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United States Department of Agriculture

Agricultural Research Service

Research Project: DEVELOPMENT AND APPLICATION OF MOLECULAR PHYLOGENETICS OF FUNGI TO ENHANCE FOOD SAFETY AND FOOD SECURITY

Location: Bacterial Foodborne Pathogens & Mycology Research Unit

Title: An Outbreak of Fusarium Keratitis Associated with Use of a New Contact Lens Solution

Authors
item Chang, Douglas - CDC, ATLANTA, GA
item Grant, Gavin - CDC, ATLANTA, GA
item O`donnell, Kerry
item Wannemuehler, Kathleen - CDC, ATLANTA, GA
item Noble-Wang, Judith - CDC, ATLANTA, GA
item Rao, Carol - CDC, ATLANTA, GA
item Jacobson, Lara - CDC, ATLANTA, GA
item Crowell, Claudia - CDC, ATLANTA, GA
item Sneed, Rodlescia - MDCHD, MIAMI, FL
item Lewis, Felicia - PDH, PHILADELPHIA, PA
item Kainer, Marion - TDH, NASHVILLE, TN
item Genese, Carol - NJDH & SS, TRENTON, NJ
item Alfonso, Eduardo - BASCOM PALMER EYE INST,FL
item Jones, Dan - CULLEN EYE INST, TX
item Srinivasan, Arjun - CDC, ATLANTA, GA
item Fridkin, Scott - CDC, ATLANTA, GA
item Park, Benjamin - CDC, ATLANTA, GA

Submitted to: Journal of the American Medical Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: August 1, 2006
Publication Date: August 23, 2006
Citation: Chang, D.C., Grant, G.B., O Donnell, K., Wannemuehler, K., Noble-Wang, J., Rao, C.Y., Jacobson, L.M., Crowell, C.S., Sneed, R., Lewis, F.M., Kainer, M.A., Genese, C.A., Alfonso, E.C., Jones, D.B., Srinivasan, A., Fridkin, S.K., Park, B.J. 2006. An outbreak of Fusarium keratitis associated with use of a new contact lens solution. Journal of the American Medical Association. 296:953-963.

Interpretive Summary: We investigated a recent outbreak of soft contact lens-associated Fusarium corneal infections within the United States with the objective of defining the specific activities, contact lens hygiene practices, or products associated with this outbreak, and to determine the genetic diversity of the fusaria. A confirmed case was defined as keratitis with illness onset after June 1, 2005, no history of recent ocular trauma, and a corneal culture growing Fusarium spp. Data were obtained by patient and ophthalmologist interview for cases and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients’ clinical and environmental specimens were genotyped by multilocus sequence typing. As of May 22, 2006, we identified 142 confirmed cases in 28 states and one U.S. territory. Median age was 41 years (range, 12-83) and 95 (67%) were female. Corneal transplantation was required or planned in 44 (33%). After controlling for the practice of storing lenses in old solution, use of Bausch & Lomb’s ReNu with MoistureLoc® in the month prior to symptom onset was significantly associated with higher odds of infection (Adjusted Odds Ratio 22.3, 3.1-infinity) as compared to persons using neither ReNu with MoistureLoc® nor ReNu MultiPlus®. Use of ReNu MultiPlus® solution was similar among cases and controls. Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. At least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. We conclude that this outbreak was associated with use of ReNu with MoistureLoc® contact lens solution. High genetic diversity of infecting isolates and absence Fusarium spp. from environmental specimens suggest intrinsic contamination is unlikely. Based on the results of this study, our public health advisory is that contact lens users should not use ReNu with MoistureLoc®.

Technical Abstract: Context: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March, 2006, CDC received multiple reports of non-traumatic Fusarium keratitis among contact lens wearers. Objective: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. Design: Epidemiologic investigation. Setting: United States. Patients: A confirmed case was defined as keratitis with illness onset after June 1, 2005, no history of recent ocular trauma, and a corneal culture growing Fusarium spp. Data were obtained by patient and ophthalmologist interview for cases and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients’ clinical and environmental specimens were genotyped by multilocus sequence typing. Main Outcome Measures: Keratitis infection with Fusarium spp. Results: As of May 22, 2006, we identified 142 confirmed cases in 28 states and one U.S. territory. Median age was 41 years (range, 12-83) and 95 (67%) were female. Corneal transplantation was required or planned in 44 (33%). After controlling for the practice of storing lenses in old solution, use of Bausch & Lomb’s ReNu with MoistureLoc® in the month prior to symptom onset was significantly associated with higher odds of infection (Adjusted Odds Ratio 22.3, 3.1-infinity) as compared to persons using neither ReNu with MoistureLoc® nor ReNu MultiPlus®. Use of ReNu MultiPlus® solution was similar among cases and controls. Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. At least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. Conclusions: This outbreak was associated with use of ReNu with MoistureLoc® contact lens solution. High genetic diversity of infecting isolates and absence Fusarium spp. from environmental specimens suggest intrinsic contamination is unlikely. Contact lens users should not use ReNu with MoistureLoc®.

Last Modified: 7/22/2014
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