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Aspergillus fumigatus is a ubiquitous mould that rarely causes ocular pathology. Aspergillus keratitis may be seen following trauma or surgery1 to the eye and has recently been reported following laser in situ keratomileusis.2,3 Endophthalmitis is also a rare event after trauma or surgery. Endogenous aspergillus endophthalmitis is seen in patients who are immunocompromised, have endocarditis, or a history of injecting drug use. An outbreak of ocular aspergillosis following cataract surgery has been reported in association with building a new hospital in the Middle East.4 We report a case of aspergillus keratitis associated with hospital construction in the United Kingdom.
A 43 year old man presented with a right sided corneal ulcer and a vision of hand movements (Fig 1). He had a past history of bilateral herpes simplex keratitis, rosacea related keratopathy, bilateral corneal grafts, and cataract surgery. The right corneal ulcer was treated with intensive topical ofloxacin and prednisolone acetate 1%. Alpha haemolytic streptococci and coagulase negative staphylococci were cultured from the corneal scrape. The central cornea thinned and a hypopyon became visible. The cornea then perforated and a bandage contact lens and glue was placed on the cornea while graft material was being obtained. A penetrating keratoplasty was performed with a 9 mm donor placed into an 8.5 mm recipient bed with interrupted sutures (Fig 2). Soon after surgery the microbiology laboratory grew Aspergillus fumigatus from two plates from the corneal scrape. The patient was taken back to theatre for intravitreal amphotericin B injection and topical amphotericin was commenced. The patient made an excellent recovery and has maintained a vision of 6/9 in the right eye with a refraction of −3.25/+3.00×105.
This patient has unfortunately had infection of the cornea with virus, bacteria, and fungus. The previous herpetic and rosacea related keratopathy resulted in his original corneal grafts and were a risk factor for the development of bacterial keratitis. Considerable demolition and construction work was taking place at the time the patient was admitted to the Royal Devon and Exeter Hospital. The old hospital tower block was being pulled down and the aspergillus infection was probably due to contamination from fungal spores released during the demolition work.
Penetrating keratoplasty is a recognised treatment for fungal keratitis,5 although the graft was performed for the corneal perforation and the fungal infection was only noted after the graft. We believe this is the first documented combined bacterial and fungal keratitis in the United Kingdom that may be attributed to contamination by fungal spores released by hospital demolition work.