Fusarium Keratitis-an upcoming threat in Germany?

Abstract

Fungal keratitis due to Fusarium species is known to be typical of developing countries; however, with the increasing use of contact lenses arise of Fusarium keratitis has been observed in Germany. In amonocentric retrospective study, we analyzed all patients who presented to our university eye hospital with infectious keratitis between January 2011 and December 2021 and had aproof of Fusarium species in either microscopy, culture or PCR. We could identify 13patients with aproof of Fusarium species. Asignificant increase of cases in 2021 was observed. In 76.9% of our cases the patients were female and in 76.9% the patients had ahistory of prior contact lens use. In only 4cases the initial corneal sample gave apositive result for Fusarium. On average the suspicion of fungal keratitis arose 13.1days after onset of symptoms, correct diagnosis was achieved after 14.6days. All isolated specimens showed resistance against at least one of the common fungicides. In 70% of our cases treatment with penetrating keratoplasty was necessary. The patients showed a57.1% recurrence rate after penetrating keratoplasty. In 80% of our cases best documented visual acuity after Fusarium keratitis was ≤ 0.4. Due to difficult detection and ahigh resistance rate to common antifungals, Fusarium keratitis is prone to delayed diagnosis and limited treatment outcomes. Whenever risk factors are present and infectious keratitis does not respond to antibiotics, antimycotic treatment must be initiated. Early keratoplasty may be necessary.