Original article : Clinical science
Multicenter Prospective Observational Study of Fungal Keratitis -Identification and Susceptibility Test of Fungi-
Atsuko Sunada1, Seishi Asari1, Yoshitsugu Inoue2, Yuichi Ohashi3, Takashi Suzuki3, Yoshikazu Shimomura4, Masahiko Fukuda4, Chie Sotozono5, Hiroshi Hatano6, Hiroshi Eguchi7, Kaoru Araki-Sasaki8, Saichi Hoshi9, Takashi Yaguchi10, Koichi Makimura11, Shunji Yokokura12, Kiyofumi Mochizuki13, Yu Monden14, Ryohei Nejima15; Multicenter Study Group of Fungal Keratitis in Japan
1 Department of Medical Technology, Osaka University Hospital
2 Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University
3 Department of Ophthalmology, Ehime University Graduate School of Medicine
4 Department of Ophthalmology, Kinki University Faculty of Medicine
5 Department of Ophthalmology, Kyoto Prefectural University of Medicine
6 Hatano Eye Clinic
7 Department of Ophthalmology, Institute of Health Biosciences, the University of Tokushima Graduate School
8 Ideta Eye Hospital
9 Department of Ophthalmology, Fujieda Municipal General Hospital
10 Medical Mycology Research Center, Chiba University
11 Institute of Medical Mycology, Teikyo University
12 Department of Ophthalmology, Tohoku University Graduate School of Medicine
13 Department of Ophthalmology, Gifu University Graduate School of Medicine
14 Department of Ophthalmology, Kurume University School of Medicine
15 Miyata Eye Hospital
Purpose: To investigate the causative fungi of fungal keratitis in Japan and their drug susceptibility.
Methods: Identification and antifungal susceptibility test for 8 drugs (micafungin, amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, miconazole and pimaricin) were performed using isolated fungi from patients with fungal keratitis treated at 27 facilities in Japan between November 1, 2011 and October 31, 2013.
Results: Fungal strains were detected in 72 (50.7%) out of 142 samples. The major isolates were Fusarium spp. (18), Candida parapsilosis (12), C. albicans (11) and Alternaria spp. (6), in all, fungi of 31 species were identified by gene analysis. In the yeast-like fungi, susceptibility rates were evident for more than 80% in voriconazole, pimaricin, flucytosine, micafungin, amphotericin B and fluconazole. In filamentous fungi, the susceptibility rate was less than 50% except for PMR (90%). Fusarium spp., which were susceptible to amphotericin B and pimaricin, showed lower susceptibility rates compared with other genera.
Conclusions: Although various genera and species of fungi cause fungal keratitis, the obtained drug susceptibility data in this study demonstrates the different susceptibility patterns among the major isolates (Fusarium spp., C. parapsilosis, C. albicans and other groups). This is important evidence useful for fungal keratitis treatment.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 120: 17-27, 2016.
Key words
Fungal keratitis, Yeast-like fungi, Filamentous fungi, Multicenter study, Antifungal susceptibility test
Reprint requests to
Yoshitsugu Inoue, M.D., Ph.D. Division of Ophthalmology, Faculty of Medicine, Tottori University. 36-1 Nishi-cho, Yonago-shi 683-8504, Japan
Received: 31 March 2015. Accepted in revised form: 23 July 2015.
Nihon Ganka Gakkai Zasshi
120: 17-27,2016
