Mycotic keratitis due to Cylindrocarpon lichenicola: Successful salvage of the eye.

We hereby report a successfully salvaged eye due to mycotic keratitis by Cylindrocarpon lichenicola in a 60-year-old female from Kasaragod (Kerala). The patient came with a history of pain, photophobia and decreased vision of the right eye. The microbiological investigations of the corneal scraping revealed C. lichenicola. C. lichenicola is a soil saprophyte. Since the ulcer worsened paracentesis followed by therapeutic keratoplasty and adjunct therapy with natamycin drops, voriconazole drops and oral ketoconazole was given. We stress that evidence-based timely medical and surgical intervention helped in the restoration of the vision in an infected eye.

Enucleation Caused by Fusarium Infection in a Child With Toxic Epidermal Necrolysis.

Fusarium species are a known cause of ocular infection that can produce local and/or systemic invasive fusariosis. Fusarium ocular infection can evolve to keratitis, endophthalmitis and, in extreme cases, ocular perforation. We report, for the first time in children, the case of a 5 year old girl diagnosed with toxic epidermal necrolysis who developed Fusarium ocular infection requiring ocular enucleation.

[Confocal microscopy as an early relapse marker after keratoplasty due to Fusarium solani keratitis]. / Konfokale Mikroskopie als früher Rezidivmarker nach Keratoplastik infolge einer Fusarium-solani-Keratitis.

In the case of therapy-resistant keratitis an infection with Fusarium solani should be taken into consideration as a rare but very severe eye disease. In the majority of cases Fusarium solani keratitis will result in a protracted clinical course despite aggressive medicinal and surgical interventions. We describe the case of a referred patient after intensive topical, intracameral and systemic antibacterial and antimycotic therapy as well as surgical treatment with emergency keratoplasty à chaud because of Fusarium solani keratitis. The patient presented to our department with persistent discomfort for further therapeutic interventions. Using confocal microscopy we were able to demonstrate the presence of fungal hyphae in the host cornea and the graft, which was important for making further surgical decisions. Furthermore, this emphasizes the role of confocal microscopy as an early relapse marker during the clinical monitoring.

Multidrug-resistant Fusarium keratitis: diagnosis and treatment considerations.

Mycotic keratitis is an ocular infective process derived from any fungal species capable of corneal invasion. Despite its rarity in developed countries, its challenging and elusive diagnosis may result in keratoplasty or enucleation following failed medical management. Filamentous fungi such as Fusarium are often implicated in mycotic keratitis. Bearing greater morbidity than its bacterial counterpart, mycotic keratitis requires early clinical suspicion and initiation of antifungal therapy to prevent devastating consequences. We describe a case of multidrug-resistant mycotic keratitis in a 46-year-old man who continued to decline despite maximal therapy and therapeutic keratoplasty. Finally, enucleation was performed as a means of source control preventing dissemination of a likely untreatable fungal infection into the orbit. Multidrug-resistant Fusarium is rare, and may progress to endophthalmitis. We discuss potential management options which may enhance diagnosis and outcome in this condition.

A Case of Fungus Ball-Type Pansinusitis Due to Fusarium proliferatum.

Incidence of fungal sinusitis due to the genus Fusarium has increased during the last two decades. We report a case of fungus ball sinusitis with multiple sinuses involvement in an Iranian 21-year-old woman. The patient was diagnosed as having a fungus ball-type sinusitis in computed tomography scan. The sinus biopsy revealed fungal structures on histopathological and direct microscopic examinations and a Fusarium species arose in culture. Partial sequencing of the translation elongation factor 1-alpha identified the isolate as F. proliferatum. Removal of all lesions by endoscopic surgery resulted in a favorable outcome. To the best of our knowledge, this is the first case of F. proliferatum-associated fungus ball which involved multi-sinus and highlights the efficiency of molecular methods for discrimination of fungal agents involved.

Multidrug resistant Fusarium keratitis.

CASE REPORT: We report a case of keratitis in a female contact lens wearer, who developed a deep corneal abscess. The culture of a corneal biopsy scraping was positive for multiresistant Fusarium solani. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, requiring eye enucleation. CONCLUSION: Fusarium keratitis may progress to severe endophthalmitis. Clinical suspicion is paramount in order to start antifungal therapy without delay. Therapy is complex due to the high resistance of this organism to usual antifungal drugs.

Therapeutic sectorial full-thickness sclero-keratoplasty for recurrent fungal keratitis.

OBJECTIVE: To report the management of a severe and recurrent fungal keratitis that required repeated penetrating keratoplasties. Despite multiple topical, intraocular and systemic antifungal treatments, superotemporal hyphal infiltration repeatedly penetrated the corneal transplant causing continuous recurrences. Cultures collected before and during surgery isolated the same organism, Fusarium spp. CONCLUSION: Corneal infection extending to the sclera and internal angle structures is the main cause of recurrence of fungal keratitis after corneal transplantation. Sectorial full-thickness sclero-keratoplasty combined with a central penetrating keratoplasty should be a surgical technique to be considered in cases where these locations are suspected to be the source of recurrence. It enables a definitive elimination of the infection, with excellent final visual acuities. No postoperative complications were reported in this case.

Therapeutic Corneal Transplant for Fungal Keratitis Refractory to Medical Therapy.

OBJECTIVES: To report the outcomes of therapeutic corneal transplant for managing fungal keratitis that is refractory to medical treatment. MATERIALS AND METHODS: Retrospective data analyses of the medical records was performed on 17 patients who underwent a therapeutic corneal transplant for severe culture-proven fungal keratitis between October 2006 and August 2013. We evaluated demographics, fungal organism type, surgical data, recurrence presentation, disease course, follow-up, and graft status. RESULTS: Mean patient age was 53.2 years (range, 33-81 y). The male/female ratio was 12/5. All patients had positive microscopic evaluation and positive culture results for fungal infection. The most common fungal agent was Fusarium sp. (35%). Nine patients reported a history of injury to the cornea and/or contact with plant material or soil. The mean best-corrected visual acuity at the initial visit was 2.45 logMAR unit (range, 0.52-3.10 logMAR unit). The mean follow-up was 14 months (range, 6-76 mo). Four patients underwent evisceration surgery because of graft lysis or uncontrolled recurrent disease. Recurrence of the fungal infection after corneal transplant was seen in 8 patients (47.05%). The graft rejection rate was 18.18%. At the final visit, 5 grafts were clear, 4 were translucent, and 2 were opaque. There were 2 phthisis bulbi owing to catastrophic disease. The mean final best-corrected visual acuity was 1.64 logMAR unit (range, 0.22-3.10 logMAR unit). CONCLUSIONS: Although therapeutic corneal transplant has a higher incidence of infection recurrence and graft failure, it continues to be an effective treatment for uncontrolled, refractory fungal keratitis cases to save the affected eye.

[Cutaneous infection due to Fusarium oxysporum in a female diabetic: molecular biological detection of the mold from formalin-fixed paraffin embedded tissue using sequencing of the ITS region of the rDNA]. / Kutane Infektion durch Fusarium oxysporum bei einer Diabetikerin: Molekularbiologischer Schimmelpilznachweis aus Formalin-fixiertem, Paraffin-eingebettetem Gewebe mittels Sequenzierung der ITS-Region der rDNA.

BACKGROUND: Skin lesions due to Fusarium spp. occur either secondarily following hematological spread in systemic infection or represent primary cutaneous infections following traumatic inoculation. CASE REPORT: A 34-year-old woman with insulin-dependent diabetes mellitus presented with a most likely posttraumatic leg ulcer present for 4 weeks. The ulcer showed superficial necrosis with cellular debris, neutrophils, and leukocytoclasia. Septate hyphae were detected both in the necrotic area and between the collagen fibers on initial H & E stained sections. Using PAS and Grocott-Gomori silver staining, the dichotomous branching hyphae were clearly visible. Unfortunately, cultural detection of the fungi was impossible. After extraction and purification of the fungal DNA from formalin-fixed and paraffin embedded (FFPE) tissue sections, the amplification of the ITS region of rDNA was done. Using sequencing and comparison with reference sequences of a gene bank, Fusarium oxysporum was identified. THERAPY: Therapy was performed by surgical excision of the entire ulcer followed by topical antiseptic treatment and wound conditioning. No systemic antifungal treatment was given. The lesion healed without any problems. DISCUSSION: Cutaneous fusarium infections are rare but emerging opportunistic infections. Histological examination represents the quickest diagnostic method for detection of the fungal infection. An alternative approach represents the species identification based on molecular techniques.

Surgical removal of an abscess associated with Fusarium solani from a Kemp's ridley sea turtle (Lepidochelys kempii).

A cold-stunned Kemp's ridley sea turtle, Lepidochelys kempii, developed an abscess associated with Fusarium solani, Vibrio alginolyticus, and a Shewenalla species after receiving a bite wound to the front flipper during rehabilitation. The lesion failed to respond to medical therapy and was treated successfully with surgery. Histopathology of the excised tissue demonstrated septic heterophilic inflammation with necrosis and granulation tissue, fungal elements, and bacteria, despite appropriate antimicrobial therapy. Variably thick bands of dense collagenous tissue partially surrounded affected areas which might have limited drug penetration into the tissue. Postoperative healing and eventual releases were uneventful. This is the first report of surgical treatment of cutaneous Fusarium infection in a sea turtle and supports surgery as an effective treatment for a fungal abscess in a reptile.

Isolation of Fusarium sp. from a claw of a dog with onychomycosis.

An 8-year-old male Golden Retriever had lameness and claw abnormality in the second digit of the left forelimb. Radiography revealed osteomyelitis in the distal phalanx bone of the affected limb. Microscopic examination of the claw revealed numerous hyphae in the claw matrix. Fungal DNA fragments coding the ribosomal internal transcribed spacer region (ITS) were detected from the claw matrix as well as fungal colonies of the clinical isolates by PCR. Nucleotide sequencing revealed that the amplicons shared > 99% homology with Fusarium sp. Therapy including oral itraconazole resulted in regrowth of a new claw, in which no hyphae were detected. To the authors' knowledge, this is the first case report of canine onychomycosis in which Fusarium sp. was isolated from the affected claw.