/2017] [Indexed: 01/26/2023] Open
Abstract
The resistance among various opportunistic Fusarium species to different antifungal agents has emerged as a cause of public health problems worldwide. Considering the significance of multi-drug resistant (MDR), this paper emphasizes the problems associated with MDR and the need to understand its clinical significance to combat microbial infections. The search platform PubMed/MEDLINE and a review of 32 cases revealed a common multidrug-resistant profile exists, and clinically relevant members of Fusarium are intrinsically resistant to most currently used antifungals. Dissemination occurs in patients with prolonged neutropenia, immune deficiency, and especially hematological malignancies. Amphotericin B displayed the lowest minimum inhibitory concentrarions (MICs) followed by voriconazole, and posaconazole. Itraconazole and fluconazole showed high MIC values, displaying in vitro resistance. Echinocandins showed the highest MIC values. Seven out of ten (70%) patients with neutropenia died, including those with fungemia that progressed to skin lesions. Clinical Fusarium isolates displayed a common MDR profile and high MIC values for the most available antifungal agents with species- and strain-specific differences in antifungal susceptibility. Species identification of Fusarium infections is important. While the use of natamycin resulted in a favorable outcome in keratitis, AmB and VRC are the most used agents for the treatment of fusariosis in clinical settings.
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Al-Hatmi AM, Hagen F, Menken SB, Meis JF, de Hoog GS. Global molecular epidemiology and genetic diversity of Fusarium, a significant emerging group of human opportunists from 1958 to 2015. Emerg Microbes Infect 2016; 5:e124. [PMID: 27924809 PMCID: PMC5180370 DOI: 10.1038/emi.2016.126] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/16/2022]
Abstract
Fusarium is a rapidly emerging, multidrug-resistant genus of fungal opportunists that was first identified in 1958 and is presently recognized in numerous cases of fusariosis each year. The authors examined trends in global Fusarium distribution, clinical presentation and prevalence since 1958 with the assumption that their distributions in each region had remained unaltered. The phylogeny and epidemiology of 127 geographically diverse isolates, representing 26 Fusarium species, were evaluated using partial sequences of the RPB2 and TEF1 genes, and compared with AFLP fingerprinting data. The molecular data of the Fusarium species were compared with archived data, which enabled the interpretation of hundreds of cases published in the literature. Our findings indicate that fusariosis is globally distributed with a focus in (sub)tropical areas. Considerable species diversity has been observed; genotypic features did not reveal any clustering with either the clinical data or environmental origins. This study suggests that infections with Fusarium species might be truly opportunistic. The three most common species are F. falciforme and F. keratoplasticum (members of F. solani species complex), followed by F. oxysporum (F. oxysporum species complex).
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Affiliation(s)
- Abdullah Ms Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, Department of Medical Mycology, Utrecht 3508 AD, The Netherlands.,Institutes of Biodiversity and Ecosystem Dynamics, Department of Biology, University of Amsterdam, Amsterdam 1098 XH, The Netherlands.,Directorate General of Health Services, Ibri Hospital, Department of laboratories, Ministry of Health, Muscat PC 113, Oman
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen 6532 SZ, The Netherlands
| | - Steph Bj Menken
- Institutes of Biodiversity and Ecosystem Dynamics, Department of Biology, University of Amsterdam, Amsterdam 1098 XH, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen 6532 SZ, The Netherlands.,Department of Medical Microbiology, Radboudumc, Nijmegen 6525 HP, The Netherlands
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Department of Medical Mycology, Utrecht 3508 AD, The Netherlands.,Institutes of Biodiversity and Ecosystem Dynamics, Department of Biology, University of Amsterdam, Amsterdam 1098 XH, The Netherlands.,Department of Basic Pathology, Federal University of Parana State, Curitiba 81540-970, Parana, Brazil.,Department of Biology, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Refojo N, Minervini P, Hevia AI, Abrantes RA, Fernández J, Apestey N, Garnero M, Villada M, Davel G. Keratitis caused by moulds in Santa Lucía Ophthalmology Hospital in Buenos Aires, Argentina. Rev Iberoam Micol 2016; 33:1-6. [DOI: 10.1016/j.riam.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/11/2015] [Accepted: 02/23/2015] [Indexed: 11/27/2022] Open
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Al-Hatmi AMS, Meletiadis J, Curfs-Breuker I, Bonifaz A, Meis JF, De Hoog GS. In vitro combinations of natamycin with voriconazole, itraconazole and micafungin against clinical Fusarium strains causing keratitis. J Antimicrob Chemother 2015; 71:953-5. [PMID: 26702918 DOI: 10.1093/jac/dkv421] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/09/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Fusarium species cause a broad spectrum of infections, from superficial to disseminated disease. Because Fusarium species are intrinsically resistant to most antifungal drugs, new approaches are needed. The aim of the present study was to evaluate the in vitro combination of natamycin with currently used antifungal drugs. METHODS The in vitro interactions of combinations between natamycin and voriconazole, itraconazole and micafungin applied to 20 clinical Fusarium strains (members of Fusarium falciforme, Fusarium napiforme, Fusarium petroliphilum, Fusarium proliferatum, Fusarium pseudensiforme and Fusarium sacchari) were evaluated using a chequerboard microdilution method. The MICs of all drugs alone and in combination were determined visually after 48 h and interactions were assessed using fractional inhibitory concentration index (FICI) analysis. RESULTS MICs of voriconazole and natamycin alone were 4 to >16 and 4-8 mg/L, respectively. Values were reduced 3.5-10-fold to 0.02-0.5 mg/L and 0.5-5-fold to 0.13-2 mg/L in combination, for the currently used antifungals and natamycin, respectively, demonstrating additive to synergistic interactions. The combinations natamycin/voriconazole, natamycin/itraconazole and natamycin/micafungin were synergistic (FICI ≤0.5) for 70%, 15% and 5% of the strains, respectively. No antagonism was found. CONCLUSIONS The combination of natamycin with voriconazole was strongly synergistic at clinically achievable serum concentrations.
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Affiliation(s)
- Abdullah M S Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, PO Box 85167, 3508 AD 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
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilse Curfs-Breuker
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G Sybren De Hoog
- CBS-KNAW Fungal Biodiversity Centre, PO Box 85167, 3508 AD Utrecht, The Netherlands Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Salah H, Al-Hatmi AMS, Theelen B, Abukamar M, Hashim S, van Diepeningen AD, Lass-Florl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Phylogenetic diversity of human pathogenic Fusarium and emergence of uncommon virulent species. J Infect 2015; 71:658-66. [PMID: 26348828 DOI: 10.1016/j.jinf.2015.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Fusarium species cause a broad spectrum of infections. However, little is known about the etiological agents to the species level. We identified Fusarium species isolated from clinical specimens including those of high risk patients to better understand the species involved in the pathogenesis. METHODS A set of 44 Fusarium isolates were identified by two-locus sequence typing using partial sequences of the second largest subunit of RNA polymerase (RPB2) and translation elongation factor 1 alpha (TEF-1α). RESULTS The identified species belonged to four species complexes (SC); the most common SC was Fusarium solani (FSSC) (75%), followed by Fusarium oxysporum (FOSC) (4.5%), Fusarium fujikuroi (FFSC) (13.6%), and Fusarium dimerum (FDSC) (6.8%). Sites of infections were nails (n = 19, 43.2%), skin (n = 7, 15.9%), cornea (n = 6, 13.6%), blood (n = 3, 9%), wound (n = 4, 6.8%), burn (n = 2, 4.5%), tissue (n = 2, 4.5%), and urine (n = 1, 2.27%). Fusarium acutatum was rare and seem restricted to the Middle East. Comorbidities associated with invasive infections were hematological malignancy and autoimmune disorders. CONCLUSIONS Members of the FSSC predominantly caused cornea, nail and bloodstream infections. Less frequently encountered were the FOSC, FFSC and FDSC. More accurate molecular identification of Fusarium species is important to predict therapeutic outcome and the emergence of these species.
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Affiliation(s)
- Husam Salah
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar; CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Abdullah M S Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands; Directorate General of Health Services, Ministry of Health, Ibri Hospital, Ibri, Oman
| | - Bart Theelen
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammed Abukamar
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Samar Hashim
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | | | - Cornelia Lass-Florl
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
| | - Teun Boekhout
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Institute of Dermatology and Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; Institute of Microbiology, Chinese Academy of Science, Beijing, People's Republic of China
| | - Muna Almaslamani
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Saad J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar.
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Fungal Peritonitis Due to Fusarium solani Species Complex Sequential Isolates Identified with DNA Sequencing in a Kidney Transplant Recipient in Brazil. Mycopathologia 2015; 180:397-401. [DOI: 10.1007/s11046-015-9929-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
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Wang L, Wang L, Han L, Yin W. Study of Pathogens of Fungal Keratitis and the Sensitivity of Pathogenic Fungi to Therapeutic Agents with the Disk Diffusion Method. Curr Eye Res 2015; 40:1095-101. [PMID: 26268399 DOI: 10.3109/02713683.2015.1056802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/AIM OF THE STUDY To identify the causative fungi of fungal keratitis, test their susceptibility to antifungal agents with the disk diffusion method and study the relationship between the organisms, the inhibition zones and the clinical outcomes. MATERIALS AND METHODS 535 patients with fungal keratitis in one eye were included in this study. Pathogenic fungi were isolated by corneal scraping, identified by fungal cultivation and subjected to drug sensitivity tests conducted with the disk diffusion method. The patients were treated initially with voriconazole, terbinafine and natamycin eye drops for one week. Further treatment continued using the most effective drug according to the drug sensitivity results. The patients were followed up every week until three months after cured. The inhibition zones of fungi cultured with voriconazole, terbinafine and natamycin were compared. The relationship between inhibition zones and organism, organism and treatment results measure, and each treatment results measure and inhibition zones were evaluated. RESULTS Of 535 patients, 53.84%, 19.25% and 26.91% were infected with Aspergillus, Fusarium and other fungi, respectively. Keratitis patients infected with Aspergillus keratitis had the worst outcome. The size of the inhibition zones of Aspergillus spp., Fusarium spp. and other fungal genera differed significantly in response to voriconazole, terbinafine and natamycin. The inhibition zone associated with natamycin correlated significantly with the clinical outcome of fungal keratitis (OR = 0.925), but no other such correlations were found for the other drugs tested. CONCLUSIONS Aspergillus and Fusarium were the predominant pathogenic genera causing fungal keratitis in our patients. Among the causative fungi, infections due to Aspergillus spp. were associated with the worst outcomes. The inhibition zones of fungal isolates in response to natamycin significantly correlated with the treatment outcomes of keratitis. Specifically, the smaller the natamycin inhibition zone, the lower the probability that the fungal keratitis had been eliminated.
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Affiliation(s)
- Lulu Wang
- a Department of Ophthalmology , Zhengzhou University People's Hospital , Zhengzhou , P.R. China
| | - Liya Wang
- a Department of Ophthalmology , Zhengzhou University People's Hospital , Zhengzhou , P.R. China
| | - Lei Han
- a Department of Ophthalmology , Zhengzhou University People's Hospital , Zhengzhou , P.R. China
| | - Weijing Yin
- a Department of Ophthalmology , Zhengzhou University People's Hospital , Zhengzhou , P.R. China
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Al-Hatmi AMS, Bonifaz A, de Hoog GS, Vazquez-Maya L, Garcia-Carmona K, Meis JF, van Diepeningen AD. Keratitis by Fusarium temperatum, a novel opportunist. BMC Infect Dis 2014; 14:588. [PMID: 25388601 PMCID: PMC4234859 DOI: 10.1186/s12879-014-0588-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/24/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Fusarium species are among the most common fungi present in the environment and some species have emerged as major opportunistic fungal infection in human. However, in immunocompromised hosts they can be virulent pathogens and can cause death. The pathogenesis of this infection relies on three factors: colonization, tissue damage, and immunosuppression. A novel Fusarium species is reported for the first time from keratitis in an agriculture worker who acquired the infection from plant material of maize. Maize plants are the natural host of this fungus where it causes stalk rot and seeding malformation under temperate and humid climatic conditions. The clinical manifestation, microbiological morphology, physiological features and molecular data are described. METHODS Diagnosis was established by using polymerase chain reaction of fungal DNA followed by sequencing portions of translation elongation factor 1 alpha (TEF1 α) and beta-tubulin (BT2) genes. Susceptibility profiles of this fungus were evaluated using CLSI broth microdilution method. RESULTS The analyses of these two genes sequences support a novel opportunist with the designation Fusarium temperatum. Phylogenetic analyses showed that the reported clinical isolate was nested within the Fusarium fujikuroi species complex. Antifungal susceptibility testing demonstrated that the fungus had low MICs of micafungin (0.031 μg/ml), posaconazole (0.25 μg/ml) and amphotericin B (0.5 μg/ml). CONCLUSION The present case extends the significance of the genus Fusarium as agents of keratitis and underscores the utility of molecular verification of these emerging fungi in the human host.
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Affiliation(s)
- Abdullah M S Al-Hatmi
- />CBS-KNAW Fungal Biodiversity Centre, Utrecht, 3508 AD The Netherlands
- />Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
- />Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman
| | | | - G Sybren de Hoog
- />CBS-KNAW Fungal Biodiversity Centre, Utrecht, 3508 AD The Netherlands
- />Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
- />Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China
- />Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- />Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- />Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná Brazil
- />King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Jacques F Meis
- />Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- />Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Tianyang Z, Ling Z, Huiyun X, Jijun H, Junjie Z. Determination of natamycin in rabbit cornea by high-performance liquid chromatography–tandem mass spectrometry with protective soaking extraction technology. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 969:53-9. [DOI: 10.1016/j.jchromb.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/04/2014] [Accepted: 08/03/2014] [Indexed: 11/16/2022]
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