Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes

Figures & data

Figure 1 Consensus Bayesian phylogenetic tree of the ITS 1 and ITS 2 regions summarized after discarding as burn-in the first 25% generations of the Metropolis-coupled Monte Carlo Markov chain analysis. Numbers in the branches indicate the posterior probabilities estimate. Letter in parentheses corresponds to the haplotype. Only one sequence of each haplotype is represented in the tree. The parenthesis marked (*) represents isolates that did not group into any species complex.

Abbreviations: FSSC, Fusarium solani species complex; FOSC, Fusarium oxysporum species complex; FDSC Fusarium dimerum species complex; ITS, internal transcribed spacer region.

Table 1 Clinical characteristics of keratitis cases

Patient	Fusarium species	Age (years)	Sex	Risk factors	Treatment delay (days)	Time to cure (days)
1	F. solani	54	M	–	10	180
2	F. solani	17	M	–	90	102
3	F. solani	56	M	Trauma	30	70
4	F. solani	52	M	Trauma	28	60
5	F. solani	36	M	Trauma	19	270
6	F. solani	37	M	Trauma	10	90
7	F. solani	46	M	Trauma	48	110
8	F. solani	44	M	Conjunctivitis	8	150
9	F. solani	52	F	–	18	–
10	F. solani	85	M	Trauma	30	180
11	F. solani	41	F	–	18	240
12	F. solani	31	F	Trauma	10	180
13	F. solani	20	M	Conjunctivitis	16	90
14	F. solani	49	M	Trauma	7	150
15	F. solani	32	M	–	12	45
16	F. solani	42	M	Trauma	10	60
17	F. solani	39	M	Trauma	30	60
18	F. solani	59	F	Trauma	40	180
19	F. solani	47	M	Trauma	15	60
20	F. solani	20	M	Trauma	30	60
21	F. solani	53	M	Trauma	–	112
22	F. solani	40	F	Conjunctivitis	25	240
23	F. solani	33	M	Trauma	–	–
24	F. solani	60	M	Trauma	26	180
25	F. solani	54	M	Trauma	15	180
26	F. solani	52	M	–	45	90
27	F. solani	36	M	Trauma	15	60
28	F. solani	35	M	–	12	90
29	F. solani	66	M	Trauma	4	60
30	F. solani	48	M	Trauma	30	90
31	F. solani	46	M	–	3	36
32	F. solani	40	M	–	18	60
33	F. solani	47	F	–	20	30
34	F. solani	76	F	–	20	–
35	F. solani	49	M	–	21	30
36	F. solani	73	M	–	17	–
37	F. oxysporum	49	M	–	–	105
38	F. oxysporum	30	M	CL	7	30
39	F. dimerum	28	M	CL	4	15
40	Fusarium species	57	M	Surgery	21	90
41	Fusarium species	41	M	Conjunctivitis	7	240
Totals/means ± standard deviation	36 F. solani	45 ± 14.7	34 M	20 trauma	19 ± 12.4	107 ± 71.5
	2 F. oxysporum		7 F	4 conjunctivitis
	1 F. dimerum			2 CL
	2 Fusarium species			1 surgery

Abbreviations: M, male; F, female; CL, contact lens wear.

Table 2 Further clinical characteristics of keratitis cases

Patient	Initial BCVA	Final BCVA	Ulcer location	Prior steroid	Penetrating keratoplasty	Treatment given	MIC N/V/A
1	2.3	2.0	C	No	Yes	N, K	4/8/4
2	2.3	1.6	–	–	–	–	8/8/1
3	2.3	2.0	C	No	–	N, K, F	0.125/8/0.5
4	0.8	0.2	C	Yes	–	A	4/8/0.5
5	2.3	2.3	C	No	Yes	N, A, F	4/4/2
6	0.1	0.1	C	Yes	–	N, K	4/16/1
7	2.6	2.3	–	No	Yes	N, K	8/8/4
8	2.0	0.5	C	No	–	N, K	4/8/4
9	1.0	0.4	–	–	–	A	–
10	2.6	2.6	C	No	Yes	K	4/4/0.5
11	3.0	2.6	C	–	Yes	A, K	4/16/2
12	2.6	2.0	C	No	Yes	N, K, A	8/8/2
13	2.3	0.4	C	No	–	A	1/16/1
14	2.6	2.6	C	No	Yes	A, K	4/8/2
15	0.4	0.4	C	No	–	N, K	4/2/4
16	2.0	2.0	C	No	Yes	N, A, K	4/2/2
17	0.4	0.5	C	No	–	N, K	0.03/8/0.5
18	2.3	2.6	C	No	Yes	A, K	4/8/2
19	0.7	0.1	C	No	–	N, K	0.125/8/0.25
20	0.7	0.7	P	No	–	N, K	8/4/4
21	1.6	1.6	–	–	–	–	4/16/2
22	3.0	2.3	C	No	Yes	A	8/8/4
23	2.3	–	–	No	–	–	4/8/1
24	2.6	2.0	C	No	Yes	K	4/4/1
25	2.6	2.3	C	No	Yes	A, K	0.25/4/0.5
26	2.3	2.3	C	No	Yes	A	8/8/2
27	0.7	0.5	C	Yes	–	A, K	4/8/1
28	2.3	2.0	C	No	Yes	A, K	8/4/2
29	0.9	0.4	P	Yes	–	A, K	–
30	2.3	–	C	No	Yes	A, F, K	–
31	2.6	2.3	C	Yes	Yes	A, K	8/8/1
32	2.3	2.3	P	–	Yes	N, K	8/16/0.5
33	2.0	2.3	C	No	–	A	4/8/0.5
34	2.6	2.6	–	–	Yes	A, K	8/2/0.5
35	2.6	2.6	C	–	Yes	A, K	8/8/1
36	2.3	2.3	–	Yes	Yes	A	4/1/0.5
37	1.6	–	–	No	–	A, K	4/2/1
38	2.3	2.0	P	No	–	–	4/8/2
39	0.2	0	C	No	–	N	4/4/2
40	2.3	0.5	C	No	Yes	A, K	8/8/4
41	2.6	2.6	C	Yes	Yes	A, K	4/8/1
Totals/means ± standard deviation	1.9 ± 0.88	1.6 ± 0.96	29 C(br/)4 P

Note: BCVAs are expressed in logarithm of the minimum angle of resolution (LogMAR).

Abbreviations: BCVA, best corrected visual acuity; C, in the central 6 mm of the cornea; P, peripheral; N, natamycin; A, amphotericin B; K, ketoconazole; F, fluconazole; MIC, minimum inhibitory concentration; n, natamycin; V, voriconazole.

Table 3 MIC₉₀ values for voriconazole, natamycin, and amphotericin B (μg/mL)

	Voriconazole (n = 35)	Natamycin (n = 35)	Amphotericin B (n = 35)
MIC90	16	8	2
Median	8	4	1
Range	1–16	0.25–16	0.03–4

Abbreviation: MIC₉₀, minimum inhibitory concentration for 90% of isolates.

Table 4 Association between mean (SD) MIC values for antifungal agents and need for PK

	No need for PK	Need for PK	P-value*
Natamycin	3.21 (2.68)	6.21 (3.27)	0.005
Voriconazole	8.93 (4.06)	7.05 (4.53)	0.116
Amphotericin B	0.74 (0.63)	1.48 (1.81)	0.183

Note:

* Mann–Whitney test.

Abbreviations: MIC, minimum inhibitory concentration; PK, penetrating keratoplasty; SD, standard deviation.