A 25-year-old Caucasic female was referred to our clinic after suffering from infectious keratitis in the right eye for a month. The patient was a contact lens user and had no history of ocular ...trauma. Furthermore, the patient did not report any relevant antecedent. The main complaint was intense photophobia and pain. Infectious keratitis remains one of the main complications of contact lens wear and can become a therapeutic challenge in some patients. Although the most frequent causal agent is bacterial, other causes such as herpes virus, Acanthamoeba or fungi should be considered when antimicrobial therapy does not work as expected clinically. Fungal keratitis normally appears on previously damaged corneas, but it can also develop in contact lens wearers. Beauveria bassiana is an unusual pathogen which has been diagnosed more frequently lately per the clinical reports in the last 30 years, so it can be included in the diagnostic scheme when a fungal keratitis is suspected. In clinical management, AS-OCT may be a functional tool to assess the evolution and monitor the response to microbial agents and surgery. Although more studies are needed, some characteristic features have been described and can help to diagnose a fungal keratitis against other infections. AS-OCT can also play an important role in monitoring the corneal scarring after the keratitis episode, and it may be useful to plan post-infection therapy for visual rehabilitation.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility.
To evaluate changes in ...the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005).
From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered.
A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P=0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P=0.002) and Extremadura (58.3 vs. 20%, P=0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%).
In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
ResumenAntecedentesRecientemente se ha observado un incremento de las fungemias causadas por especies diferentes de Candida albicans y una disminución de la sensibilidad de los microorganismos ...responsables al fluconazol. ObjetivosEvaluar la epidemiología y la sensibilidad al fluconazol de los casos de fungemia en España en 2009, comparando los resultados con los obtenidos entre los años 1997-1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005).MétodosEstudio prospectivo multicéntrico con 44 centros participantes realizado desde enero de 2009 a febrero de 2010. Los aislamientos fúngicos procedentes de hemocultivo fueron recogidos en cada centro, donde se realizó el estudio de sensibilidad antifúngica mediante microdilución colorimétrica (Sensititre Yeast One).ResultadosDesde enero de 2009 a febrero de 2010 se recogieron 1.377 aislamientos en hemocultivos, correspondientes a 1.357 episodios de fungemia. Las fungemias se observaron principalmente en mayores de 64 años (46,7%) y el 8,6% en menores de 1 año. C. albicans (44,7%), Candida parapsilosis (29,1%), Candida glabrata (11,5%), Candida tropicalis (8,2%) y Candida krusei (1,9%) fueron las especies más frecuentes, pero su distribución no fue geográficamente homogénea. En los últimos 10 años la incidencia de C. albicans ha aumentado significativamente en Cataluña (39,1 vs. 54,7%, P = 0,03) y reducido en la Comunidad Valenciana (49,1 vs. 34,6%, P = 0,01). C. parapsilosis ha disminuido en Cataluña (29 vs. 12,4%, P = 0,002) y Extremadura (58,3 vs. 20%, P = 0,01). La sensibilidad a fluconazol fue similar en toda España pero en los aislamientos de C. albicans la resistencia fue diez veces superior en mayores de 64 años. Sin embargo, la tasa de resistencia (CMI > 32 mg/L) global ha disminuido con respecto a la obtenida hace 10 años (3,7 vs. 2,5% actual), sobre todo en C. albicans (3 vs. 1,6%). ConclusionesEn los últimos 10 años la distribución de las especies causantes de fungemia en España y la sensibilidad al fluconazol no han variado significativamente, aunque se observa una menor tasa de resistencia. La distribución de las especies varía según la unidad de hospitalización, hospital y Comunidad Autónoma.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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