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Molecular characterization of fungal endophthalmitis and keratitis caused by yeasts

Nicole L Belanger1,2, Su Jeoung Kim1,2, Paulo J M Bispo1,2

  • 1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.

Medical Mycology
|December 24, 2022
PubMed

Insights

Candida species cause sight-threatening eye infections. This study found Candida albicans is common, but emerging non-albicans species like Candida parapsilosis and Candida dubliniensis are also significant causes of ocular infections.

Area of Science:

  • Ophthalmology
  • Medical Mycology
  • Molecular Epidemiology

Background:

  • Fungal ocular infections, particularly those caused by Candida species, pose a significant threat to vision globally.
  • Limited understanding exists regarding the emergence of novel Candida species and the molecular epidemiology of these infections.

Purpose of the Study:

  • To molecularly characterize yeast isolates from ocular infections to identify causative Candida species and their epidemiological patterns.
  • To investigate the molecular epidemiology of Candida albicans isolates, including clonal complex distribution and potential niche-specific enrichment.

Main Methods:

  • Sequencing of the ITS1-5.8S-ITS2 regions for species identification of 38 yeast isolates from endophthalmitis and keratitis.
  • Multilocus sequence typing (MLST) for molecular subtyping of Candida albicans isolates.
  • Correlation of species and strain types with clinical diagnoses (endophthalmitis vs. keratitis).

Main Results:

  • Candida species accounted for 97% of isolates, with Candida albicans being the most prevalent (58%).
  • Emerging non-albicans species, primarily Candida parapsilosis and Candida dubliniensis, were identified.
  • Candida dubliniensis isolates were exclusively from endophthalmitis, while Candida parapsilosis were mostly from keratitis.
  • Candida albicans isolates predominantly belonged to clonal complex 1 (CC1), which was more prevalent in endophthalmitis cases.
  • One multi-azole resistant Candida albicans isolate was identified.

Conclusions:

  • Candida albicans is a major cause of fungal ocular infections, with emerging non-albicans species showing distinct clinical associations.
  • Specific Candida albicans clades, particularly CC1, may be enriched in endophthalmitis, suggesting potential virulence or niche adaptation.
  • Molecular characterization is crucial for understanding the epidemiology and guiding treatment of fungal eye infections.
Keywords:
CandidaEndophthalmitiskeratitismolecular typingocular surface disease

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