P-582. Purpureocillium lilacinum Keratitis Cases Associated with an Ophthalmology Clinic — New York City, 2024

TL;DR

A mold called Purpureocillium lilacinum caused severe eye infections in three patients at an ophthalmology clinic in New York City, linked to lapses in infection control practices.

Contribution

Identification of P. lilacinum keratitis cases and investigation into clinic practices revealing infection control failures.

Findings

Three patients developed P. lilacinum keratitis after procedures at the clinic, with one requiring corneal transplantation.

Infection prevention lapses included improper instrument reprocessing, environmental cleaning, and use of nonsterile water.

Genetic analysis showed clinical isolates were closely related but distinct from control isolates, and P. lilacinum DNA was detected in a surgical device.

Abstract

Purpureocillium lilacinum, an environmental mold, can cause sight-threatening infections after ocular surgery and demonstrates intrinsic resistance to certain antifungals. On December 18, 2024, a clinical laboratory notified the New York City Health Department of multiple patients with P. lilacinum keratitis after procedures at an ophthalmology clinic (Clinic A). We investigated to identify exposures associated with illness and recommend control measures.

A case was defined as eye pain or vision loss in a patient after laser eye surgery at Clinic A during December 5–18, 2024, with corneal cultures demonstrating P. lilacinum or scrapings detecting fungal elements. We reviewed medical records, interviewed clinicians, and assessed Clinic A’s infection prevention and control (IPC) practices. We performed antifungal susceptibility testing (AFST) and whole genome sequencing (WGS) on P. lilacinum clinical isolates, and environmental cultures and fungal amplicon sequencing (ITS1, ITS2, and 28S rDNA) of a saline bottle, refrigerator, and surgical device for presence of P. lilacinum.

We identified 3 cases. All patients experienced vision loss; 1 required corneal transplantation. IPC assessment identified lapses in instrument reprocessing, environmental cleaning, medication safety, and exposure to nonsterile water. We observed an undated bottle of sterile saline solution used for surgical irrigation for multiple patients across multiple weeks. We gave recommendations addressing potential exposures. AFST showed resistance to amphotericin B and susceptibility to azoles. WGS showed that clinical isolates were genetically related (∼55 single nucleotide polymorphisms [SNPs] apart) but different from control isolates (∼200,000 SNPs apart). Environmental cultures were negative for P. lilacinum but amplicon sequencing detected P. lilacinum DNA in the surgical device’s suction tubing.

P. lilacinum caused severe disease in all 3 patients. Whether detection of P. lilacinum in the surgical device supported this as the infection source or represented environmental contamination is unclear. Our investigation uncovered and addressed breakdowns in IPC practices. No further cases have been identified.

All Authors: No reported disclosures