In vitro susceptibility of filamentous fungi from mycotic keratitis to azole drugs

Shobana, Coimbatore Subramanian; Mythili, A.; Homa, Mónika; Galgóczy, László; Priya, R.; Singh, Yendrembam Randhir Babu; Panneerselvam, K.; Vágvölgyi, Csaba; Kredics, László; Narendran, Venkatapathy; Palanisamy, M.

doi:10.1016/j.mycmed.2014.10.024

Cited by 17 publications

(11 citation statements)

References 32 publications

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“…and Fusarium spp. constitute the main parts of the causal agents, more than 100 species have been reported as the aetiological agent of keratomycosis . Among them, a rare human pathogen such as Sporothrix pallida which is a member of Sporothrix schenckii complex, the causal agents of subcutaneous infections in human and animal, could be found .…”

Section: Introductionmentioning

confidence: 99%

Fungal keratitis: An overview of clinical and laboratory aspects

Mahmoudi

Masoomi

Ahmadikia

et al. 2018

Mycoses

180

174

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Mycotic keratitis or keratomycosis is a fungal infection with global distribution. The dominant aetiology of this disease varies based on geographical origin, socioeconomic status, and climatic condition. Generally, Aspergillus spp. and Fusarium spp. are common in tropical and subtropical regions and Candida spp. are dominant in temperate areas. Demonstration of fungal elements in microscopic examination besides the isolation of fungi in culture is the gold standard of laboratory diagnosis. As the culture is a time-consuming procedure, other approaches such as in vivo confocal microscopy which produces real-time imaging of corneal tissue and molecular techniques have been developed to facilitate rapid diagnosis of fungal keratitis. The first choice of treatment is topical natamycin, although topical amphotericin B is the best choice for Aspergillus and Candida keratitis. Regarding the diversity of fungal aetiology and the emergence of drug resistance in some genera and species, proper identification using molecular methods and antifungal susceptibility testing could provide useful data. Furthermore, as the better efficacy of combination therapy in comparison to monotherapy is reported, in vitro determination of interactions between various drugs seem informative. This review aims to provide a general and updated view on the aetiology, risk factors, epidemiology, clinical and laboratory diagnosis, and management of fungal keratitis.

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Section: Introductionmentioning

confidence: 99%

Fungal keratitis: An overview of clinical and laboratory aspects

Mahmoudi

Masoomi

Ahmadikia

et al. 2018

Mycoses

180

174

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“…In contrast to the currently reported susceptibility results, one of our previous studies revealed higher MIC values for all the tested antifungal drugs (Homa et al, 2013 ). However, in another South Indian keratitis study, Shobana et al ( 2015 ) reported lower azole MICs (especially for ITC) for fusaria. According to Al-Hatmi et al ( 2016 ), Fusarium spp.…”

Section: Discussionmentioning

confidence: 92%

South Indian Isolates of the Fusarium solani Species Complex From Clinical and Environmental Samples: Identification, Antifungal Susceptibilities, and Virulence

et al. 2018

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Members of the Fusarium solani species complex (FSSC) are the most frequently isolated fusaria from soil. Moreover, this complex solely affects more than 100 plant genera, and is also one of the major opportunistic human pathogenic filamentous fungi, being responsible for approximately two-third of fusariosis cases. Mycotic keratitis due to Fusarium species is among the leading causes of visual impairment and blindness in South India, but its management is still challenging due to the poor susceptibility of the isolates to conventional antifungal drugs. Aims of the present study were to isolate South Indian clinical and environmental FSSC strains and identify them to species level, to determine the actual trends in their susceptibilities to antifungal therapeutic drugs and to compare the virulence of clinical and environmental FSSC members. Based on the partial sequences of the translation elongation factor 1α gene, the majority of the isolates—both from keratomycosis and environment—were confirmed as F. falciforme, followed by F. keratoplasticum and F. solani sensu stricto. In vitro antifungal susceptibilities to commonly used azole, allylamine and polyene antifungals were determined by the CLSI M38-A2 broth microdilution method. The first generation triazoles, fluconazole and itraconazole proved to be ineffective against all isolates tested. This phenomenon has already been described before, as fusaria are intrinsically resistant to them. However, our results indicated that despite the intensive agricultural use of azole compounds, fusaria have not developed resistance against the imidazole class of antifungals. In order to compare the virulence of different FSSC species from clinical and environmental sources, a Drosophila melanogaster model was used. MyD88 mutant flies having impaired immune responses were highly susceptible to all the examined fusaria. In wild-type flies, one F. falciforme and two F. keratoplasticum strains also reduced the survival significantly. Pathogenicity seemed to be independent from the origin of the isolates.

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“…Eventhough the evidence shows that natamycin is more effective than voriconazole in the treatment of fungal ulcers,6,7 voriconazole has been reported to be an alternative option in some cases such as drug-resistant fungal keratitis or rare fungal species causing keratitis 8,9…”

Section: Discussionmentioning

confidence: 99%

“…This may be explained by the lower minimum inhibitory concentrations of voriconazole against numerous mould isolates causing fungal keratitis 9. In addition, voriconazole concentrations in the aqueous humor after topical 1% voriconazole eyedrops are above the minimum inhibitory concentrations, which is sufficient to eradicate most fungal species 5.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of <em>Chrysosporium</em> keratitis with voriconazole

Thanathanee¹,

Bhoomibunchoo²,

Anutarapongpan³

et al. 2017

IMCRJ

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ObjectiveTo report a patient with severe Chrysosporium keratitis successfully treated by voriconazole.MethodCase report.ResultsA 37-year-old healthy male presented with irritation, pain and reduced vision in his left eye after mud contamination. Examination demonstrated corneal stromal infiltration, endothelial plaque and hypopyon. Corneal scrapings demonstrated numerous septate hyphae, and specimen cultures were positive for Chrysosporium sp. The lesion did not respond to aggressive topical 5% natamycin, 0.15% topical amphotericin B and oral itraconazole. The patient was then treated by topical 1% voriconazole every hour. Intracameral and intrastromal voriconazole injections (50 μg/0.1 mL) were also undertaken. The keratitis was significantly improved after voriconazole.ConclusionTo the best of the authors’ knowledge, this is the first report on the use of voriconazole for Chrysosporium keratitis. Voriconazole may be an effective alternative to conventional antifungal agents in some cases of fungal keratitis. It should be considered before shifting to therapeutic keratoplasty.

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In vitro susceptibility of filamentous fungi from mycotic keratitis to azole drugs

Cited by 17 publications

References 32 publications

Fungal keratitis: An overview of clinical and laboratory aspects

Fungal keratitis: An overview of clinical and laboratory aspects

South Indian Isolates of the Fusarium solani Species Complex From Clinical and Environmental Samples: Identification, Antifungal Susceptibilities, and Virulence

Successful treatment of <em>Chrysosporium</em> keratitis with voriconazole

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