Trends in Fungal keratitis in the United States, 2001 to 2007

Emily W. Gower, Lisa J. Keay, Rafael A. Oechsler, Alfonso Iovieno, Eduardo C Alfonso, Dan B. Jones, Kathryn Colby, Sonal S. Tuli, Seema R. Patel, Salena M. Lee, John Irvine, R. Doyle Stulting, Thomas F. Mauger, Oliver D. Schein

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective: Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population. Design: Retrospective, multicenter case series. Participants: Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007. Methods: Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research. Main Outcome Measures: Quarterly number of fungal keratitis cases and fungal species. Results: We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P<0.0001). Conclusions: The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish
Pages (from-to)2263-2267
Number of pages5
JournalOphthalmology
Volume117
Issue number12
DOIs
StatePublished - Dec 1 2010

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Keratitis
Contact Lenses
Fusarium
Product Recalls and Withdrawals
Research Ethics Committees
Disclosure
Eye Infections
Microbiology
Tertiary Care Centers
Confocal Microscopy
Disease Outbreaks
Fungi
Medicine
Outcome Assessment (Health Care)
Pathology

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Gower, E. W., Keay, L. J., Oechsler, R. A., Iovieno, A., Alfonso, E. C., Jones, D. B., ... Schein, O. D. (2010). Trends in Fungal keratitis in the United States, 2001 to 2007. Ophthalmology, 117(12), 2263-2267. https://doi.org/10.1016/j.ophtha.2010.03.048

Trends in Fungal keratitis in the United States, 2001 to 2007. / Gower, Emily W.; Keay, Lisa J.; Oechsler, Rafael A.; Iovieno, Alfonso; Alfonso, Eduardo C; Jones, Dan B.; Colby, Kathryn; Tuli, Sonal S.; Patel, Seema R.; Lee, Salena M.; Irvine, John; Stulting, R. Doyle; Mauger, Thomas F.; Schein, Oliver D.

In: Ophthalmology, Vol. 117, No. 12, 01.12.2010, p. 2263-2267.

Research output: Contribution to journalArticle

Gower, EW, Keay, LJ, Oechsler, RA, Iovieno, A, Alfonso, EC, Jones, DB, Colby, K, Tuli, SS, Patel, SR, Lee, SM, Irvine, J, Stulting, RD, Mauger, TF & Schein, OD 2010, 'Trends in Fungal keratitis in the United States, 2001 to 2007', Ophthalmology, vol. 117, no. 12, pp. 2263-2267. https://doi.org/10.1016/j.ophtha.2010.03.048
Gower EW, Keay LJ, Oechsler RA, Iovieno A, Alfonso EC, Jones DB et al. Trends in Fungal keratitis in the United States, 2001 to 2007. Ophthalmology. 2010 Dec 1;117(12):2263-2267. https://doi.org/10.1016/j.ophtha.2010.03.048
Gower, Emily W. ; Keay, Lisa J. ; Oechsler, Rafael A. ; Iovieno, Alfonso ; Alfonso, Eduardo C ; Jones, Dan B. ; Colby, Kathryn ; Tuli, Sonal S. ; Patel, Seema R. ; Lee, Salena M. ; Irvine, John ; Stulting, R. Doyle ; Mauger, Thomas F. ; Schein, Oliver D. / Trends in Fungal keratitis in the United States, 2001 to 2007. In: Ophthalmology. 2010 ; Vol. 117, No. 12. pp. 2263-2267.
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abstract = "Objective: Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population. Design: Retrospective, multicenter case series. Participants: Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007. Methods: Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research. Main Outcome Measures: Quarterly number of fungal keratitis cases and fungal species. Results: We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P<0.0001). Conclusions: The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
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AU - Alfonso, Eduardo C

AU - Jones, Dan B.

AU - Colby, Kathryn

AU - Tuli, Sonal S.

AU - Patel, Seema R.

AU - Lee, Salena M.

AU - Irvine, John

AU - Stulting, R. Doyle

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N2 - Objective: Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population. Design: Retrospective, multicenter case series. Participants: Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007. Methods: Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research. Main Outcome Measures: Quarterly number of fungal keratitis cases and fungal species. Results: We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P<0.0001). Conclusions: The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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