title: Alternaria is an Infrequent Cause of Keratitis: A Case Report and Review of the Literature.
abstract: OBJECTIVE
  To report a case of fungal keratitis caused by Alternaria in a 49-year-old female who developed an acute onset of eye infection after ocular trauma caused by an olive leaf.
  
  
  METHODS
  The clinical presentation, microbiological diagnosis, and therapeutic approaches are reported.
  
  
  RESULTS
  The patient was referred to our university hospital clinic with corneal abscess in her left eye. Before the start of an empirical antibacterial therapy (both topical and systemic), a swab of the cornea was obtained which at microscopic examination revealed a few fragments of hyphal elements, probably for the paucity of material collected. After one week, the corneal abscess had increased in size, and the corneal stroma was filled with filamentous structures similar to fungal hyphae. Oral and topical voriconazole was administered because of the clinical picture and the response of microbiological laboratory whose examination of the material removed from the anterior chamber showed numerous hyphal fragments identified by culture as Alternaria spp. The corneal abscess healed in two weeks, but the patient now has a corneal scar and is awaiting a corneal transplant.
  
  
  CONCLUSIONS
  Ophthalmologists and microbiologists must take fungi into greater consideration as a possible cause of keratitis as they are emerging as the cause of this infectious disease in many countries. Voriconazole spreads well in the eye and is effective in the cure of fungal keratitis including those caused by Alternaria.
authors: Departments of Basic Medical Sciences, Neuroscience and Sense Organs (R.M., G.A., S.G.D.D.V.,), Biomedical Sciences and Human Oncology (G.C.), School of Medicine, University of Bari Aldo Moro, Bari, Italy; Institute of Microbiology (R.M., C.C., D.D.V.), Universitá Cattolica del Sacro Cuore, Rome, Italy; and Microbiology and Virology (R.M., C.C., D.D.V.), Policlinico Hospital, Bari, Italy.
authors: Rosa
authors: R
authors: Monno
authors: Giovanni
authors: G
authors: Alessio
authors: Silvana
authors: S
authors: Guerriero
authors: Giuseppina
authors: G
authors: Caggiano
authors: Carmen
authors: C
authors: Capolongo
authors: Danila
authors: D
authors: De Vito
authors: Maurizio
authors: M
authors: Sanguinetti
mesh_terms: D000528:Alternaria / Q000302:isolation & purification*; D060487:Alternariosis / Q000150:complications*; D003320:Corneal Ulcer / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000382:microbiology*; D005131:Eye Injuries / Q000150:complications; D005260:Female; D006801:Humans; D008875:Middle Aged