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Trends in fungal keratitis in the United States, 2001 to 2007
Emily W Gower1, Lisa J Keay, Rafael A Oechsler
1Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland 21287, USA. egower1@jhmi.edu
Objective:
Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population.
Design:
Retrospective, multicenter case series.
Participants:
Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007.
Methods:
Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research.
Main Outcome Measures:
Quarterly number of fungal keratitis cases and fungal species.
Results:
We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P < 0.0001).
Conclusions:
The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear.
Insights
Fungal keratitis cases among contact lens wearers decreased after a specific product withdrawal. However, other filamentous fungal keratitis cases saw a rise, with causes remaining unclear.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Fungal keratitis is a severe eye infection.
- It is considered rare in contact lens wearers.
- A recent Fusarium keratitis outbreak prompted investigation into fungal keratitis rates in this population.
Purpose of the Study:
- To determine the background rate of fungal keratitis, specifically Fusarium, in contact lens wearers.
- To investigate trends in fungal keratitis cases among contact lens wearers between 2001 and 2007.
Main Methods:
- Retrospective, multicenter case series.
- Reviewed 695 culture-positive fungal keratitis cases from 10 US tertiary care centers (2001-2007).
- Collected data on contact lens status, diagnosis methods, and identified organisms; analyzed quarterly trends using Poisson regression.
Main Results:
- Identified 695 fungal keratitis cases; 283 involved contact lens wearers.
- Fusarium cases increased among contact lens wearers while a specific contact lens solution was marketed, returning to baseline post-withdrawal.
- Other filamentous fungal keratitis cases significantly increased among contact lens wearers from 2004-2007 compared to 2001-2004.
Conclusions:
- The incidence of Fusarium keratitis among contact lens wearers returned to pre-outbreak levels after product removal.
- A small but statistically significant increase in other filamentous fungal keratitis cases was observed in contact lens wearers.
- The reasons for the increase in non-Fusarium fungal keratitis remain undetermined.