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Fungi and paper-based archives. A case report of fungal keratitis in a documentalist
Hongos y archivos de papel. Caso clínico sobre queratitis fúngica en una paciente documentalista
A. Lopez-Vazquez
, A. Mora-Cantallops, D. Mingo-Botín
Corresponding author
Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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A case report of fungal keratitis in a documentalist" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 474 "Ancho" => 1255 "Tamanyo" => 48615 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imagen clínica del ojo 3 días después de su presentación (izquierda) y de la cicatrización corneal tras el tratamiento (derecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lopez-Vazquez, A. Mora-Cantallops, D. Mingo-Botín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." 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A case report of fungal keratitis in a documentalist" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "223" "paginaFinal" => "225" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Lopez-Vazquez, A. Mora-Cantallops, D. Mingo-Botín" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Lopez-Vazquez" "email" => array:1 [ 0 => "alopezvazquez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Mora-Cantallops" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Mingo-Botín" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hongos y archivos de papel. Caso clínico sobre queratitis fúngica en una paciente documentalista" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 474 "Ancho" => 1259 "Tamanyo" => 53655 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinic image of the eye 3 days after presentation (left) and corneal cicatrization after treatment (right).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fungal keratitis accounts for approximately 1–5% of infectious keratitis in warm climates and can be produced by filamentous fungi or yeast. <span class="elsevierStyleItalic">Aspergillus</span> spp., <span class="elsevierStyleItalic">Fusarium</span> spp. and <span class="elsevierStyleItalic">Candida</span> spp. are the most frequently involved genders.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Fungi are eukaryote living beings that are ubiquitously present in the environment. Temperature and humidity are the 2 main conditions for their development. Libraries, old books and paper archives have demonstrated to fulfill excellent conditions for the growth of fungi considering that cellulose is an excellent nutrient for them. To the best of the authors’ knowledge, the first case of fungal keratitis attributable to the profession of documentalist is presented.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case</span><p id="par0010" class="elsevierStylePara elsevierViewall">Female, 32, contact lens user, visited the emergency Dept. of the authors’ hospital referring right painful red eye with 5 days evolution. Corrected visual acuity was finger counting in the right eye and 20/20 in the left one. After thorough anamnesis, the only risk factor that was the frequent use of contact lenses due to moderate myopia even though the patient referred adequate hygiene and care thereof. The patient worked at that time as a documentalist handling antique books and old paper archives. She was considering refractive surgery. No relevant ophthalmological or systemic diseases were found and the patient was not taking medications apart from oral contraceptives.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Biomicroscopic examination evidenced an infiltrated and fluoro-positive central ulcer in the right eye. Margins were uneven, no satellite lesions could be observed and anterior chamber reaction was slight. The Gram test evidenced nonseptate hyphae, leading to a presumed diagnostic of fungal keratitis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly, the infection was treated with 1% topical voriconazole at 1-h intervals, 5% natamycin every 2<span class="elsevierStyleHsp" style=""></span>h and topical moxifloxacin every 2<span class="elsevierStyleHsp" style=""></span>h. The microbiological analysis revealed <span class="elsevierStyleItalic">Fusarium</span> spp. and response to treatment was satisfactory, achieving control of the infection. Central corneal cicatrization was inevitable. Even so, BCVA was 30/50 and the clinic condition remains stable 8 months later (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">It is well-known that looks deteriorate with time due to the action of biological agents such as micro-organisms (filamentous fungi, yeasts and bacteria) as well as rodents and insects.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Fungi can easily develop under different conditions, with temperature and humidity being the main factors. As fungi cannot obtain energy from chlorophyll, feeding on organic matter is crucial for their survival. Paper carbohydrates (cellulose and others) are good nutrients for fungi. They also need other oligoelements such as carbon, nitrogen, oxygen, potassium or magnesium. Paper archives and libraries have demonstrated to be adequate environments for fungal development because they generously meet all the above conditions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fungi propagate by means of conidia or sexual spores. These structures are easily airborne (when cleaning dust) or can be transported in clothes and shoes as well as through air-conditioning systems. Infections caused by books can be divided in primary (if the colonization occurs during manufacture) or secondary if derived from use, preservation or restoration. The main fungal genders found in libraries include <span class="elsevierStyleItalic">Alternaria</span> spp., that produces brown spots on paper, <span class="elsevierStyleItalic">Aspergillus</span> spp., the most common fungus that is responsible for 80% of the destruction of books, <span class="elsevierStyleItalic">Cladosporium</span> spp., <span class="elsevierStyleItalic">Fusarium</span> spp., <span class="elsevierStyleItalic">Penicillium</span> spp. and <span class="elsevierStyleItalic">Trichoderma</span> spp.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusarium</span> spp., the gender that accounts for the infection being discussed, has demonstrated its ability to form biofilms on cellulose surfaces which cause various color losses and acidify paper producing its deterioration.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> Infection by <span class="elsevierStyleItalic">Fusarium</span> spp. in humans include onychomycosis, keratitis and slight infections in the respiratory pathways in immunocompetent individuals and severe pneumonia or disseminated systemic infections in immunodepressed individuals.</p><p id="par0040" class="elsevierStylePara elsevierViewall">To date, established risk factors for fungal keratitis include the use of contact lenses, ocular surgery, topical steroids and traumatism with vegetable materials. Professions such as farming or gardening as well as outdoor activities are typical risk factors for this type of infection.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, in the knowledge of the authors no relationships have been established between books, paper archives or libraries and fungal keratitis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">After collecting all the information of this case, it is reasonable to assume a link between the manipulation of paper archives colonized by fungi and fungal keratitis, even more so in patients with other risk factors such as the use of contact lenses. The present patient was actively working as a librarian manipulating paper archives when the infection arose. Even though she was aware of the possibility of fungal colonization from the material she manipulated, she did not take additional measures to avoid ocular contact because she was not aware of corneal infection risks.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Presumably, subclinic damage on the ocular surface caused by contact lenses enables the passage of the infection arising from fungi in the surface of books and other paper archives.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Books, paper archives and libraries constitute a reservoir of fungi that could be a potential risk factor for corneal infections.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1335164" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1229790" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1335163" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1229789" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-09" "fechaAceptado" => "2020-02-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1229790" "palabras" => array:5 [ 0 => "Cornea" 1 => "Infectious keratitis" 2 => "Funghi" 3 => "Fungal keratitis" 4 => "Bio-deterioration" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1229789" "palabras" => array:5 [ 0 => "Córnea" 1 => "Queratitis infecciosas" 2 => "Hongos" 3 => "Queratitis fúngicas" 4 => "Biodeterioro" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A description of a case is presented on a relationship between paper-based documents as a risk factor for fungal keratitis. A 32-year-old woman, a long-term contact lens user, presented with fungal keratitis in her right eye caused by <span class="elsevierStyleItalic">Fusarium</span> spp. while working with books and old documents as a librarian. Her visual acuity was hand motion in the right eye. She was satisfactorily treated with topical antifungal and antibiotic agents.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pretendemos describir mediante un caso clínico la relación entre los archivos en formato de papel como factor de riesgo para queratitis fúngicas. Para ello, presentamos un caso de una mujer de 32 años, usuaria crónica de lentes de contacto, que se presentó con una queratitis fúngica en su ojo derecho producida por <span class="elsevierStyleItalic">Fusarium</span> spp. mientras trabajaba con libros y documentos antiguos en su profesión como bibliotecaria. Su agudeza visual era de movimiento de manos en el ojo derecho. Fue tratada satisfactoriamente con antibióticos y antifúngicos tópicos, con buena evolución.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lopez-Vazquez A, Mora-Cantallops A, Mingo-Botín D. Hongos y archivos de papel. Caso clínico sobre queratitis fúngica en una paciente documentalista. Arch Soc Esp Oftalmol. 2020;95:223–225.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 474 "Ancho" => 1259 "Tamanyo" => 53655 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinic image of the eye 3 days after presentation (left) and corneal cicatrization after treatment (right).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update of the management of infectious keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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