Aspergillus hiratsukae as a causative agent of endophthalmitis: A case report

Aspergillus flavus and Aspergillus fumigatus are commonly involved in fungal endophthalmitis. However, other less pathogenic species of the genus are also causal agents of opportunistic infections. Aspergillus hiratsukae, a species within Aspergillus section Fumigati, is an uncommon fungus responsible for a few infectious cases worldwide.

We present a case of post-surgical endophthalmitis in a man caused by A. hiratsukae after phacoemulsification surgery and intraocular lens implantation. The patient underwent an urgent vitrectomy in which infectious foci were observed. Due to adverse clinical evolution, evisceration was performed five days after admission. In the study of the intraoperative samples fungal growth was observed. Microscopic analysis showed conidial heads resembling Aspergillus species. The final identification of A. hiratsukae was achieved by amplifying and sequencing the ITS1-5.8S-ITS2 spacer region. Antifungal susceptibility testing was performed using the method described by EUCAST. The isolate exhibited sensitivity to azoles and polyenes.

Due to the morphological similarity of the Aspergillus species, molecular techniques are essential for discriminating among them, as there are different antifungal susceptibility profiles within the same complex. Further studies to improve clinical surveillance, make an early diagnosis and start a targeted therapy are necessary.