Outbreak of Fusarium keratitis in soft contact lens wearers in San Francisco

Cornea Service, Department of Ophthalmology, University of California-San Francisco, 10 Koret Way K-301, San Francisco, CA 94143, USA.
Archives of Ophthalmology (Impact Factor: 4.4). 08/2006; 124(7):1051-3. DOI: 10.1001/archopht.124.7.ecr60006
Source: PubMed
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    • "They are found commonly in air and water [3]. Fusarium keratitis may be caused by ocular trauma with involvement of organic matter or may be related to contact lens wear or refractive surgery [5] [6]. Natamycin is a naturally occurring antifungal agent produced during fermentation by the bacterium Streptomyces natalensis and commonly found in soil. "
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    ABSTRACT: Purpose. To present the success of posaconazole in two cases with recalcitrant fugal keratitis that were resistant to conventional antifungal drugs. Method. We presented two cases that were treated with posaconazole after the failure of fluconazole or voriconazole, amphotericin B, and natamycin therapy. Case 1 was a 62-year-old man with a history of ocular trauma. He had been using topical fluorometholone and tobramycin. His best corrected visual acuity (BCVA) was hand motion. He had 5.0 × 4.5 mm area of deep corneal ulcer with stromal infiltration. Case 2 was a 14-year-old contact lens user. He had been using topical moxifloxacin, tobramycin, and cyclopentolate. His BCVA was 20/200. He had a 4.0 × 3.0 mm area of pericentral corneal ulcer with deep corneal stromal infiltration and 2 mm hypopyon. Results. Both patients initially received systemic and topical fluconazole or voriconazole and amphotericin B and topical natamycin that were all ineffective. But the response of posaconazole was significant. After posaconazole, progressive improvement was seen in clinical appearance. BCVA improved to 20/100 in case 1 and 20/40 in case 2. Conclusion. Posaconazole might be an effective treatment option for recalcitrant fusarium keratitis and/or endophthalmitis resistant to conventional antifungal drugs.
    Full-text · Article · Aug 2014
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    • "– have led to an increased incidence of keratomycosis (Benz et al., 2004; Marangon et al., 2004; Srinivasan, 2004). Recently, a minor epidemic of fungal keratitis was linked to specific contact lens disinfections solutions (Bernal et al., 2006). Therefore, fungal infections of the eye are of increasing concern. "
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    ABSTRACT: Fungal keratitis is a sight-threatening infection of the cornea. It sometimes leads to loss of the eye. Despite an expanding range of fungal pathogens, there are only few therapeutic agents for its treatment available. Voriconazole is a second-generation synthetic triazole with a broad action against yeasts and molds. The current study investigates the safety of voriconazole for intracameral application in a cell culture model. Endothelial toxicity of voriconazole was evaluated in cultured human corneas. Possible toxic effects of voriconazole (10 microg /mL-10mg/mL) in corneal endothelial cells (CEC), primary human trabecular meshwork cells (TMC), and primary human retinal pigment epithelium (RPE) cells were evaluated after 24h and under conditions of inflammatory stress by treatment with tumor-necrosis-factor alpha (TNF-alpha), lipopolysaccharides (LPS), or interleukin-6 (IL-6) and hydrogen peroxide. Toxicity was evaluated by tetrazolium dye-reduction assay, and cell viability was quantified by a microscopic live-dead assay. No corneal endothelial toxicity could be detected after 30 days of treatment with 250 microg /mL of voriconazole. Concentrations up to 1mg/mL had no influence on CEC, TMC, or RPE cell proliferation, or on cell viability when administered for 24h. Hydrogen peroxide exposure did not increase cellular toxicity of voriconazole at concentrations from 10 to 250 microg /mL. After preincubation with TNF-alpha, LPS, or IL-6 for 24h and subsequent voriconazole treatment for 24h, no significant decrease in proliferation or viability was observed. This study showed no significant toxicity for voriconazole on CEC, TMC, RPE cells, or human corneal endothelium when administered in therapeutic concentrations up to 250 microg /mL.
    Full-text · Article · May 2009 · Toxicology
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    • "Fungal keratitis is rare in non-tropical or sub-tropical areas. Despite this well recognized climate-associated pattern, Fusarium CL-MK was reported in states including Pennsylvania, Ohio, and California even during the cold winter months (Bernal et al 2006; Cohen 2006; Jeng et al 2006). "
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    ABSTRACT: The 2005-2006 outbreak of Fusarium keratitis associated with soft hydrophilic contact lens wear was both unprecedented and unexpected. More than 250 cases have been reported worldwide that have primarily been associated with Bausch & Lomb ReNu with MoistureLoc and, more recently, with Bausch and Lomb ReNu MultiPlus multipurpose contact lens disinfecting solutions. This article documents the outbreak, presenting the time line and the historical and scientific basis for its occurrence. Underlying causes are explored including likely mechanisms of contamination and subsequent corneal infection. Thorough exploration of this unique occurrence affords the opportunity to examine contact lens and lens care actions and interactions and to develop greater understanding of possible associated risks and ways to minimize them.
    Full-text · Article · Jan 2008 · Clinical ophthalmology (Auckland, N.Z.)
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