Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution

Douglas C. Chang, Gavin B. Grant, Kerry O'Donnell, Kathleen A. Wannemuehler, Judith Noble-Wang, Carol Y. Rao, Lara M. Jacobson, Claudia S. Crowell, Rodlescia S. Sneed, Felicia M T Lewis, Joshua K. Schaffzin, Marion A. Kainer, Carol A. Genese, Eduardo C Alfonso, Dan B. Jones, Arjun Srinivasan, Scott K. Fridkin, Benjamin J. Park

Research output: Contribution to journalArticle

385 Citations (Scopus)

Abstract

Context: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. Objective: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. Design, Setting, and Participants: Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. Main Outcome Measures: Keratitis infection with Fusarium species. Results: As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. Conclusions: The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.

Original languageEnglish
Pages (from-to)953-963
Number of pages11
JournalJournal of the American Medical Association
Volume296
Issue number8
DOIs
StatePublished - Aug 23 2006

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Contact Lens Solutions
Keratitis
Fusarium
Disease Outbreaks
Contact Lenses
Fusariosis
Odds Ratio
Confidence Intervals
Hydrophilic Contact Lens
Multilocus Sequence Typing
Corneal Transplantation
Centers for Disease Control and Prevention (U.S.)
Hygiene
Case-Control Studies
Genotype
Outcome Assessment (Health Care)
Interviews

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chang, D. C., Grant, G. B., O'Donnell, K., Wannemuehler, K. A., Noble-Wang, J., Rao, C. Y., ... Park, B. J. (2006). Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. Journal of the American Medical Association, 296(8), 953-963. https://doi.org/10.1001/jama.296.8.953

Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. / Chang, Douglas C.; Grant, Gavin B.; O'Donnell, Kerry; Wannemuehler, Kathleen A.; Noble-Wang, Judith; Rao, Carol Y.; Jacobson, Lara M.; Crowell, Claudia S.; Sneed, Rodlescia S.; Lewis, Felicia M T; Schaffzin, Joshua K.; Kainer, Marion A.; Genese, Carol A.; Alfonso, Eduardo C; Jones, Dan B.; Srinivasan, Arjun; Fridkin, Scott K.; Park, Benjamin J.

In: Journal of the American Medical Association, Vol. 296, No. 8, 23.08.2006, p. 953-963.

Research output: Contribution to journalArticle

Chang, DC, Grant, GB, O'Donnell, K, Wannemuehler, KA, Noble-Wang, J, Rao, CY, Jacobson, LM, Crowell, CS, Sneed, RS, Lewis, FMT, Schaffzin, JK, Kainer, MA, Genese, CA, Alfonso, EC, Jones, DB, Srinivasan, A, Fridkin, SK & Park, BJ 2006, 'Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution', Journal of the American Medical Association, vol. 296, no. 8, pp. 953-963. https://doi.org/10.1001/jama.296.8.953
Chang, Douglas C. ; Grant, Gavin B. ; O'Donnell, Kerry ; Wannemuehler, Kathleen A. ; Noble-Wang, Judith ; Rao, Carol Y. ; Jacobson, Lara M. ; Crowell, Claudia S. ; Sneed, Rodlescia S. ; Lewis, Felicia M T ; Schaffzin, Joshua K. ; Kainer, Marion A. ; Genese, Carol A. ; Alfonso, Eduardo C ; Jones, Dan B. ; Srinivasan, Arjun ; Fridkin, Scott K. ; Park, Benjamin J. / Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. In: Journal of the American Medical Association. 2006 ; Vol. 296, No. 8. pp. 953-963.
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abstract = "Context: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. Objective: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. Design, Setting, and Participants: Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. Main Outcome Measures: Keratitis infection with Fusarium species. Results: As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34{\%}). One hundred fifty-four (94{\%}) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69{\%} vs 15{\%}; odds ratio, 13.3; 95{\%} confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18{\%} vs 20{\%}; odds ratio, 0.7; 95{\%} confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. Conclusions: The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.",
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AU - Chang, Douglas C.

AU - Grant, Gavin B.

AU - O'Donnell, Kerry

AU - Wannemuehler, Kathleen A.

AU - Noble-Wang, Judith

AU - Rao, Carol Y.

AU - Jacobson, Lara M.

AU - Crowell, Claudia S.

AU - Sneed, Rodlescia S.

AU - Lewis, Felicia M T

AU - Schaffzin, Joshua K.

AU - Kainer, Marion A.

AU - Genese, Carol A.

AU - Alfonso, Eduardo C

AU - Jones, Dan B.

AU - Srinivasan, Arjun

AU - Fridkin, Scott K.

AU - Park, Benjamin J.

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N2 - Context: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. Objective: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. Design, Setting, and Participants: Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. Main Outcome Measures: Keratitis infection with Fusarium species. Results: As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. Conclusions: The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.

AB - Context: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. Objective: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. Design, Setting, and Participants: Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. Main Outcome Measures: Keratitis infection with Fusarium species. Results: As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. Conclusions: The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.

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