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Epidemiology of Aspergillus species causing keratitis in Mexico
Abdullah M S Al-Hatmi1,2,3, Marino Alcantara Castro4, G Sybren de Hoog1,3
1Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.
Background:
The incidence of fungal keratitis has increased in recent years. While the epidemiology and clinical roles of various Candida and Fusarium species have been relatively well-identified in infections of the eye, data regarding keratitis caused by Aspergillus species are scant. Accurate and rapid diagnosis is important for successful management of this infection.
Objectives:
To present the first molecular epidemiological data from Mexico during a 4-year period of cases admitted with Aspergillus keratitis to a tertiary care eye institution in Mexico City.
Patients/Methods:
A total of 25 cases of keratitis were included in the study. Aspergillus isolates were identified by sequencing the calmodulin gene. Antifungal susceptibility was tested according to CLSI.
Results:
The aetiological agents belonged to Aspergillus flavus (n = 13), Aspergillus effusus (n = 1), Aspergillus tamarii (n = 4), Aspergillus sydowii (n = 1), Aspergillus protuberus (n = 3) and Aspergillus terreus (n = 3). All strains had low minimum inhibitory concentrations (MICs) of itraconazole and voriconazole (VCZ). Amphotericin B and natamycin showed moderate elevated MICs.
Conclusions:
Early diagnosis and application of topical VCZ 1% were associated with good outcome. Monitoring of local epidemiological data plays an important role in clinical practice.
Insights
Aspergillus keratitis is an emerging threat. This study identified Aspergillus species causing eye infections in Mexico and found topical voriconazole (VCZ) effective for treatment.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis incidence is rising, with limited data on Aspergillus species.
- Accurate diagnosis of Aspergillus keratitis is crucial for effective management.
Purpose of the Study:
- To report the first molecular epidemiology of Aspergillus keratitis in Mexico.
- To analyze cases from a tertiary eye care institution over four years.
Main Methods:
- Molecular identification of Aspergillus isolates using calmodulin gene sequencing.
- Antifungal susceptibility testing according to Clinical and Laboratory Standards Institute (CLSI) guidelines.
- Analysis of 25 cases of Aspergillus keratitis.
Main Results:
- Aspergillus flavus was the most common species (n=13).
- All isolates showed low minimum inhibitory concentrations (MICs) for itraconazole and voriconazole (VCZ).
- Moderate elevated MICs were observed for Amphotericin B and natamycin.
Conclusions:
- Early diagnosis and topical voriconazole (VCZ) 1% are linked to favorable outcomes.
- Local epidemiological surveillance is vital for clinical practice in managing Aspergillus keratitis.
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