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Published on: October 28, 2021
Fusarium keratitis: genotyping, in vitro susceptibility and clinical outcomes
Rafael A Oechsler1, Michael R Feilmeier, Darlene Miller
1Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA. rafallan@hotmail.com
Purpose:
To determine differences in the clinical characteristics and antifungal susceptibility patterns among molecularly characterized ocular Fusarium sp isolates.
Methods:
Fifty-eight isolates of Fusarium sp obtained from 52 eyes of 52 patients were retrieved from the Ocular Microbiology Laboratory of the Bascom Palmer Eye Institute and grown in pure culture. These isolates were characterized based on DNA sequence analysis of the ITS1/2 and ribosomal deoxyribonucleic acid regions. Antifungal susceptibilities were determined for each isolate using broth microdilution methods, and the corresponding medical records were reviewed to determine the clinical outcomes.
Results:
Fusarium solani isolates had significantly higher values of minimum inhibitory concentration for 90% isolates (MIC90) with voriconazole than F. non-solani organisms (16 and 4 μg/mL, respectively). Isolates of F. solani also exhibited a significantly longer time to cure (65 vs. 40.5 days), a worse follow-up best-corrected visual acuity (20/118 vs. 20/36), and an increased need for urgent surgical management (7 vs. 0 penetrating keratoplasties) when compared with those of F. non-solani.
Conclusions:
This is the first report to examine the correlation between ocular genotyped Fusarium sp and clinical outcomes. It supports the overall worse prognosis of F. solani versus F. non-solani isolates, including higher voriconazole resistance by the former. The clinical implementation of molecular-based diagnostics and antifungal efficacy testing may yield important prognostic and therapeutic information that could improve the management of fungal ocular infections.
Insights
Molecularly characterized Fusarium solani isolates show worse clinical outcomes and higher voriconazole resistance compared to F. non-solani. This highlights the importance of molecular diagnostics for managing fungal eye infections.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Ocular fungal infections pose a significant threat to vision.
- Accurate identification of Fusarium species is crucial for effective treatment.
- Previous studies have not fully elucidated the clinical impact of genotyped Fusarium species.
Purpose of the Study:
- To compare clinical characteristics and antifungal susceptibility of molecularly identified ocular Fusarium species.
- To determine if Fusarium solani isolates have different clinical outcomes and drug resistance compared to other Fusarium species.
Main Methods:
- Fifty-eight ocular Fusarium isolates were molecularly characterized using DNA sequencing.
- Antifungal susceptibility testing was performed using broth microdilution.
- Clinical data and outcomes were reviewed from patient medical records.
Main Results:
- Fusarium solani isolates demonstrated significantly higher minimum inhibitory concentration (MIC90) for voriconazole (16 μg/mL) than F. non-solani (4 μg/mL).
- F. solani infections resulted in longer time to cure (65 vs. 40.5 days), poorer visual acuity, and increased need for surgery.
- A statistically significant difference in outcomes was observed between F. solani and F. non-solani.
Conclusions:
- This study is the first to correlate genotyped ocular Fusarium species with clinical outcomes.
- Fusarium solani is associated with a worse prognosis and higher antifungal resistance.
- Molecular diagnostics and antifungal susceptibility testing can provide valuable prognostic and therapeutic information for fungal keratitis.
