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Fusarium Keratitis in Taiwan: Molecular Identification, Antifungal Susceptibilities, and Clinical Features
Tsung-En Huang1, Jie-Hao Ou2, Ning Hung1
1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
Abstract:
We performed molecular identification and antifungal susceptibilities of pathogens and investigated clinical features of 43 culture-proven Fusarium keratitis cases from 2015-2020 in Taiwan. The pathogens were identified by sequencing of their internal transcribed spacer regions of ribosomal DNA and translation elongation factor 1α gene; their antifungal susceptibilities (to seven agents) were determined by broth microdilution method. We also collected clinical data to compare the drug susceptibilities and clinical features of Fusarium solani species complex (FSSC) isolates with those of other Fusarium species complexes (non-FSSC). The FSSC accounted for 76.7% pathogens, among which F. falciforme (32.6%) and F. keratoplasticum (27.9%) were the most common species. Among clinically used antifungal agents, amphotericin B registered the lowest minimal inhibitory concentration (MIC), and the new azoles efinaconazole, lanoconazole and luliconazole, demonstrated even lower MICs against Fusarium species. The MICs of natamycin, voriconazole, chlorhexidine, lanoconazole, and luliconazole were higher for the FSSC than the non-FSSC, but no significant differences were noted in clinical outcomes, including corneal perforation and final visual acuity. In Taiwan, the FSSC was the most common complex in Fusarium keratitis; its MICs for five tested antifungal agents were higher than those of non-FSSC, but the clinical outcomes did not differ significantly.
Insights
The Fusarium solani species complex (FSSC) is the most common cause of Fusarium keratitis in Taiwan. Despite higher antifungal resistance in FSSC, clinical outcomes for Fusarium keratitis remain similar across species complexes.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fusarium keratitis is a serious ocular infection, with the Fusarium solani species complex (FSSC) being a predominant pathogen.
- Understanding the antifungal susceptibility patterns and clinical characteristics of different Fusarium species complexes is crucial for effective treatment.
Purpose of the Study:
- To identify Fusarium species causing keratitis in Taiwan and determine their antifungal susceptibilities.
- To compare the clinical features and drug susceptibilities between FSSC and non-FSSC isolates.
Main Methods:
- Molecular identification of Fusarium pathogens using ribosomal DNA internal transcribed spacer regions and translation elongation factor 1α gene sequencing.
- Antifungal susceptibility testing of seven agents using the broth microdilution method.
- Retrospective analysis of clinical data from 43 culture-proven Fusarium keratitis cases.
Main Results:
- FSSC accounted for 76.7% of Fusarium keratitis cases, with *F. falciforme* and *F. keratoplasticum* being the most frequent species.
- Newer azoles (efinaconazole, lanoconazole, luliconazole) and amphotericin B showed low minimal inhibitory concentrations (MICs).
- FSSC isolates exhibited higher MICs for several antifungals (natamycin, voriconazole, chlorhexidine, lanoconazole, luliconazole) compared to non-FSSC, but clinical outcomes were similar.
Conclusions:
- The FSSC is the predominant cause of Fusarium keratitis in Taiwan.
- While FSSC demonstrates increased resistance to certain antifungals, this does not translate to significantly different clinical outcomes compared to other Fusarium species.
- Continued surveillance and susceptibility testing are important for managing Fusarium keratitis.
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