Purpureocillium lilacinum is an environmental mold that can cause a range of infections in humans. Although infection in immunocompetent persons is uncommon, eye infections have been reported. Most cases of P. lilacinum keratitis have been reported in association with soft contact lens use, eye trauma, eye surgery, and immunosuppression.
Three patients developed P. lilacinum corneal infections after laser eye surgery at a New York City ophthalmology clinic, one of whom required corneal transplantation. Investigation identified infection prevention and control deficiencies at the clinic that potentially resulted in mold exposure. All environmental cultures were negative for P. lilacinum, but fungal amplicon sequencing detected P. lilacinum DNA in the epikeratome suction tubing (an epikeratome is a surgical device that uses suction to separate the corneal epithelium from the underlying corneal layers. The epikeratome consists of the machine that generates suction, suction tubing, and a handheld attachment that touches the eye during surgery and is sterilized after each use).
During surgery, the epikeratome draws air away from the eye through a handheld attachment that touches the eye and is connected to suction tubing that contains a filter to prevent flow of debris into the machine. The handheld attachment is sterilized after each use and was therefore not made available for sampling. The suction tubing is intended for single use and is provided as a sterile product. Whether the P. lilacinum DNA in the epikeratome tubing was the source of infection is unclear because of the way the tubing was used and the possibility of environmental contamination. Clinic staff members reported that tubing was never shared between patients; it is not known whether the set of tubing collected for testing was the one used for any of the infected patients’ procedures. The epikeratome machine is a multiuse item. It was not sent for testing because no clear sampling approach could be identified. After implementation of infection prevention and control measures, no further cases were identified.
The humidifiers were another possible source of the infection. Cool-mist humidifiers were previously implicated in an outbreak of Mycobacterium chelonae eye infections at a laser eye surgery clinic; however, the humidifiers in use at the time the P. lilacinum infections in this outbreak occurred had been replaced and were unavailable for testing. CDC environmental infection control guidelines recommend avoidance of cool-mist humidifiers in health care facilities, and current health care engineering guidelines specify that steam humidification should be used.
The CDC advises that adherence to published infection prevention and control guidance during all procedures in ambulatory settings can reduce the risk for health care–associated infections and related complications. The CDC further stated that because P. lilacinum is known to cause drug-resistant keratitis, and rates of detection are increasing, P. lilacinum should be considered as a potential cause of infection after eye surgery, even before definitive culture identification.
If you or a family member suffered serious injury or other harm from an infection following laser eye surgery in the United States, you should promptly find a medical malpractice attorney in your state who may investigate your possible laser surgery malpractice claim for you and represent you or your family member in an eye surgery medical malpractice case, if appropriate.
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