title: Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Mycotic Diseases Branch, Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Ga, USA. DChang@cdc.gov
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Chang
authors.forename: Gavin B
authors.initials: GB
authors.lastname: Grant
authors.forename: Kerry
authors.initials: K
authors.lastname: O'Donnell
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Judith
authors.initials: J
authors.lastname: Noble-Wang
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Rao
authors.forename: Lara M
authors.initials: LM
authors.lastname: Jacobson
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Crowell
authors.forename: Rodlescia S
authors.initials: RS
authors.lastname: Sneed
authors.forename: Felicia M T
authors.initials: FM
authors.lastname: Lewis
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Schaffzin
authors.forename: Marion A
authors.initials: MA
authors.lastname: Kainer
authors.forename: Carol A
authors.initials: CA
authors.lastname: Genese
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Alfonso
authors.forename: Dan B
authors.initials: DB
authors.lastname: Jones
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D018639:Contact Lens Solutions; D004271:DNA, Fungal; D004196:Disease Outbreaks; D004349:Drug Packaging; D004866:Equipment Contamination; D005260:Female; D005670:Fusarium / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007634:Keratitis / Q000453:epidemiology* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology
chemical_list: D018639:Contact Lens Solutions; D004271:DNA, Fungal