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Fusarium Keratitis in Germany
Grit Walther1, Serena Stasch2, Kerstin Kaerger2
1National Reference Center for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany Grit.Walther@hki-jena.de.
Abstract:
Fusarium keratitis is a destructive eye infection that is difficult to treat and results in poor outcome. In tropical and subtropical areas, the infection is relatively common and associated with trauma or chronic eye diseases. However, in recent years, an increased incidence has been reported in temperate climate regions. At the German National Reference Center, we have observed a steady increase in case numbers since 2014. Here, we present the first German case series of eye infections with Fusarium species. We identified Fusarium isolates from the eye or eye-related material from 22 patients in 2014 and 2015. Thirteen isolates belonged to the Fusarium solani species complex (FSSC), 6 isolates belonged to the Fusarium oxysporum species complex (FOSC), and three isolates belonged to the Fusarium fujikuroi species complex (FFSC). FSSC was isolated in 13 of 15 (85%) definite infections and FOSC in 3 of 4 (75%) definite contaminations. Furthermore, diagnosis from contact lens swabs or a culture of contact lens solution turned out to be highly unreliable. FSSC isolates differed from FOSC and FFSC by a distinctly higher MIC for terbinafine. Outcome was often adverse, with 10 patients requiring keratoplasty or enucleation. The use of natamycin as the most effective agent against keratitis caused by filamentous fungi was rare in Germany, possibly due to restricted availability. Keratitis caused by Fusarium spp. (usually FSSC) appears to be a relevant clinical problem in Germany, with the use of contact lenses as the predominant risk factor. Its outcome is often adverse.
Insights
Fusarium keratitis, a severe eye infection, is increasingly seen in Germany, particularly linked to contact lens use. This fungal infection often leads to poor outcomes, necessitating advanced treatments.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fusarium keratitis is a destructive fungal eye infection, historically common in tropical regions.
- An increasing incidence of Fusarium keratitis is now reported in temperate climates, including Germany.
- The German National Reference Center observed a rise in Fusarium cases since 2014.
Purpose of the Study:
- To present the first German case series of Fusarium keratitis.
- To identify Fusarium species involved and their clinical significance.
- To analyze risk factors and treatment outcomes.
Main Methods:
- Retrospective analysis of 22 Fusarium isolates from ocular samples (2014-2015).
- Identification of Fusarium species complexes: Fusarium solani species complex (FSSC), Fusarium oxysporum species complex (FOSC), and Fusarium fujikuroi species complex (FFSC).
- Antifungal susceptibility testing (MIC) and clinical outcome assessment.
Main Results:
- FSSC was the predominant species in definite infections (13/15 cases).
- Contact lens wear was identified as the primary risk factor.
- Adverse outcomes were common, with 10 patients requiring keratoplasty or enucleation; natamycin use was limited.
Conclusions:
- Fusarium keratitis, especially FSSC, is a significant and growing clinical issue in Germany.
- Contact lens wear is a major risk factor for this infection.
- Effective treatment options like natamycin are underutilized, contributing to poor outcomes.
