An Outbreak of Fusarium Keratitis Associated With Contact Lens Wear in Singapore

Khor, Wei-Boon; Aung, Tin; Saw, Seang‐Mei; Wong, Tien-Yin; Tambyah, Paul Ananth; Tan, A.; Beuerman, Roger W.; Lim, Liangzhong; Chan, Wing-Kwong; Heng, Wee-Jin; Lim, Jimmy; Loh, Raymond; Lee, Sao-Bing; Tan, Donald

doi:10.1001/jama.295.24.2867

Cited by 231 publications

(171 citation statements)

References 30 publications

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“…16 Previously published studies have also reported associations between certain multipurpose solution types and Fusarium and Acanthamoeba outbreaks of contact lens-related microbial keratitis. [25][26][27] Certain polymeric biguanide-based care solutions have been demonstrated to be less effective against bacterial biofilms in comparison with hydrogen peroxide or polyquaternium-based solutions. 28 In addition, reduction in microbial efficacy of this product has been reported when used for the storage of contact lenses in lens cases over a prolonged period of time.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for contact lens-related microbial keratitis in Singapore

Lim

Carnt

Farook

et al. 2015

Eye

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Purpose: To investigate independent risk factors for contact lens-related microbial keratitis in Singapore and estimate their impact on disease load. Methods: Cases were contact lens wearers presenting to Singapore National Eye Centre with microbial keratitis between 2008 and 2010. Community contact lens wearers were recruited as controls. All wearers completed a previously validated questionnaire describing contact lens wear history, hygiene and compliance habits, and demographics. Risk factors significant in univariate analysis (Po0.2) were evaluated in a multivariate model. Results: In all, 58 cases of microbial keratitis and 152 contemporaneous controls were identified. When controlling for other variables, Chinese had a 7 × lower risk compared with other races (95% CI: 2.3-21.3, P = 0.001). Those aged between 25 and 44 years were at 3 × increased risk compared with younger wearers (95% CI: 1.1-9.6, P = 0.04). Occasional overnight contact lens wear (less often than one night per week) was associated with a 4 × higher risk (95% CI: 1.2-15.4, P = 0.03) compared with daily use. Not washing hands before handling was associated with a 13 × increased risk (95% CI: 1.9-84.8, P = 0.008). Use of multipurpose solution A carried a 16 × higher risk compared with hydrogen peroxide (95% CI: 1.5-174.0, P = 0.02). The combined PAR% for modifiable risk factors (occasional overnight wear, not washing of hands, and MPS A) was 82%. Conclusions: Consistent with previous findings, independent risk factors for contact lens-related microbial keratitis include poor hand hygiene, occasional overnight wear, and type of lens care solution. Prolonged overnight or extended contact lens use was infrequent in this population.

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Section: Discussionmentioning

confidence: 99%

Risk factors for contact lens-related microbial keratitis in Singapore

Lim

Carnt

Farook

et al. 2015

Eye

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“…Fusarium oxysporum keratitis has been reported to respond to treatment with tobramycin, 11 and in vitro studies have shown antibiotic inhibition of pectolytic and cellulolytic enzyme activity in F oxysporum by amoxycillin, and to a lesser extent by chloramphenicol, erythromycin and raficillin. 12 In the outbreak of Fusarium keratitis associated with contact lens wear that was recently reported from Singapore, 13 11 (16.2%) of the 68 eyes treated with topical antibiotics alone (gentamicin and cefalzolin) resolved ''without the need for specific antifungal therapy''. Fusarium spp was isolated from all 11 eyes.…”

Section: Duringmentioning

confidence: 99%

Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics

Srinivasan

Upadhyay

Priyadarsini

et al. 2006

British Journal of Ophthalmology

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Aim: To determine whether topical antifungal prophylaxis distributed by paid village health workers (VHWs) in south India is necessary after corneal abrasion to prevent fungal keratitis in a population where half of the ulcers are fungal. Methods: Two panchayaths (village administrative units in Madurai district with a combined population of 48 039 were followed prospectively for 18 months by 15 VHWs who were trained to identify posttraumatic corneal abrasions. Patients fulfilling the eligibility criteria were randomised into two groups and treated with either 1% chloramphenicol and 1% clotrimazole ointment or 1% chloramphenicol and a placebo ointment three times a day for 3 days. Patients, doctors and VHWs were blinded to treatment. Results: During the 18-month period, 1365 people reported to VHWs with ocular injuries, of whom 374 with corneal abrasions were eligible for treatment. Of these, 368 (98.5%) abrasions healed without complications. Two patients had mild localised allergic reactions to the ointment, two dropped out and two patients in the placebo group developed microscopic culture-negative corneal stromal infiltrates that healed in 1 week with natamycin drops. Conclusions: Both fungal and bacterial ulcers that occur after traumatic corneal abrasions seem to be effectively prevented in a village setting using only antibiotic prophylaxis.

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“…While the pathogenesis of contact lens-related Pseudomonas keratitis remains unclear, bacterial contamination of the eye appears to play a major role [2,20]. Although P. aeruginosa is the most important cause of contact lens-associated corneal ulcers, other bacteria, fungi, or Acanthamoeba may also cause this condition [1,[7][8][9][10][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…In developed countries, the incidence of fungal keratitis is generally low and fungal infection in contact lens wearers is much rarer when compared with bacterial and Acanthamoeba keratitis. In July 2005, the Hong Kong Department of Health became aware of an [13] reported on an outbreak of contact lens-related Fusarium keratitis in Singapore. Initially, the epidemic was believed to have followed contamination of the Bausch & Lomb multipurpose solution by a single strain of Fusarium during manufacture or storage.…”

Section: Discussionmentioning

confidence: 99%

“…Fungal keratitis from contact lens wear is rare, constituting less than 5% of microbial keratitis cases in patients who wear contact lenses for refractive errors [7][8][9][10][11]. Recent reports of disproportionate outbreaks of microbial keratitis caused by F. solani in Singapore and the United States have led to the removal of the Bausch & Lomb multipurpose lens care solution ReNu with MoistureLoc from the worldwide market in 2006 [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Susceptibility of various corneal fungal isolates and Pseudomonas aeruginosa to contact lens disinfecting solutions

Pinna

Usai

Zanetti

et al. 2013

J Infect Dev Ctries

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Introduction: We aimed to investigate the susceptibility of a combined inoculum of Pseudomonas aeruginosa and different fungal strains to 6 soft contact lens disinfectants. Methodology: One corneal isolate of P. aeruginosa and 13 corneal fungal isolates (9 Aspergillus spp, 3 Fusarium spp, 1 Curvularia sp.) were used. The following solutions were tested: Arion Cronos, Complete RevitaLens, Dua Elite, Opti-Free Express, Regard, Oxysept Comfort, and Oxysept Comfort without catalase. The effect of the solutions was assessed on a combined inoculum of P. aeruginosa plus 1 fungal strain. Suspensions of P. aeruginosa and fungi were made in the solutions (1x10 6 colony-forming units/mL). After 1 hour (Arion Cronos only), 6, 8, and 24 hours, aliquots of suspension were removed and seeded on Luria-Bertani and Sabouraud agar plates. Results: After 6 hours' exposure, all the solutions but Dua Elite and Oxysept Comfort eradicated P. aeruginosa. Conversely, apart from 3% hydrogen peroxide-based Oxysept Comfort without catalase, which eradicated all the fungi tested after 6 hours, all the other solutions were partly ineffective at killing some of the fungal isolates, even after 24 hours' exposure. Conclusions: Most contact lens disinfectants may be ineffective if contact lens care systems become co-contaminated with P. aeruginosa and fungi. In our experiment, only exposure to 3% hydrogen peroxide without neutralizer for at least 6 hours was always able to kill a combined inoculum of P. aeruginosa and different fungal strains.

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An Outbreak of Fusarium Keratitis Associated With Contact Lens Wear in Singapore

Abstract: A new and evolving epidemic of Fusarium keratitis associated with contact lens wear was found in Singapore. Physicians and eye care practitioners worldwide need to be aware of the likelihood of similar outbreaks emerging among contact lens wearers.

Cited by 231 publications

References 30 publications

Risk factors for contact lens-related microbial keratitis in Singapore

Risk factors for contact lens-related microbial keratitis in Singapore

Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics

Susceptibility of various corneal fungal isolates and Pseudomonas aeruginosa to contact lens disinfecting solutions

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