A decade of ocular fungal infections due to Penicillium-like fungi in France (2012-2021).

Penicillium, Talaromyces, and Purpureocillium species (so called Penicillium-like) are increasingly recognised as opportunistic fungal pathogens capable of causing a wide range of infections, from superficial to invasive. Although ocular infections caused by these environmental fungi have been reported in the literature, they remain relatively underrecognised. We conducted a multicentric retrospective study of Penicillium-like ocular cases reported in the RESeau de Surveillance des Infections Fongique (RESSIF) database of the French National Reference Center for Invasive Mycoses and Antifungals between 2012 and 2021. Among 55 cases of Penicillium-like invasive infections reported to the RESSIF network in France, a total of 24 cases (44%) were identified, which predominantly presented as keratitis (n = 22, 92%). Predisposing factors were as follows: contact lens wear (n = 11, 46%), topical corticosteroid use (n = 9, 37.5%), ocular trauma (n = 5, 21%), pre-existing corneal disease (n = 4, 17%), and previous ocular surgery (n = 2, 8%). Purpureocillium lilacinum was the predominant pathogen (n = 19, 79%), followed by four Penicillium species and one Talaromyces species. Direct examination of ocular samples was positive in 13 cases (54%). Antifungal susceptibility testing (European Committee on Antimicrobial Susceptibility Testing) revealed that all species exhibited high minimal inhibitory concentrations to amphotericin B (> 1 mg/l). Most patients were treated with a combination of topical voriconazole and amphotericin B (n = 15, 62.5%), which was administered alongside oral voriconazole in nine cases (37.5%). Surgical intervention was required in six cases (25%) and included keratoplasty (n = 4) and enucleation (n = 2). This study provides a valuable overview of Penicillium-like fungal ocular infections and highlights the importance of systematically surveilling filamentous fungal keratitis.