Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series
2018
espanolAntecedentes Afortunadamente, las infecciones por Fusarium son poco frecuentes en paises de clima templado; sin embargo, determinados factores como la inmunodepresion clinica o farmacologica, pueden convertirlas en un problema emergente. Fusarium es uno de los microrganismos etiologicos mas importantes de la endoftalmitis exogena, favorecida habitualmente por una rotura de las barreras epiteliales. Objetivos En esta serie de casos clinicos queremos identificar hallazgos clinicos caracteristicos que puedan establecer un diagnostico temprano y un tratamiento mas eficiente de esta urgencia oftalmologica. Metodos Se presentan tres casos de endoftalmitis por Fusarium solani y Fusarium oxysporum que se produjeron en los anos 2009, 2010 y 2014, en pacientes de dos areas de salud diferentes, pero pertenecientes al mismo sistema sanitario, las cuales distan 43 millas una de la otra. Las cepas aisladas de Fusarium se identificaron inicialmente por microscopia y su identidad se confirmo posteriormente mediante secuenciacion del factor de elongacion alfa (EFα) y de la region codificadora espaciadora interna (ITS). La sensibilidad a los antifungicos se llevo a cabo por el metodo de dilucion en caldo del EUCAST. Resultados Se produjo una mala evolucion, ya que dos de los tres pacientes evolucionaron haca la atrofia ocular a pesar de las medidas quirurgicas y el tratamiento antibiotico y antifungico de amplio espectro. Conclusiones Es importante actuar rapidamente con medidas multidisciplinarias ante la sospecha de una endoftalmitis por Fusarium por el mal pronostico de este tipo de infecciones. Palabras clave Fusarium, Endoftalmitis, Traumatismo corneal, Lentes de contacto, Fusarium oxysporum, Fusarium solani, Tratamiento de Fusarium, Queratoplastia EnglishBackground Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. Aims The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. Methods Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. Results Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. Conclusions It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection Keywords Fusarium, Endophthalmitis, Corneal trauma, Contact lenses, Fusarium oxysporum, Fusarium solani, Fusarium treatment, Keratoplasty
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
24
References
2
Citations
NaN
KQI