Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution
Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution
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DOI：
10.1001/jama.296.8.953
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发表时间：
2006-08-23
影响因子：
120.7
通讯作者：
Park, Benjamin J.
中科院分区：
文献类型：
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作者：
Chang, Douglas C.;Grant, Gavin B.;Park, Benjamin J.
镰刀菌性角膜炎是一种严重的角膜感染，最常见的与角膜损伤有关。从2006年3月开始，美国疾病控制与预防中心收到多份隐形透镜佩戴者中出现镰刀菌角膜炎的报告。目的定义与此次疫情相关的具体活动、隐形透镜卫生习惯或产品。设计、设置和参与者对美国发生的镰刀菌角膜炎进行流行病学调查。确诊病例定义为2005年6月1日以后发病的角膜炎，无近期眼外伤史，角膜培养生长镰刀菌属。数据由经过培训的人员通过患者和眼科医生对病例患者和邻居匹配对照的访谈获得。从患者的临床和环境标本中分离的镰刀菌可用多位点序列分型进行基因分型。镰刀菌的环境采样进行接触透镜解决方案制造plant.Main结果措施角膜炎感染与镰刀菌species.Results截至2006年6月30日，我们确定了164例确诊病例患者在33个州和1个美国领土。中位年龄为41岁（范围：12-83岁）。55例（34%）需要或计划进行角膜移植。154例（94%）确诊病例患者佩戴软性角膜接触镜。45例患者和78名对照被纳入病例对照研究。病例患者报告使用特定接触透镜溶液ReNu和MoistureLoc的可能性显著高于对照组（69% vs 15%;比值比，13.3; 95%置信区间，3.1-119.5）。病例患者和对照组报告的ReNu MultiPlus溶液使用率相似（18% vs 20%;比值比，0.7; 95%置信区间，0.2-2.8）。未从工厂、仓库、溶液滤液或未开封的溶液瓶中回收镰刀菌;未及时对相关批次的生产进行聚类。在39个测试菌株中，至少有10个不同的镰刀菌物种被确定，包括19个独特的多位点genotype.Conclusions从这次调查的结果表明，这爆发的镰刀菌角膜炎与使用ReNu与MoistureLoc接触透镜解决方案。隐形透镜用户不应将ReNu与MoistureLoc配合使用。
Context Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers.Objective To define the specific activities, contact lens hygiene practices, or products associated with this outbreak.Design, Setting, and Participants Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant.Main Outcome Measures Keratitis infection with Fusarium species.Results As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes.Conclusions The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.