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Alternaria is an Infrequent Cause of Keratitis: A Case Report and Review of the Literature

Monno, Rosa B.S.; Alessio, Giovanni M.D.; Guerriero, Silvana M.D.; Caggiano, Giuseppina B.S.; Capolongo, Carmen B.S.; De Vito, Danila M.D.; Sanguinetti, Maurizio M.D.

Eye & Contact Lens: Science & Clinical Practice: July 2015 - Volume 41 - Issue 4 - p e14–e17
doi: 10.1097/ICL.0000000000000012
Case Report
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Objective: To report a case of fungal keratitis caused by Alternaria in a 49-year-old female who developed an acute onset of eye infection after ocular trauma caused by an olive leaf.

Methods: The clinical presentation, microbiological diagnosis, and therapeutic approaches are reported.

Results: The patient was referred to our university hospital clinic with corneal abscess in her left eye. Before the start of an empirical antibacterial therapy (both topical and systemic), a swab of the cornea was obtained which at microscopic examination revealed a few fragments of hyphal elements, probably for the paucity of material collected. After one week, the corneal abscess had increased in size, and the corneal stroma was filled with filamentous structures similar to fungal hyphae. Oral and topical voriconazole was administered because of the clinical picture and the response of microbiological laboratory whose examination of the material removed from the anterior chamber showed numerous hyphal fragments identified by culture as Alternaria spp. The corneal abscess healed in two weeks, but the patient now has a corneal scar and is awaiting a corneal transplant.

Conclusions: Ophthalmologists and microbiologists must take fungi into greater consideration as a possible cause of keratitis as they are emerging as the cause of this infectious disease in many countries. Voriconazole spreads well in the eye and is effective in the cure of fungal keratitis including those caused by Alternaria.

Departments of Basic Medical Sciences, Neuroscience and Sense Organs (R.M., G.A., S.G.D.D.V.,), Biomedical Sciences and Human Oncology (G.C.), School of Medicine, University of Bari Aldo Moro, Bari, Italy; Institute of Microbiology (R.M., C.C., D.D.V.), Universitá Cattolica del Sacro Cuore, Rome, Italy; and Microbiology and Virology (R.M., C.C., D.D.V.), Policlinico Hospital, Bari, Italy.

Address correspondence to Rosa Monno, B.S., Department Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; e-mail: rosa.monno@uniba.it

The authors have no funding or conflicts of interest to disclose.

Accepted October 24, 2013

© 2015 Contact Lens Association of Ophthalmologists, Inc.