title: Successful medical management of recalcitrant Fusarium solani keratitis: molecular identification and susceptibility patterns.
abstract: Fungal keratitis is a rare but sight-threatening infection of the cornea that may be caused by several fungal pathogens. A delay in diagnosis and inadequate treatment may even lead to loss of the affected eye. Fungal keratitis is often misdiagnosed as bacterial keratitis because isolation and identification of the fungal pathogen is difficult and requires experience, and fungal growth in culture requires time. In this report, a 14-year-old boy with recalcitrant Fusarium solani keratitis, unresponsive to initial therapy, is presented. CLSI M38-A2 in vitro antifungal susceptibility tests demonstrated that only amphotericin B (0.5 μg/ml) had potent activity against F. solani; however, fluconazole (>64 μg/ml), itraconazole (>16 μg/ml), voriconazole (8 μg/ml), and posaconazole (>16 μg/ml) had high minimum inhibitory concentrations. In addition, caspofungin (>16 μg/ml) and anidulafungin (>16 μg/ml) exhibited high minimum effective concentrations. Repeated intrastromal voriconazole injections, topical voriconazole, and caspofungin combined with systemic antifungal agents improved of the corneal lesion with a significant increase in visual acuity. Intrastromal voriconazole injection may be used as an adjunctive treatment method for recalcitrant fungal keratitis with no prominent complications. The intrastromal route could be an effective route of administration of antifungal agents, especially for F. solani keratitis, as in this case. A combination of various antifungal agents administered by different routes prevented loss of the eye.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Çukurova University, Adana, Turkey. h_taylan@yahoo.com
authors.forename: Hande
authors.initials: H
authors.lastname: Taylan Sekeroglu
authors.forename: Elif
authors.initials: E
authors.lastname: Erdem
authors.forename: Meltem
authors.initials: M
authors.lastname: Yagmur
authors.forename: Ramazan
authors.initials: R
authors.lastname: Gumral
authors.forename: Reha
authors.initials: R
authors.lastname: Ersoz
authors.forename: Macit
authors.initials: M
authors.lastname: Ilkit
authors.forename: Ibrahim Inan
authors.initials: II
authors.lastname: Harbiyeli
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000494:pharmacology; D060585:Fusariosis / Q000188:drug therapy* / Q000382:microbiology*; D005670:Fusarium / Q000145:classification* / Q000302:isolation & purification*; D006801:Humans; D007267:Injections; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents