title: Multidrug-resistant Fusarium in keratitis: a clinico-mycological study of keratitis infections in Chennai, India.
abstract: In this study, we aimed to present the first molecular epidemiological data from Chennai, India, analyse keratitis cases that have been monitored in a university hospital during 2 years, identify the responsible Fusarium species and determine antifungal susceptibilities. A total of 10 cases of keratitis were included in the study. Fusarium isolates were identified using the second largest subunit of the RNA polymerase gene (RPB2) and the translation elongation factor 1 alpha (TEF1). Antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. The aetiological agents belonged to Fusarium solani species complex (FSSC) (n = 9) and Fusarium sambucinum species complex (FSAMSC) (n = 1), and the identified species were Fusarium keratoplasticum (n = 7), Fusarium falciforme (n = 2) and Fusarium sporotrichioides (n = 1). All strains showed multidrug resistance to azoles and caspofungin but exhibited lower minimum inhibitory concentration (MIC) to natamycin and amphotericin B. Fusarium keratoplasticum and Fusarium falciforme belonging to the Fusarium solani species complex were the major aetiological agents of Fusarium keratitis in this study. Early presentation and 5% topical natamycin was associated with better patient outcome. Preventative measures and monitoring of local epidemiological data play an important role in clinical practice.
authors.affiliation: Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, India.
authors.forename: Ananya
authors.initials: A
authors.lastname: Tupaki-Sreepurna
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands.|Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands.|Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman.
authors.forename: Abdullah M S
authors.initials: AM
authors.lastname: Al-Hatmi
authors.affiliation: Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, India.
authors.forename: Anupma J
authors.initials: AJ
authors.lastname: Kindo
authors.affiliation: Department of Dermatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, India.
authors.forename: Murugan
authors.initials: M
authors.lastname: Sundaram
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands.|Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands.|Basic Pathology Department, Federal University of Paraná State, Curitiba, Brazil.|Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: G Sybren
authors.initials: GS
authors.lastname: de Hoog
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001393:Azoles / Q000494:pharmacology; D000077336:Caspofungin; D026141:Drug Resistance, Multiple, Fungal; D054714:Echinocandins / Q000494:pharmacology; D005260:Female; D060585:Fusariosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005670:Fusarium / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005800:Genes, Fungal / Q000235:genetics; D006785:Hospitals, University; D006801:Humans; D007194:India / Q000453:epidemiology; D007634:Keratitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055666:Lipopeptides / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010866:Natamycin / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D010866:Natamycin; D000077336:Caspofungin
keywords: 
  Fusarium
  ; 
  RPB2
  ; 
  TEF1
  ; antifungal resistance; keratomycosis; trauma