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2021 OMIG Abstract
Correlation of Clinical Features and Outcome to Type of Fusarium Species
Bhupesh Bagga1, Saurav Das2, Savitri Sharma1, Anup Ghosh2
1LV Prasad Eye Institute, Inda; 2Postgraduate Institute of Medical Education & Research Chandigarh
Purpose: Species determination of Fusarium isolates, obtained from patients of keratitis with MALDI-TOF mass spectrometry with their clinical correlation.
Methods: We have enrolled all consecutive cases of culture proven cases of Fusarium keratitis from October 2018 to December 2018. Medical records were reviewed for their demographic profile, clinical features at presentation and response to medical therapy. All fungal isolates underwent MALDI-TOF (Bruker MALDI-TOF MS) mass spectrometry for species identification and further grouped into species complex. All patients were treating medically with topical Natamycin ophthalmic suspension 5% with or without oral Ketoconazole. Each case was regularly followed up with slit lamp examination to assess the signs of resolution or worsening.
Results: There were total 29 cases of confirmed Fusarium keratitis as confirmed by its growth on culture media and identification of spores. There were male and female ratio of 12:17. Median age of the patients was 44 (IQR, 37-53) years. Based on MALDI-TOF MS, out of 29 isolates, 26 could be identified correctly. Out of them, 18 (69/2 %) isolates were identified as Fusarium Solani species complex (FSSC), 4(15.4%) were Fusarium fujikuroi species complexes (FFSC) while 4 (15.4%) were F. dimerum species complex (FDSC). Among FSSC, Fusarium Falciforme (11/18, 61.1%) were the most common. On comparison between FSSC and other two groups (FDSC+FFSC), both the groups were similar in their demographic and clinical profiles. Median duration from the onset of infection to presentation at clinic was 15 (7-15) vs 5 (4-11) days. Median geometric mean of diameter of the infiltrate was 4 (3.5-6.3) mm and 3.5 (2.9-4.9)) mm respectively. The location of the ulcer was limited to central cornea in 16 (84.2%) vs 6 (66.7%). Hyphate edge of the infiltrate was noticed in 17 (94.4%) and 7 (100%) eyes with plaque like presentation in 3(15.8%) and 1 eye and presence of endo-exudates in 7 (38.9%) and 2 (28.5%) eyes respectively. Ratio of depth of the infiltrate (anterior: middle: posterior stroma) was 1:8:10 vs 1:5:3 in comparing of the species complexes. Three patients were lost to follow-up after early 1-2 visits. Median follow-up was 143 (44-253) in FSSC and 56 (30-303) in other SC. Clinical resolution was achieved in 9/17 (52.9%. vs 5 (71.4%) cases with mean duration of 53.7 + 28.6 days where as 8 (42.31%) vs 2 (28.6%) cases underwent therapeutic penetrating keratoplasty due to worsening on treatment.
Conclusions: FSSC are the most common species complex among Fusarium species causing keratitis and Fusarium flaciforme is the most common species among them. There was no difference in the clinical features and outcome on comparing between FSSC and other species complexes.
Disclosure: N
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