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[Fusarium Keratitis-an upcoming threat in Germany?]
Bogdana Kovalchuk1, Ramin Khoramnia1, Marcell Tóth2
1Univ.-Augenklinik Heidelberg, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
Background:
Fungal keratitis due to Fusarium species is known to be typical of developing countries; however, with the increasing use of contact lenses a rise of Fusarium keratitis has been observed in Germany.
Methods:
In a monocentric retrospective study, we analyzed all patients who presented to our university eye hospital with infectious keratitis between January 2011 and December 2021 and had a proof of Fusarium species in either microscopy, culture or PCR.
Results:
We could identify 13 patients with a proof of Fusarium species. A significant increase of cases in 2021 was observed. In 76.9% of our cases the patients were female and in 76.9% the patients had a history of prior contact lens use. In only 4 cases the initial corneal sample gave a positive result for Fusarium. On average the suspicion of fungal keratitis arose 13.1 days after onset of symptoms, correct diagnosis was achieved after 14.6 days. All isolated specimens showed resistance against at least one of the common fungicides. In 70% of our cases treatment with penetrating keratoplasty was necessary. The patients showed a 57.1% recurrence rate after penetrating keratoplasty. In 80% of our cases best documented visual acuity after Fusarium keratitis was ≤ 0.4.
Conclusion:
Due to difficult detection and a high resistance rate to common antifungals, Fusarium keratitis is prone to delayed diagnosis and limited treatment outcomes. Whenever risk factors are present and infectious keratitis does not respond to antibiotics, antimycotic treatment must be initiated. Early keratoplasty may be necessary.
Insights
Fusarium keratitis, a fungal eye infection, is increasingly seen in Germany, particularly with contact lens use. High antifungal resistance and delayed diagnosis lead to poor visual outcomes and frequent need for corneal transplants.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Fusarium keratitis is traditionally associated with developing countries.
- An increasing incidence of Fusarium keratitis has been noted in Germany, linked to contact lens usage.
Purpose of the Study:
- To analyze cases of Fusarium keratitis in Germany.
- To understand the clinical characteristics, diagnostic challenges, and treatment outcomes.
Main Methods:
- A monocentric retrospective study analyzed patients with infectious keratitis from 2011-2021.
- Identification of Fusarium species was confirmed via microscopy, culture, or PCR.
Main Results:
- 13 patients with Fusarium keratitis were identified, with a notable increase in 2021.
- Contact lens use was a significant risk factor (76.9%), predominantly affecting females.
- Delayed diagnosis (average 14.6 days), high antifungal resistance, and frequent need for penetrating keratoplasty (70%) with a 57.1% recurrence rate were observed.
Conclusions:
- Difficult detection and high antifungal resistance contribute to delayed diagnosis and poor treatment outcomes.
- Antimycotic treatment should be initiated promptly when risk factors are present and keratitis is unresponsive to antibiotics.
- Early penetrating keratoplasty may be required for effective management.
