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Multistate Outbreak of Fusarium Keratitis Associated With Use of a Contact Lens Solution
Douglas C. Chang, MD;
Gavin B. Grant, MD, MPH;
Kerry O’Donnell, PhD;
Kathleen A. Wannemuehler, MSc;
Judith Noble-Wang, PhD;
Carol Y. Rao, PhD;
Lara M. Jacobson, MD;
Claudia S. Crowell, MD;
Rodlescia S. Sneed, MPH;
Felicia M. T. Lewis, MD;
Joshua K. Schaffzin, MD, PhD;
Marion A. Kainer, BS, MS, MPH;
Carol A. Genese, MBA;
Eduardo C. Alfonso, MD;
Dan B. Jones, MD;
Arjun Srinivasan, MD;
Scott K. Fridkin, MD;
Benjamin J. Park, MD; for the Fusarium Keratitis Investigation Team
JAMA. 2006;296:953-963.
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.
Author Affiliations: Mycotic Diseases Branch (Drs Chang, Rao, Fridkin, and Park), Respiratory Diseases Branch (Dr Grant), and Biostatistics Office (Ms Wannemuehler), Division of Bacterial and Mycotic Diseases, and Epidemiology and Laboratory Branch (Drs Noble-Wang and Srinivasan), Division of Healthcare Quality Promotion, National Center for Infectious Diseases and Epidemic Intelligence Service (Drs Chang, Grant, Lewis, and Schaffzin) and Epidemiology Elective Program (Drs Jacobson and Crowell), Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Ga; Microbial Genomics Research Unit, National Center for Agricultural Utilization Research, Agricultural Research Service, US Department of Agriculture, Peoria, Ill (Dr O’Donnell); Miami-Dade County Health Department, Miami, Fla (Ms Sneed); Philadelphia Department of Health, Philadelphia, Pa (Dr Lewis); New York State Department of Health, Albany, NY (Dr Schaffzin); Tennessee Department of Health, Nashville, Tenn (Dr Kainer); New Jersey Department of Health and Senior Services, Trenton, NJ (Ms Genese); Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Fla (Dr Alfonso); and Cullen Eye Institute, Baylor College of Medicine, Houston, Tex (Dr Jones).
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