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We report a case of Aspergillus tamarii keratitis. Ocular injury was known to be a predisposing factor. Topical natamycin and econazole treatment and subsequent systemic ketoconazole treatment proved effective.
The isolate was identified by morphological characteristics and sequence analysis as A. A year-old female from Coimbatore was presented to the Aravind Eye Hospital, Coimbatore, South India, on December 27, , with complaints of pain, redness, and defective vision of a 4-day duration in the left eye.
She indicated that she had suffered an ocular injury caused by an iron piece while hammering 4 days earlier. An anterior segment examination of the left eye showed lid edema and conjunctival congestion. The cornea showed a central 3-bymm ulcer with an anterior midstromal infiltrate with feathery edges and surrounding edema.
The lens was clear. The anterior segment of the right eye and the posterior segments of both eyes were within normal limits. The microscopic examination of the KOH wet mount and Gram staining showed fungal filaments. Based on the colony appearance, the fungus was identified as an Aspergillus sp.
The anterior chamber showed a hypopyon of 0. The patient was admitted as an inpatient and advised to continue the same medications along with mg oral ketoconazole and 0. The patient showed improvement during the next 3 weeks; the infiltrate reduced gradually, and the anterior segment inflammations subsided. The patient was advised to use glasses and to report for review after 6 months. The clinical isolate was further examined at the CBS Fungal Biodiversity Centre and at the University of Szeged for species assignment and antifungal susceptibility tests.
The fungus was subcultured on malt extract agar plates and identified as Aspergillus tamarii Kita based on the colony morphology and microscopic features of the isolate Fig. Colonies on malt extract agar at room temperature attained diameters of 6.
The phialides were borne directly on the vesicle or on metulae mostly on large heads. The conidia were globose to subglobose, 5 to 6. However, in contrast with those of typical wild A.
Conidia of a typical A. For purposes of molecular identification, mycelia grown in liquid YPG medium 0. A segment of the calmodulin gene was amplified using primers cmd5 and cmd6 as described by Hong et al. Both strands of each fragment were sequenced. The resulting sequences were deposited in the GenBank database. The ITS, tubulin, and calmodulin sequences of the case isolate proved to be completely identical to the corresponding sequences of A.
The Etest drug concentrations ranged from 0. The MIC was read as the drug concentration at which the elliptical inhibition zone intersected the scale of the Etest strip. Combating fungal keratitis is of special importance in India, which harbors the largest agrarian population at risk for developing blindness due to the limited availability of antifungal drugs and the lack of response during therapy. Certain Aspergillus species, mainly Aspergillus flavus 23 , 25 , Aspergillus terreus 25 , Aspergillus fumigatus 23 , 25 , and Aspergillus niger 4 , have long been regarded as important pathogens in eye infections, especially keratitis.
Other members of the genus less frequently occurring in keratitis include Aspergillus glaucus and Aspergillus ochraceus. Most of the Aspergillus strains isolated from keratomycosis patients are being identified and reported at the genus level only Their molecular identification at the species level would be of great importance, as the pathogenic potential may vary between different species of the genus.
This species is widely used in the food industry for the production of soy sauce known as red Awamori koji 14 and in the fermentation industry for the production of various enzymes, including amylases, proteases, and xylanolytic enzymes 3 , 7 , Although A. The only known cases are an eyelid infection 5 , invasive nasosinusal aspergillosis in an immunocompetent patient 20 , and onychomycosis in a 3-year-old boy To our knowledge, the present case of fungal keratitis is the first report on an ocular infection caused by A.
This work was supported by the Indian National Science Academy and the Hungarian Academy of Sciences within the frames of the Indo-Hungarian bilateral exchange program no. National Center for Biotechnology Information , U. Journal List J Clin Microbiol v.
J Clin Microbiol. Published online Aug Robert A. Author information Article notes Copyright and License information Disclaimer. Phone: 91 Fax: 91 E-mail: gro. This article has been cited by other articles in PMC. Abstract We report a case of Aspergillus tamarii keratitis. Mycological study and diagnosis.
Open in a separate window. TABLE 1. Locus GenBank accession no. Antifungal susceptibility testing. Nucleotide sequence accession numbers. Acknowledgments This work was supported by the Indian National Science Academy and the Hungarian Academy of Sciences within the frames of the Indo-Hungarian bilateral exchange program no.
Etest technical guide Antifungal susceptibility testing of moulds. Altschul, S. Gish, W. Miller, E. Myers, and D. Basic local alignment search tool. Anandan, D. Marmer, and R. Isolation, characterization and optimization of culture parameters for production of an alkaline protease isolated from Aspergillus tamarii. Chowdhary, A. Spectrum of fungal keratitis in North India. Cornea 24 : Degos, R. Segretain, G. Badillet, and A.
Dev, S. Rajaraman, and A. Severe fungal keratitis treated with subconjunctival fluconazole. Ferreira, G. Boer, and R. Production of xylanolytic enzymes by Aspergillus tamarii in solid state fermentation. FEMS Microbiol. Gams, W.
Christensen, A. Onions, J. Pitt, and R. Infrageneric taxa of Aspergillus , p. Samson and J. Pitt ed. Glass, N. Development of primer sets designed for use with the PCR to amplify conserved genes from filamentous ascomycetes.
Gopinathan, U. Garg, M. Fernandes, S. Sharma, S. Athmanathan, and G. The epidemiological features and laboratory results of fungal keratitis: a year review at a referral eye care center in South India. Cornea 21 : Haugland, R. Varma, L.
Genetic variation and aflatoxin production in Aspergillus tamarii and A. caelatus
Production of tannase by Aspergillus tamarii in submerged cultures. Costa I ; Wanessa X. The production of tannase by Aspergillus tamarii was studied in submerged cultures. The fungus produced an extracellular tannase after two days of growth in mineral medium containing tannic acid, gallic acid and methyl gallate as carbon source. The best result was obtained using gallic acid as inducer The production of enzyme was strongly repressed by the presence of glucose.
Aspergillus tamarii appears to be an emerging aetiological agent of human keratomycoses in South India. The investigated strains were isolated from six suspected fungal keratitis patients attending a tertiary care eye hospital in Coimbatore Tamil Nadu, India , and were initially identified by the microscopic examinations of the scrapings and the cultures. Our data suggest that A. According to the collected clinical data, ocular trauma is a common risk factor for the infection that gradually developed from mild to severe ulcers and could be healed with an appropriate combined antifungal therapy. Antifungal susceptibility testing revealed that A.