Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes

Rafael A Oechsler,1 Tiago M Yamanaka,1 Paulo JM Bispo,1 Juliana Sartori,1 Maria Cecilia Zorat Yu,1 Analy Salles A Melo,2 Darlene Miller,3 Ana Luisa Hofling-Lima1 1Ophthalmology Department, 2Division of Infectious Diseases, Internal Medicine Department, Federal University of São Paulo, S&a...

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Autores principales:	Oechsler RA, Yamanaka TM, Bispo PJ, Satori JF, Yu MC, Melo AS, Miller D, Hofling-Lima AL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/fa66ea84f16c4d519f1e1684bff2c816
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spelling	oai:doaj.org-article:fa66ea84f16c4d519f1e1684bff2c8162021-12-02T03:36:14ZFusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes1177-54671177-5483https://doaj.org/article/fa66ea84f16c4d519f1e1684bff2c8162013-08-01T00:00:00Zhttp://www.dovepress.com/fusarium-keratitis-in-brazil-genotyping-in-vitro-susceptibilities-and--a14199https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Rafael A Oechsler,1 Tiago M Yamanaka,1 Paulo JM Bispo,1 Juliana Sartori,1 Maria Cecilia Zorat Yu,1 Analy Salles A Melo,2 Darlene Miller,3 Ana Luisa Hofling-Lima1 1Ophthalmology Department, 2Division of Infectious Diseases, Internal Medicine Department, Federal University of São Paulo, São Paulo, Brazil; 3Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA Background: The purpose of this paper is to describe clinical characteristics and determine correlations between clinical outcomes and antifungal susceptibility among molecularly characterized ocular Fusarium isolates in Brazil. Methods: Forty-one Fusarium isolates obtained from 41 eyes of 41 patients were retrieved from the ophthalmic microbiology laboratory at São Paulo Federal University and grown in pure culture. These isolates were genotyped and antifungal susceptibilities determined for each isolate using a broth microdilution method. The corresponding medical records were reviewed to determine clinical outcomes. Results: The 41 isolates were genotypically classified as Fusarium solani species complex (36 isolates, 88%), Fusarium oxysporum species complex (two isolates, 5%), Fusarium dimerum species complex (one isolate, 2%) and two isolates that did not group into any of the species complexes. Final best corrected visual acuity varied from 20/20 to light perception and was on average 20/800 (logarithm of the minimum angle of resolution (LogMAR) 1.6). A history of trauma was the most common risk factor, being present in 21 patients (51%). Therapeutic penetrating keratoplasty was necessary in 22 patients (54%). Amphotericin B had the lowest minimum inhibitory concentration for 90% of isolates (MIC90) value (2 µg/mL) and voriconazole had the highest (16 µg/mL). There was an association between a higher natamycin MIC and need for therapeutic penetrating keratoplasty (Mann–Whitney test, P < 0.005). Conclusion: Trauma was the main risk factor, and therapeutic penetrating keratoplasty was necessary in 54% of patients. Amphotericin B had the lowest MIC90 (2 µg/mL) of the three antifungal agents tested. There was an association between higher natamycin MIC levels and corneal perforation, emphasizing the need for antifungal susceptibility testing and tailoring of antifungal strategies. Keywords: keratitis, Fusarium species, genotyping, antifungal, clinical outcomeOechsler RAYamanaka TMBispo PJSatori JFYu MCMelo ASMiller DHofling-Lima ALDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2013, Iss default, Pp 1693-1701 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Oechsler RA Yamanaka TM Bispo PJ Satori JF Yu MC Melo AS Miller D Hofling-Lima AL Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes
description	Rafael A Oechsler,1 Tiago M Yamanaka,1 Paulo JM Bispo,1 Juliana Sartori,1 Maria Cecilia Zorat Yu,1 Analy Salles A Melo,2 Darlene Miller,3 Ana Luisa Hofling-Lima1 1Ophthalmology Department, 2Division of Infectious Diseases, Internal Medicine Department, Federal University of São Paulo, São Paulo, Brazil; 3Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA Background: The purpose of this paper is to describe clinical characteristics and determine correlations between clinical outcomes and antifungal susceptibility among molecularly characterized ocular Fusarium isolates in Brazil. Methods: Forty-one Fusarium isolates obtained from 41 eyes of 41 patients were retrieved from the ophthalmic microbiology laboratory at São Paulo Federal University and grown in pure culture. These isolates were genotyped and antifungal susceptibilities determined for each isolate using a broth microdilution method. The corresponding medical records were reviewed to determine clinical outcomes. Results: The 41 isolates were genotypically classified as Fusarium solani species complex (36 isolates, 88%), Fusarium oxysporum species complex (two isolates, 5%), Fusarium dimerum species complex (one isolate, 2%) and two isolates that did not group into any of the species complexes. Final best corrected visual acuity varied from 20/20 to light perception and was on average 20/800 (logarithm of the minimum angle of resolution (LogMAR) 1.6). A history of trauma was the most common risk factor, being present in 21 patients (51%). Therapeutic penetrating keratoplasty was necessary in 22 patients (54%). Amphotericin B had the lowest minimum inhibitory concentration for 90% of isolates (MIC90) value (2 µg/mL) and voriconazole had the highest (16 µg/mL). There was an association between a higher natamycin MIC and need for therapeutic penetrating keratoplasty (Mann–Whitney test, P < 0.005). Conclusion: Trauma was the main risk factor, and therapeutic penetrating keratoplasty was necessary in 54% of patients. Amphotericin B had the lowest MIC90 (2 µg/mL) of the three antifungal agents tested. There was an association between higher natamycin MIC levels and corneal perforation, emphasizing the need for antifungal susceptibility testing and tailoring of antifungal strategies. Keywords: keratitis, Fusarium species, genotyping, antifungal, clinical outcome
format	article
author	Oechsler RA Yamanaka TM Bispo PJ Satori JF Yu MC Melo AS Miller D Hofling-Lima AL
author_facet	Oechsler RA Yamanaka TM Bispo PJ Satori JF Yu MC Melo AS Miller D Hofling-Lima AL
author_sort	Oechsler RA
title	Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes
title_short	Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes
title_full	Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes
title_fullStr	Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes
title_full_unstemmed	Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes
title_sort	fusarium keratitis in brazil: genotyping, in vitro susceptibilities, and clinical outcomes
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/fa66ea84f16c4d519f1e1684bff2c816
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Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes

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