Fungal Keratitis Associated With Contact Lenses

Abstract

JAMA Multistate Outbreak of<i>Fusarium</i>Keratitis Associated With Use of a Contact Lens Solution <h3>Context:</h3> <i>Fusarium</i>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<i>Fusarium</i>keratitis among contact lens wearers. <h3>Objective:</h3> To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. <h3>Design, Setting, and Participants:</h3> Epidemiological investigation of<i>Fusarium</i>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<i>Fusarium</i>species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available<i>Fusarium</i>isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for<i>Fusarium</i>was conducted at a contact lens solution manufacturing plant. <h3>Main Outcome Measures:</h3> Keratitis infection with<i>Fusarium</i>species. <h3>Results:</h3> 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).<i>Fusarium</i>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<i>Fusarium</i>species were identified, comprising 19 unique multilocus genotypes. <h3>Conclusions:</h3> The findings from this investigation indicate that this outbreak of<i>Fusarium</i>keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.