title: Fusarium and Candida albicans biofilms on soft contact lenses: model development, influence of lens type, and susceptibility to lens care solutions.
abstract: Fungal keratitis is commonly caused by Fusarium species and less commonly by Candida species. Recent outbreaks of Fusarium keratitis were associated with contact lens wear and with ReNu with MoistureLoc contact lens care solution, and biofilm formation on contact lens/lens cases was proposed to play a role in this outbreak. However, no in vitro model for contact lens-associated fungal biofilm has been developed. In this study, we developed and characterized in vitro models of biofilm formation on various soft contact lenses using three species of Fusarium and Candida albicans. The contact lenses tested were etafilcon A, galyfilcon A, lotrafilcon A, balafilcon A, alphafilcon A, and polymacon. Our results showed that clinical isolates of Fusarium and C. albicans formed biofilms on all types of lenses tested and that the biofilm architecture varied with the lens type. Moreover, differences in hyphal content and architecture were found between the biofilms formed by these fungi. We also found that two recently isolated keratitis-associated fusaria formed robust biofilms, while the reference ATCC 36031 strain (recommended by the International Organization for Standardization guidelines for testing of disinfectants) failed to form biofilm. Furthermore, using the developed in vitro biofilm model, we showed that phylogenetically diverse planktonic fusaria and Candida were susceptible to MoistureLoc and MultiPlus. However, Fusarium biofilms exhibited reduced susceptibility against these solutions in a species- and time-dependent manner. This in vitro model should provide a better understanding of the biology and pathogenesis of lens-related fungal keratitis.
authors.affiliation: Center for Medical Mycology, University Hospitals Case Medical Center and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Imamura
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Chandra
authors.forename: Pranab K
authors.initials: PK
authors.lastname: Mukherjee
authors.forename: Ali Abdul
authors.initials: AA
authors.lastname: Lattif
authors.forename: Loretta B
authors.initials: LB
authors.lastname: Szczotka-Flynn
authors.forename: Eric
authors.initials: E
authors.lastname: Pearlman
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lass
authors.forename: Kerry
authors.initials: K
authors.lastname: O'Donnell
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Ghannoum
mesh_terms: D018441:Biofilms / Q000187:drug effects / Q000254:growth & development*; D002176:Candida albicans / Q000187:drug effects / Q000235:genetics / Q000254:growth & development*; D018639:Contact Lens Solutions / Q000145:classification / Q000494:pharmacology; D003263:Contact Lenses, Hydrophilic / Q000145:classification / Q000382:microbiology*; D003470:Culture Media; D005670:Fusarium / Q000187:drug effects / Q000235:genetics / Q000254:growth & development*; D006801:Humans; D007634:Keratitis / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D008954:Models, Biological; D008969:Molecular Sequence Data; D011108:Polymers / Q000737:chemistry; D017422:Sequence Analysis, DNA
chemical_list: D018639:Contact Lens Solutions; D003470:Culture Media; D011108:Polymers