Multistate Outbreak of Fusarium Keratitis Associated With Use of a Contact Lens Solution

• Published in: JAMA : the journal of the American Medical Association Vol. 296; no. 8; pp. 953 - 963
• Main Authors: Chang, Douglas C, Grant, Gavin B, O’Donnell, Kerry, Wannemuehler, Kathleen A, Noble-Wang, Judith, Rao, Carol Y, Jacobson, Lara M, Crowell, Claudia S, Sneed, Rodlescia S, Lewis, Felicia M. T, Schaffzin, Joshua K, Kainer, Marion A, Genese, Carol A, Alfonso, Eduardo C, Jones, Dan B, Srinivasan, Arjun, Fridkin, Scott K, Park, Benjamin J, Fusarium Keratitis Investigation Team, for the
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 23.08.2006
• Subjects: Adult; animal pathogenic fungi; Biological and medical sciences; Case-Control Studies; contact lens; Contact Lens Solutions; Contact lenses; Disease Outbreaks; Diseases of cornea, anterior segment and sclera; disinfectants; DNA, Fungal; Drug Packaging; epidemiological studies; Epidemiology; Equipment Contamination; Eye diseases; Female; Fusarium; Fusarium - genetics; Fusarium - isolation & purification; Fusarium keratitis; General aspects; Genotype & phenotype; human health; Humans; Infections; Investigations; keratitis; Keratitis - epidemiology; Keratitis - microbiology; Male; Medical sciences; microbial contamination; Middle Aged; Miscellaneous; mycoses; Mycoses - epidemiology; Mycoses - etiology; Ophthalmology; public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; United States - epidemiology; United States; USA; Epidemic; Keratitis; Contact lens; Use; Instrumentation therapy; Keratopathy; Fungi; Medicine; Eye disease; Association; Fusarium; Fungi Imperfecti; Anterior segment disease; Public health; Thallophyta
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.296.8.953

CONTEXT Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. OBJECTIVE To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. DESIGN, SETTING, AND PARTICIPANTS Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. MAIN OUTCOME MEASURES Keratitis infection with Fusarium species. RESULTS As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. CONCLUSIONS The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.