Corneal scrapings were obtained for pathological examination and cultures. Cultures were plated on blood and Sabouraud’s agars. Her general examination was normal, as were the serum C-reactive protein and WBC levels. At this point, the infectious diseases team was consulted. A revision ICG-001 ic50 of the Sabouraud’s plates after 48 hours revealed a small colony consistent with Candida spp., and she was therefore started with fluconazole 400 mg. A revision of the pathological specimen was performed the following day and raised the suspicion of an “Aspergillus” species. As a result, the bacteriological cultures were reexamined and plain slides were prepared from the growing colony. These clearly demonstrated “boat
shaped” conidia, consistent with Fusarium spp. A thorough investigation identified the fungus as Fusarium dimerum. The patient’s treatment was subsequently changed to oral voriconazole 400 mg twice daily for 24 hours (accompanied
by voriconazole 1% drops every hour), followed by 200 mg bid until discharge (total hospitalization was 8 d). Her central corneal infiltrate quickly cleared and within 3 days diminished to approximately Romidepsin cell line one-third their original size (Figure 1A and B). Contact lenses from the same batch she had used in Namibia, which were left at home, were cultured on Sabouraud’s agar but were negative. Final examination carried out 2 months after Parvulin discharge revealed a visual acuity of 6/9p. There was still a remaining central corneal opacity. The rest of the examination was normal.
Fusarium species belong to the Hypocreaceae family. They are widely distributed in soil and on subterranean and aerial plant parts, plant debris, and other organic substrates. They are common in tropical and temperate zones but are also found in desert and arctic regions, where harsh climatic conditions prevail.5 Most reported cases stem from North America, Western Europe, and Australia; however, the fungus is also present in the Indian subcontinent and Africa.6–9 To the best of our knowledge, human cases from Namibia have never been reported. Although Fusarium is often regarded as soilborne, wind is possibly important in the dissemination of these fungi. Wind dispersal may explain the isolation of Fusarium spp. from 17% of throat specimens of 27 nonhospitalized healthy adults.5 In our presented case, there is temporal evidence linking the infection and the airborne object that the patient suddenly felt in her eye. We speculate that the grain of soil probably contained multiple microorganisms. The treatment she received in Namibia most likely eliminated the bacterial pathogens, leaving Fusarium as the sole culprit. Infectious keratitis is a rare but serious complication that may lead to permanent vision loss.10 The risk of microbial keratitis among contact lens wearers was found in one study to be 80-fold higher.