OMIG, Abstract 3
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Genotypic Identification of Fusarium sp from Ocular Sources and Correlation to Clinical Outcomes.
R A Oechsler1,2, M R Feilmeier1, D R Ledee1, D Miller1, M R Diaz3, M E Fini1, J W Fell3, E C Alfonso1.
1Bascom Palmer Eye Institute - Miller School of Medicine - University of Miami, Miami, FL; 2Ophthalmology Department, Federal University of Sao Paulo, Sao Paulo, Brazil; 3Rosenstiel School of Marine and Atmospheric Science - University of Miami, Miami, FL.
Purpose: Fungal keratitis is a prevalent cause of ocular morbidity throughout the world. Fusarium, a genus of filamentous fungi, is the most frequent corneal fungal pathogen in subtropical and tropical regions. Traditional identification methods have yielded discordant species level identification. We utilized sequence genotyping to confirm and classify a select group of cases from southern Florida, and explore the correlation between genotype and clinical outcome.
Methods: Sequence for the nuclear internal transcribed spacer (ITS) region of 58 ocular Fusarium sp isolates was determined (41 corneas, 4 aqueus humor, 1 vitreous, 8 contact lenses and 4 contact lens cases)and relatedness assessed by phylogenetic analysis. Clinical outcomes were assessed by a retrospective review of 50 available medical records of the 52 source patients with ocular Fusarium sp infections between May 2000 and April 2007.
Results: Genotypic analysis placed the 58 isolates into 4 species complexes: Fusarium solani species complex (FSSC)= 76% and Fusarium non-solani species complexes (FNSSC)= 24% (Fusarium oxysporum species complex (FOSC)=16%, Fusarium incarnatum-equiseti species complex (FEISC)=5% and Fusarium dimerum species complex (FDSC)=3%). Time to resolution was on average 57 days for isolates in the FSSC compared to 41 days for the FNSSC (p=0.01). All patients that underwent urgency penetrating keratoplasty (PK) (n=7) had infections caused by F. solani. Final average best corrected visual acuity (BCVA) was 0.57 LogMAR (+/-20/80) in the FSSC group and 0.27 LogMAR (+/-20/40) for the FNSSC group (p<0.01).
Conclusions: All cases of legal blindness and urgency PK’s occurred in the patients with F. solani infection. Correlation of the Fusarium genotypes with the clinical outcomes established that final BCVA and time to resolution tended to be significantly worse in the F. solani than in the F. non-solani group.
Disclosure code: N