title: Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes.
abstract: BACKGROUND
  The purpose of this paper is to describe clinical characteristics and determine correlations between clinical outcomes and antifungal susceptibility among molecularly characterized ocular Fusarium isolates in Brazil.
  
  
  METHODS
  Forty-one Fusarium isolates obtained from 41 eyes of 41 patients were retrieved from the ophthalmic microbiology laboratory at São Paulo Federal University and grown in pure culture. These isolates were genotyped and antifungal susceptibilities determined for each isolate using a broth microdilution method. The corresponding medical records were reviewed to determine clinical outcomes.
  
  
  RESULTS
  The 41 isolates were genotypically classified as Fusarium solani species complex (36 isolates, 88%), Fusarium oxysporum species complex (two isolates, 5%), Fusarium dimerum species complex (one isolate, 2%) and two isolates that did not group into any of the species complexes. Final best corrected visual acuity varied from 20/20 to light perception and was on average 20/800 (logarithm of the minimum angle of resolution (LogMAR) 1.6). A history of trauma was the most common risk factor, being present in 21 patients (51%). Therapeutic penetrating keratoplasty was necessary in 22 patients (54%). Amphotericin B had the lowest minimum inhibitory concentration for 90% of isolates (MIC90) value (2 μg/mL) and voriconazole had the highest (16 μg/mL). There was an association between a higher natamycin MIC and need for therapeutic penetrating keratoplasty (Mann-Whitney test, P < 0.005).
  
  
  CONCLUSIONS
  Trauma was the main risk factor, and therapeutic penetrating keratoplasty was necessary in 54% of patients. Amphotericin B had the lowest MIC90 (2 μg/mL) of the three antifungal agents tested. There was an association between higher natamycin MIC levels and corneal perforation, emphasizing the need for antifungal susceptibility testing and tailoring of antifungal strategies.
authors.affiliation: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Oechsler
authors.forename: Tiago M
authors.initials: TM
authors.lastname: Yamanaka
authors.forename: Paulo Jm
authors.initials: PJ
authors.lastname: Bispo
authors.forename: Juliana
authors.initials: J
authors.lastname: Sartori
authors.forename: Maria Cecilia Zorat
authors.initials: MC
authors.lastname: Yu
authors.forename: Analy Salles A
authors.initials: AS
authors.lastname: Melo
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Hofling-Lima
keywords: Fusarium species; antifungal; clinical outcome; genotyping; keratitis
references.citation: Antimicrob Agents Chemother. 1989 Sep;33(9):1647-9
references.pmid: 2817867
references.citation: J Clin Microbiol. 2007 Jul;45(7):2235-48
references.pmid: 17507522
references.citation: Ophthalmology. 2006 Nov;113(11):1943-8
references.pmid: 16935335
references.citation: Am J Ophthalmol. 2004 May;137(5):820-5
references.pmid: 15126145
references.citation: Invest Ophthalmol Vis Sci. 2012 Jul 03;53(8):4450-7
references.pmid: 22669723
references.citation: Curr Eye Res. 1986 Nov;5(11):877-82
references.pmid: 3490954
references.citation: J Clin Microbiol. 2008 Oct;46(10):3477-8
references.pmid: 18701666
references.citation: J Clin Microbiol. 2004 Oct;42(10):4494-7
references.pmid: 15472299
references.citation: Arch Ophthalmol. 1994 Mar;112(3):329-35
references.pmid: 8129657
references.citation: Cornea. 2012 Jun;31(6):662-7
references.pmid: 22333662
references.citation: Am J Ophthalmol. 2008 Mar;145(3):409-412
references.pmid: 18207124
references.citation: Ophthalmology. 2011 May;118(5):920-6
references.pmid: 21295857
references.citation: Cornea. 2000 May;19(3):307-12
references.pmid: 10832689
references.citation: Clin Infect Dis. 2012 May;54(10):1381-7
references.pmid: 22447793
references.citation: Mol Biol Evol. 2008 Jul;25(7):1253-6
references.pmid: 18397919
references.citation: Invest Ophthalmol Vis Sci. 2010 Jan;51(1):362-8
references.pmid: 19684005
references.citation: Eur J Ophthalmol. 2009 May-Jun;19(3):355-61
references.pmid: 19396778
references.citation: Cornea. 2005 Jan;24(1):8-15
references.pmid: 15604861
references.citation: Bioinformatics. 2001 Aug;17(8):754-5
references.pmid: 11524383
references.citation: Br J Ophthalmol. 2010 Mar;94(3):384-5
references.pmid: 20215380
references.citation: Int Ophthalmol. 2011 Jun;31(3):197-204
references.pmid: 21448786
references.citation: CLAO J. 1997 Oct;23(4):275-81
references.pmid: 9348453
references.citation: Invest Ophthalmol Vis Sci. 2009 May;50(5):2230-6
references.pmid: 19136697
references.citation: BMC Ophthalmol. 2011 Dec 22;11:39
references.pmid: 22188671
references.citation: Indian J Ophthalmol. 2011 Nov-Dec;59(6):512-4
references.pmid: 22011503
references.citation: Cornea. 2013 May;32(5):667-73
references.pmid: 23343947
references.citation: Mycopathologia. 2001;150(3):101-15
references.pmid: 11469757
references.citation: Mol Biol Evol. 2007 Aug;24(8):1596-9
references.pmid: 17488738
references.citation: Antimicrob Agents Chemother. 2008 Jul;52(7):2683-5
references.pmid: 18443107
references.citation: J Clin Microbiol. 1998 Jan;36(1):198-202
references.pmid: 9431946
references.citation: Arq Bras Oftalmol. 2005 Jan-Feb;68(1):21-7
references.pmid: 15824799
references.citation: Arch Ophthalmol. 2006 Jul;124(7):941-7
references.pmid: 16769827
references.citation: Eye Contact Lens. 2006 Dec;32(6):267-71
references.pmid: 17099386
references.citation: J Clin Microbiol. 2011 May;49(5):1890-8
references.pmid: 21389150
references.citation: Eur J Ophthalmol. 2010 May-Jun;20(3):498-503
references.pmid: 20175055
references.citation: Cornea. 2006 Apr;25(3):264-7
references.pmid: 16633023