was read the article
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"MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1638 "Ancho" => 3042 "Tamanyo" => 329892 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Level of complexity of the laboratories and organizational structure of the Mycology Network.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mariana Mazza, Nicolás Refojo, Graciela Davel, Nelson Lima, Nicolina Dias, Cosme Marcelo Furtado Passos da Silva, Cristina Elena Canteros" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Mariana" "apellidos" => "Mazza" ] 1 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Refojo" ] 2 => array:2 [ "nombre" => "Graciela" "apellidos" => "Davel" ] 3 => array:2 [ "nombre" => "Nelson" "apellidos" => "Lima" ] 4 => array:2 [ "nombre" => "Nicolina" "apellidos" => "Dias" ] 5 => array:2 [ "nombre" => "Cosme Marcelo Furtado" "apellidos" => "Passos da Silva" ] 6 => array:2 [ "nombre" => "Cristina Elena" "apellidos" => "Canteros" ] 7 => array:1 [ "colaborador" => "Mycology Network of the Province of Buenos Aires (MNPBA)" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140617301171?idApp=UINPBA00004N" "url" => "/11301406/0000003500000002/v2_201809080414/S1130140617301171/v2_201809080414/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130140618300184" "issn" => "11301406" "doi" => "10.1016/j.riam.2018.01.002" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "477" "copyright" => "Asociación Española de Micología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Iberoam Micol. 2018;35:88-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 813 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 405 "PDF" => 361 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Drug susceptibility profile of <span class="elsevierStyleItalic">Candida glabrata</span> clinical isolates from Iran and genetic resistant mechanisms to caspofungin" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "88" "paginaFinal" => "91" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfil de sensibilidad antifúngica de aislamientos clínicos de <span class="elsevierStyleItalic">Candida glabrata</span> de Irán y mecanismos genéticos de resistencia a la caspofungina" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1120 "Ancho" => 1678 "Tamanyo" => 99117 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relative expression of three different <span class="elsevierStyleItalic">C. glabrata FKS</span> genes compared to <span class="elsevierStyleItalic">C. glabrata URA3</span> gene. Significant relative gene expressions have been marked with an asterisk.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Saeid Amanloo, Masoomeh Shams-Ghahfarokhi, Mohammad Ghahri, Mehdi Razzaghi-Abyaneh" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Saeid" "apellidos" => "Amanloo" ] 1 => array:2 [ "nombre" => "Masoomeh" "apellidos" => "Shams-Ghahfarokhi" ] 2 => array:2 [ "nombre" => "Mohammad" "apellidos" => "Ghahri" ] 3 => array:2 [ "nombre" => "Mehdi" "apellidos" => "Razzaghi-Abyaneh" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140618300184?idApp=UINPBA00004N" "url" => "/11301406/0000003500000002/v2_201809080414/S1130140618300184/v2_201809080414/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Endophthalmitis caused by <span class="elsevierStyleItalic">Fusarium</span>: An emerging problem in patients with corneal trauma. A case series" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "96" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Luis Barrios Andrés, Leyre Mónica López-Soria, Ana Alastruey Izquierdo, Jaime Echevarría Ecenarro, Raquel Feijoó Lera, Jesus Garrido Fierro, Francisco Javier Cabrerizo Nuñez, Andrés Canut Blasco" "autores" => array:8 [ 0 => array:4 [ "nombre" => "José Luis" "apellidos" => "Barrios Andrés" "email" => array:1 [ 0 => "joseluis.barriosandres@osakidetza.eus" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Leyre Mónica" "apellidos" => "López-Soria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "Alastruey Izquierdo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Jaime" "apellidos" => "Echevarría Ecenarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Raquel" "apellidos" => "Feijoó Lera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Jesus" "apellidos" => "Garrido Fierro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Cabrerizo Nuñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 7 => array:3 [ "nombre" => "Andrés" "apellidos" => "Canut Blasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Microbiology Service, Araba University Hospital, Vitoria-Gasteiz, Araba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Microbiology Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Ophthalmology Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Ophthalmology Service, Araba University Hospital, Vitoria-Gasteiz, Araba, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endoftalmitis por <span class="elsevierStyleItalic">Fusarium</span>: un problema emergente en pacientes con traumatismo corneal. Serie de casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1376 "Ancho" => 950 "Tamanyo" => 146032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Early postoperative findings after tectonic penetrating keratoplasty in the left eye. Corneal transplant is edematous and shows fibrotic changes. Note the superior neovascularization secondary to graft failure. Early postoperative findings in the right eye after the first penetrating keratoplasty. Severe conjunctival infection with a dense superior infiltrate in the interface suggestive of infection. The transplant appears edematous and with Descemet folds in the visual axis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although fungal eye infections are fortunately not common, an immunocompromised condition or the use of increasing number of drugs in patients with ophthalmologic disorders may cause these infections to become an emerging problem. Some of these ophthalmologic drugs, such as corticosteroids, long-term treatment, or the use of broad-spectrum antibiotics in damaged corneas, may be risk factors for the development of fungal endophthalmitis (FE).<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,13,25</span></a> The origin and etiology of this disease can vary, with <span class="elsevierStyleItalic">Fusarium</span> being one of the most important etiologic agents in exogenous FE (directly from an external source such as keratitis, trauma, or intraocular surgery).<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21,25</span></a> A dysfunctional epithelial barrier is required for <span class="elsevierStyleItalic">Fusarium</span> to colonize the corneal stroma. Once inside the stroma, this microorganism produces an intense inflammatory reaction that breaks down internal barriers, thus leading to rapid tissue degradation and the characteristic clinical features of endophthalmitis.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> In this case series, we aim to identify clinical findings characteristic of <span class="elsevierStyleItalic">Fusarium</span> infection that may enable a prompt diagnosis and a more efficient management of this ophthalmologic condition.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and methods</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 79-year-old woman, wearer of soft contact lenses, was sent to our casualty department by her general practitioner. She complained of having had redness and discomfort of the eyes for the past 15 days which did not improve with topical tobramycin and oral azithromycin. A central corneal ulcer with associated stromal infiltrate was found to be the cause. A corneal sample was taken and the initial result was positive for coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span>. As there was a strong suspicion of fungal infection, treatment with fortified topical antibiotics and topical voriconazole was prescribed. Ten days later the infection progressed to endophthalmitis, therefore posterior vitrectomy and a penetrating keratoplasty was performed. Samples of the cornea, vitreous humor, and crystalline capsule were sent for microbiological analysis, and <span class="elsevierStyleItalic">Fusarium solani</span> species complex was obtained in culture (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Antifungal susceptibility testing was performed using the EUCAST method and the MICs were as follows: amphotericin B, 1<span class="elsevierStyleHsp" style=""></span>μg/ml; caspofungin, >16<span class="elsevierStyleHsp" style=""></span>μg/ml; itraconazole, >8<span class="elsevierStyleHsp" style=""></span>μg/ml; voriconazole, >8<span class="elsevierStyleHsp" style=""></span>μg/ml; posaconazole, 8<span class="elsevierStyleHsp" style=""></span>μg/ml, and terbinafine, >16<span class="elsevierStyleHsp" style=""></span>μg/ml. Despite changing the treatment to amphotericin B, the graft failed and developed an exudative retinal detachment. At this point no additional interventions were considered to be necessary. The eye currently remains free from infection but in a state of phthisis bulbi (phthisis bulbi is the end-stage ocular response to trauma and/or severe ocular disease. The presentation is that of a very soft, atrophic, blind, and shrunken eye with disorganization of the intraocular structures).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patient 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 56-year-old woman, wearer of soft contact lenses, was admitted to our department complaining about redness and discomfort in both eyes for the past 48<span class="elsevierStyleHsp" style=""></span>h. She had been using anesthetic drops since the onset of the symptoms. Slit lamp examination showed bilateral conjunctival inflammation, a central corneal erosion, and stromal keratitis in the left eye. Treatment with topical ciprofloxacin was initiated and a conjunctival exudate sample was taken for microbiological examination. After clinical worsening, the treatment was changed to topical vancomycin and ceftazidime on the second day. Five days later, the patient showed bilateral central infiltrates with severe anterior chamber inflammation and hypopyon in both eyes. Due to the rapid evolution of the eye infection despite intensive treatment with antibiotics, and given the clinical suspicion of fungal endophthalmitis, antimicrobial treatment was extended to include topical voriconazole. The microbiological cultures were positive for <span class="elsevierStyleItalic">Fusarium oxysporum</span> species complex and voriconazole was replaced with topical 5% natamycin. Due to progressive stromal melting, further surgical management with intracameral ceftazidime, vancomycin, voriconazole, and an amniotic membrane graft was performed. A keratoplasty on the left eye to re-establish the corneal architecture was performed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Keratoplasty and phacoemulsification with intraocular lens implantation was carried out on the right eye two months after the onset of symptoms. The same procedure had to be repeated on the left eye nine months later (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The evolution was good and a transparent keratoplasty with no signs of rejection was observed in both eyes in subsequent medical checks.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patient 3</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 66-year-old male with posterior polymorphous corneal dystrophy had received in his right eye six previous failed penetrating keratoplasties, cataract surgery, and one trabeculectomy for glaucoma. He had also undergone four previous failed keratoplasties, cataract surgery, limbal allograft transplantation, and trabeculectomy in his left eye. In September 2007, the patient underwent Boston type I keratoprosthesis surgery on his right eye, reaching a BCVA (best corrected visual acuity) of 20/40. During follow-up he developed cystic macular edema, which was successfully treated with intravitreous steroids and bevacizumab. In August 2008 he developed cornea melting in the inferior hemicornea, which was unsuccessfully treated with topical medroxyprogesterone and tetracyclines, therefore a new Boston keratoprosthesis type I for aphakia was repeated in October 2008, achieving a BCVA of 20/60 despite his glaucoma (disc excavation 5/6). In December 2008, he developed vitritis, which was treated with pars plana vitrectomy, with the microbiological conclusion that the vitritis was sterile. The patient was prescribed oral prednisone, topical vancomycin bid, topical tobramycin bid, topical dexamethasone bid, Combigan<span class="elsevierStyleSup">®</span> bid (for glaucoma), and topical medroxyprogesterone tid.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two months later, the patient presented a corneal feather infiltrate (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) suggestive of a vitreous fungal infection. Samples of the cornea and vitreous humor were cultured and the patient started with topical 1% voriconazole six times a day as well as vancomycin and topical medroxyprogesterone. Two days later a new pars plana vitrectomy was performed, removing the Boston keratoprosthesis and inserting a penetrating keratoplasty. The cultures yielded filamentous colonies of a fungus that was identified as <span class="elsevierStyleItalic">F. oxysporum</span> species complex. The patient initiated oral voriconazole and topical voriconazole, vancomycin, tobramycin, cyclosporine A, and ketorolac.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Seven days later, with a new fungal infiltrate in the keratoplasty and on the basis of the susceptibility testing results (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), the patient started systemic and topical amphotericin B, which controlled the endophthalmitis but, unfortunately, the eye developed phthisis bulbi.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Identification of fungal isolates</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fungal isolates were identified as <span class="elsevierStyleItalic">Fusarium</span> spp. based on the characteristics of colonies grown on potato-dextrose agar (PDA) at 35<span class="elsevierStyleHsp" style=""></span>°C and microscopic examination with lactophenol cotton blue stain.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Identification of the species was done by molecular methods. The isolate was cultured in GYEP medium (0.3% yeast extract, 1% peptone; Difco, Soria Melguizo SA, Madrid, Spain) with 2% glucose (Sigma Aldrich Química, Madrid, Spain) for 24–48<span class="elsevierStyleHsp" style=""></span>h at 30<span class="elsevierStyleHsp" style=""></span>°C. Genomic DNA was extracted using a previously described procedure.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> DNA segments comprising a region of elongation factor alpha (EFα) and the internal transcribed spacers (ITS) were amplified using the primers EF1 (5′-ATGGGTA AGARGACAAGAC-3′), EF2 (5′-GGARGTACCAGTS ATCATGTT-3′), ITS1 (5′-TCCGTAGGTGAACCTGCG G-3′), and ITS4 (5′-TCCTCCGCTTATTGATATGC-3′) in a GeneAmp 9700 PCR system (Applied Biosystems, Madrid, Spain).<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14,24</span></a> The reaction mixtures contained 0.5<span class="elsevierStyleHsp" style=""></span>μM of each primer, 0.2<span class="elsevierStyleHsp" style=""></span>μM of each deoxynucleoside triphosphate, 5<span class="elsevierStyleHsp" style=""></span>μl PCR buffer (Applied Biosystems), 2.5<span class="elsevierStyleHsp" style=""></span>U Taq DNA polymerase (AmpliTaq; Applied Biosystems), and 25<span class="elsevierStyleHsp" style=""></span>ng DNA in a final volume of 50<span class="elsevierStyleHsp" style=""></span>μl. The samples were amplified in a GeneAmp 9700 PCR system (Applied Biosystems) using the following cycling conditions: 1 initial cycle of 5<span class="elsevierStyleHsp" style=""></span>min at 94<span class="elsevierStyleHsp" style=""></span>°C, followed by 35 cycles of 30<span class="elsevierStyleHsp" style=""></span>s at 94<span class="elsevierStyleHsp" style=""></span>°C, 45<span class="elsevierStyleHsp" style=""></span>s at 47<span class="elsevierStyleHsp" style=""></span>°C (EFα) or 56<span class="elsevierStyleHsp" style=""></span>°C (ITS), and 2<span class="elsevierStyleHsp" style=""></span>min at 72<span class="elsevierStyleHsp" style=""></span>°C, with a final cycle of 5<span class="elsevierStyleHsp" style=""></span>min at 72<span class="elsevierStyleHsp" style=""></span>°C. The reaction products were analyzed on a 0.8% agarose gel and purified with illustra ExoProStar 1-Step (VWR International Eurolab, Spain) following the manufacturer's recommendations. Sequencing reactions were performed with 5<span class="elsevierStyleHsp" style=""></span>μl of the PCR product, 1<span class="elsevierStyleHsp" style=""></span>μl of primers (EF1, EF2, ITS1, or ITS4), and 4<span class="elsevierStyleHsp" style=""></span>μl of DNA using a sequencing kit (BigDye Terminator Cycle Sequencing Ready Reaction, Applied Biosystems) in a final volume of 10<span class="elsevierStyleHsp" style=""></span>μl. Sequences were assembled and edited using the SeqMan II and EditSeq software (Lasergene package; DNAstar, Inc., Madison, WI). Sequence analysis was performed by comparing the DNA sequences with EFα sequences from <span class="elsevierStyleItalic">Fusarium</span> strains obtained from the GenBank database (<a id="intr0005" class="elsevierStyleInterRef" href="http://www.ncbi.nih.gov/Genbank/">http://www.ncbi.nih.gov/Genbank/</a>). The sequences were submitted to GenBank database with accession numbers: KY688091, KY688092 and KY688093 for ITS and KY886147, KY886148 and KY886149 for EF. The strains were stored in the collection of filamentous fungi of the National Center for Microbiology with the numbers CNM-CM5601, CNM-CM6230 and CNM-CM7600.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Antifungal susceptibility testing</span><p id="par0045" class="elsevierStylePara elsevierViewall">The in vitro susceptibilities to antifungal drugs were determined using the broth dilution method, following the EUCAST method.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleItalic">Aspergillus fumigatus</span> ATCC 2004305 and <span class="elsevierStyleItalic">Aspergillus flavus</span> ATCC 2004304 were used as quality-control strains. The antifungal agents used in the study were amphotericin B (range 16–0.03<span class="elsevierStyleHsp" style=""></span>μg/ml) (Sigma Aldrich Química), itraconazole (range 8–0.015<span class="elsevierStyleHsp" style=""></span>μg/ml) (Janssen Pharmaceutica SA, Madrid, Spain), voriconazole (range 8–0.015<span class="elsevierStyleHsp" style=""></span>μg/ml) (Pfizer SA, Madrid, Spain), posaconazole (range 8–0.015<span class="elsevierStyleHsp" style=""></span>μg/ml) (Schering-Plough Research Institute, Kenilworth, NJ), terbinafine (range 16–0.03<span class="elsevierStyleHsp" style=""></span>μg/ml) (Novartis, Basel, Switzerland), and caspofungin (range 16–0.03<span class="elsevierStyleHsp" style=""></span>μg/ml) (Merck & Co., Inc., Rahway, NJ).</p></span></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Fungal keratitis and its more serious associated consequences, such as FE, are a major health problem in rural regions of tropical countries, whereas the prevalence of these infections is much lower in warm climate countries.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> However, we must not overlook the possibility of this etiologic agent due to the severity and poor visual outcomes of these infections. Although <span class="elsevierStyleItalic">Fusarium</span> spp. is the leading cause of exogenous FE secondary to keratitis,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7,19,25</span></a> several predisposing factors, such as corneal trauma or disruption of the ocular barriers, are necessary for an infection to progress. As corneal damage is a leading factor, the use of contact lenses is of particular relevance. The frequent use of these devices, the hygiene required for the proper care of the lenses and, occasionally, low clinical suspicion, may lead to a diagnosis of FE being overlooked.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> Although the origin of two of the cases herein was the use of contact lenses, the patients did not receive antifungal therapy from the beginning as some fungal infections may be clinically undistinguishable from bacterial endophthalmitis.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> As such, the specific treatment was only administrated once the clinical situation had worsened. Surgery is another factor that clearly alters the structure of the eye and may represent a risk factor for this condition. We have to take into account that fungi were isolated in 21.8% of cultures in cases with postoperative endophthalmitis.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2,7</span></a> The emergence of these surgery-related infections greatly complicates the health of the patient, and outbreaks of FE due to <span class="elsevierStyleItalic">Fusarium</span> following surgery can sometimes appear.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> Our third case reflects this finding, with concomitant steroid and immunomodulator treatment probably increasing the risk of infection with these fungi. More rarely, outbreaks of fungal endophthalmitis may be associated with intraocular use of contaminated products, so physicians should be aware of the use of such compounds.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> A warning in this regard may come from the Microbiology Laboratory, although there are several barriers to submitting a prompt report. Thus, although <span class="elsevierStyleItalic">Fusarium</span> is one of the most common causes of keratitis and FE, with <span class="elsevierStyleItalic">F. solani</span> and <span class="elsevierStyleItalic">F. oxysporum</span> being the most prevalent species,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7,15,16</span></a> identification may be difficult without experience as this polymorphic fungus could be misidentified or confused with contaminant molds. FE is a destructive intraocular infection that has extremely poor visual prognosis, especially when the <span class="elsevierStyleItalic">Fusarium</span> genus is involved, even after appropriate antifungal treatment. Therefore, rapid communication between the Microbiology Laboratory and practitioners in high suspicion cases should be facilitated as any delay in applying the right treatment may have fatal consequences.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,22</span></a> In our cases, despite a rapid beginning of the antifungal treatment, only one patient preserved an acceptable degree of vision following a rigorous and difficult treatment. Unfortunately, the remaining cases had a much worse outcome, thus confirming the poor prognosis of this disease.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusarium</span> is one of the most drug-resistant fungi, with <span class="elsevierStyleItalic">F. solani</span> being the most resistant species in this group.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1,9</span></a> Our cases involved two <span class="elsevierStyleItalic">F. oxysporum</span> and one <span class="elsevierStyleItalic">F. solani</span> strains, in agreement with other cases in the literature.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7,9</span></a> When <span class="elsevierStyleItalic">Fusarium</span> is identified as the cause of FE, the multi-resistant condition of this mold and the poor tissue penetration of topical antifungal agents make treatment very difficult. Amphotericin B, which has a low minimum inhibitory concentration (MIC) in vitro, has traditionally been the prescribed antifungal therapy.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1,4,9</span></a> However, intravitreal injection can cause retinal necrosis, the number of necessary injections is not standardized, and refractory cases may be observed.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">25,26</span></a> Although natamycin has been successfully used to treat endophtalmitis by <span class="elsevierStyleItalic">Fusarium</span>, an intravitreal formulation is not usually available and voriconazole has a varying activity against these molds.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7,26</span></a> However, despite its high MIC, voriconazole may be a treatment option as it achieves good aqueous and vitreous concentration (53% and 38%, respectively) with oral administration. Furthermore, intravitreal inoculation of voriconazole (25<span class="elsevierStyleHsp" style=""></span>mg/l) is effective in refractory endophthalmitis and the topical formulation has good stability and activity over 21 days.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> In light of the above, topical voriconazole is increasingly being used by ophthalmologists, even as a first-line antifungal therapy.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6,10,25</span></a> However, despite several doubts regarding its benefits, combined antifungal therapy is usually recommended as an empirically acceptable option to ensure the activity of at least one agent.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11,20,23</span></a> Furthermore, combined therapy should be started as soon as the suspicion becomes high.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> Likewise, it is clear that such therapy should involve two different types of antifungals and different routes of access in FE. Thus, the simultaneous use of topical, intravitreous, and systemic drugs is recommended due to the severity of the disease and its poor prognosis. The use and combination of antifungals varied in our case series, with widespread use of voriconazole, although combined therapy was started once the diagnosis had been confirmed. A systemic approach with amphotericin B was only used in one case, although this compound does not achieve therapeutic concentrations in the eye and the final outcome was poor, mainly due to the fact that the patient was in an advanced disease state.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> It should be noted that visual outcomes depend on the severity of the infection at presentation, and the prognosis of FE will depend upon the virulence of the organism, the extent of intraocular involvement, and the timing and mode of interventions.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> In light of the above, a rapid reaction is required when the infection is suspected and, in the majority of cases, multidisciplinary measures should be included in the treatment as antimicrobial therapy is not usually sufficient if FE is already established.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1079511" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1024937" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1079510" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1024936" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient 2" ] 2 => array:3 [ "identificador" => "sec0020" "titulo" => "Patient 3" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Identification of fungal isolates" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Antifungal susceptibility testing" ] ] ] ] ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 7 => array:2 [ "identificador" => "xack365882" "titulo" => "Acknowledgments" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-16" "fechaAceptado" => "2017-09-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1024937" "palabras" => array:8 [ 0 => "<span class="elsevierStyleItalic">Fusarium</span>" 1 => "Endophthalmitis" 2 => "Corneal trauma" 3 => "Contact lenses" 4 => "<span class="elsevierStyleItalic">Fusarium oxysporum</span>" 5 => "<span class="elsevierStyleItalic">Fusarium solani</span>" 6 => "<span class="elsevierStyleItalic">Fusarium</span> treatment" 7 => "Keratoplasty" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1024936" "palabras" => array:8 [ 0 => "<span class="elsevierStyleItalic">Fusarium</span>" 1 => "Endoftalmitis" 2 => "Traumatismo corneal" 3 => "Lentes de contacto" 4 => "<span class="elsevierStyleItalic">Fusarium oxysporum</span>" 5 => "<span class="elsevierStyleItalic">Fusarium solani</span>" 6 => "Tratamiento de <span class="elsevierStyleItalic">Fusarium</span>" 7 => "Queratoplastia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause <span class="elsevierStyleItalic">Fusarium</span>-related fungal infections to become an emerging problem. Moreover, <span class="elsevierStyleItalic">Fusarium</span> is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aims</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Three cases of endophthalmitis due to <span class="elsevierStyleItalic">Fusarium solani</span> and <span class="elsevierStyleItalic">Fusarium oxysporum</span>, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The <span class="elsevierStyleItalic">Fusarium</span> isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to <span class="elsevierStyleItalic">Fusarium</span> given the poor prognosis of this type of infection.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Afortunadamente, las infecciones por <span class="elsevierStyleItalic">Fusarium</span> son poco frecuentes en países de clima templado; sin embargo, determinados factores como la inmunodepresión clínica o farmacológica, pueden convertirlas en un problema emergente. <span class="elsevierStyleItalic">Fusarium</span> es uno de los microrganismos etiológicos más importantes de la endoftalmitis exógena, favorecida habitualmente por una rotura de las barreras epiteliales.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En esta serie de casos clínicos queremos identificar hallazgos clínicos característicos que puedan establecer un diagnóstico temprano y un tratamiento más eficiente de esta urgencia oftalmológica.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se presentan tres casos de endoftalmitis por <span class="elsevierStyleItalic">Fusarium solani</span> y <span class="elsevierStyleItalic">Fusarium oxysporum</span> que se produjeron en los años 2009, 2010 y 2014, en pacientes de dos áreas de salud diferentes, pero pertenecientes al mismo sistema sanitario, las cuales distan 43 millas una de la otra. Las cepas aisladas de <span class="elsevierStyleItalic">Fusarium</span> se identificaron inicialmente por microscopia y su identidad se confirmó posteriormente mediante secuenciación del factor de elongación alfa (EFα) y de la región codificadora espaciadora interna (ITS). La sensibilidad a los antifúngicos se llevó a cabo por el método de dilución en caldo del EUCAST.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se produjo una mala evolución, ya que dos de los tres pacientes evolucionaron haca la atrofia ocular a pesar de las medidas quirúrgicas y el tratamiento antibiótico y antifúngico de amplio espectro.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Es importante actuar rápidamente con medidas multidisciplinarias ante la sospecha de una endoftalmitis por <span class="elsevierStyleItalic">Fusarium</span> por el mal pronóstico de este tipo de infecciones.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 661 "Ancho" => 950 "Tamanyo" => 128693 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Fusarium solani</span> conidia stained with lactophenol cotton blue (40×).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1376 "Ancho" => 950 "Tamanyo" => 146032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Early postoperative findings after tectonic penetrating keratoplasty in the left eye. Corneal transplant is edematous and shows fibrotic changes. Note the superior neovascularization secondary to graft failure. Early postoperative findings in the right eye after the first penetrating keratoplasty. Severe conjunctival infection with a dense superior infiltrate in the interface suggestive of infection. The transplant appears edematous and with Descemet folds in the visual axis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 83599 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Endophthalmitis in a patient with Boston type I keratoprosthesis (Boston KPro). The whole cornea was infiltrated (keratitis) and the posterior chamber was also involved (endophthalmitis). Prompt surgery is imperative in these patients (Pars plana vitrectomy<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>remove the KPro and replace with a penetrating keratoplasty).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Antifungal agent \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MIC (μg/ml)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 1<br><span class="elsevierStyleItalic">F. solani</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 2<br><span class="elsevierStyleItalic">F. solani</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 3<br><span class="elsevierStyleItalic">F. oxysporum</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amphotericin B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Itraconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Voriconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posaconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Terbinafine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caspofungin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>16 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1842983.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">In vitro antifungal susceptibility of the isolates.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antifungal susceptibility profile of clinical <span class="elsevierStyleItalic">Fusarium</span> spp. isolates identified by molecular methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Alastruey-Izquierdo" 1 => "M. Cuenca-Estrella" 2 => "A. Monzón" 3 => "E. Mellado" 4 => "J.L. Rodríguez-Tudela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkn022" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "805" "paginaFinal" => "809" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18263569" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spectrum of aetiological agents of postoperative endophthalmitis and antibiotic susceptibility of bacterial isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Anand" 1 => "K.L. Therese" 2 => "H.N. Madhavan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Ophthalmol" "fecha" => "2000" "volumen" => "48" "paginaInicial" => "123" "paginaFinal" => "128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11116508" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Arendrup MC, Cuenca-Estrella M, Lass-Flörl C, Hope W, Howard SJ, (EUCAST), and the S. of A. S. T. (AFST) of the E. E. C. for A. S. T. In: EUCAST DEFINITIVE DOCUMENT EDef 9.2. Method for the determinatios of broth dilution minimum inhibitory concentrations of antifungal agents for conidia forming moulds." ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Universal in vitro antifungal resistance of genetic clades of the <span class="elsevierStyleItalic">Fusarium solani</span> spp. complex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Azor" 1 => "J. Gené" 2 => "J. Cano" 3 => "J. Guarro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01618-06" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2007" "volumen" => "51" "paginaInicial" => "1500" "paginaFinal" => "1503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17220423" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of fungal endophthalmitis due to <span class="elsevierStyleItalic">Fusarium oxysporum</span> following cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Buchta" 1 => "A. Feuermannová" 2 => "M. Váša" 3 => "L. Bašková" 4 => "R. Kutová" 5 => "A. Kubátová" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Mycopathol" "fecha" => "2014" "volumen" => "177" "paginaInicial" => "115" "paginaFinal" => "121" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical and oral voriconazole in the treatment of fungal keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V.Y. Bunya" 1 => "K.M. Hammersmith" 2 => "C.J. Rapuano" 3 => "B.D. Ayres" 4 => "E.J. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2006.07.033" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "151" "paginaFinal" => "153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17188052" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Retrieved from: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://informahealthcare.com/doi/abs/10.1586/eri.11.139%5Cnpapers3%3A//publication/doi/10.1586/eri.11.139">http://informahealthcare.com/doi/abs/10.1586/eri.11.139%5Cnpapers3://publication/doi/10.1586/eri.11.139</a>" "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Chhablani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2014" "paginaInicial" => "1191" "paginaFinal" => "1201" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of <span class="elsevierStyleItalic">Fusarium</span> endophthalmitis with voriconazole and <span class="elsevierStyleItalic">Aspergillus</span> endophthalmitis with voriconazole plus caspofungin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Durand" 1 => "I.K. Kim" 2 => "D.J. D’Amico" 3 => "J.I. Loewenstein" 4 => "E.H. Tobin" 5 => "S.J. Kieval" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2005" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endophthalmitis caused by <span class="elsevierStyleItalic">Fusarium proliferatum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Ferrer" 1 => "J. Alio" 2 => "A. Rodriguez" 3 => "M. Andreu" 4 => "F. Colom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.43.10.5372-5375.2005" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2005" "volumen" => "43" "paginaInicial" => "5372" "paginaFinal" => "5375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16208022" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Voriconazole in the treatment of fungal eye infections: a review of current literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.M. Hariprasad" 1 => "W.F. Mieler" 2 => "T.K. Lin" 3 => "W.E. Sponsel" 4 => "J.R. Graybill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Brit J Ophthalmol" "fecha" => "2008" "volumen" => "92" "paginaInicial" => "871" "paginaFinal" => "878" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating disseminated fusariosis: amphotericin B, voriconazole or both?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.Y. Ho" 1 => "J.D. Lee" 2 => "F. Rosso" 3 => "J.G. Montoya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1439-0507.2006.01346.x" "Revista" => array:6 [ "tituloSerie" => "Mycoses" "fecha" => "2007" "volumen" => "50" "paginaInicial" => "227" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17472622" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.W. Holden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "editores" => "BMarescaGKobayashi" "serieTitulo" => "Molecular biology of pathogenic fungi, a laboratory manual (3–4)" "serieFecha" => "1994" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral endogenous <span class="elsevierStyleItalic">Fusarium solani</span> endophthalmitis in a liver-transplanted patient: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.S. Jørgensen" 1 => "J.U. Prause" 2 => "J.F. Kiilgaard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2014" "paginaInicial" => "8" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phylogeny and toxigenic potential is correlated in <span class="elsevierStyleItalic">Fusarium</span> species as revealed by partial translation elongation factor 1 alpha gene sequences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Kristensen" 1 => "M. Torp" 2 => "B. Kosiak" 3 => "A. Holst-Jensen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mycol Res" "fecha" => "2005" "volumen" => "109" "paginaInicial" => "173" "paginaFinal" => "186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15839101" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endogenous endophthalmitis by <span class="elsevierStyleItalic">Fusarium solani</span>: an animal experimental model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Mayayo" 1 => "J. Guarro" 2 => "I. Pujol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Mycol" "fecha" => "1998" "volumen" => "36" "paginaInicial" => "249" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10075492" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experimental pathogenicity of four opportunist <span class="elsevierStyleItalic">Fusarium</span> species in a murine model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Mayayo" 1 => "I. Pujol" 2 => "J. Guarro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/00222615-48-4-363" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "1999" "volumen" => "48" "paginaInicial" => "363" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10509478" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fungal endophthalmitis associated with compounded products" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Mikosz" 1 => "R.M. Smith" 2 => "M. Kim" 3 => "C. Tyson" 4 => "E.H. Lee" 5 => "E. Adams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid2002.131257" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "248" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24447640" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Filamentous fungal endophthalmitis: results of combination therapy with intravitreal amphotericin b and voriconazole" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Mithal" 1 => "A. Pathengay" 2 => "A. Bawdekar" 3 => "A. Jindal" 4 => "D. Vira" 5 => "N. Relhan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/OPTH.S80387" "Revista" => array:6 [ "tituloSerie" => "Clin Ophthalmol" "fecha" => "2015" "volumen" => "9" "paginaInicial" => "649" "paginaFinal" => "655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25926714" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and outcomes of <span class="elsevierStyleItalic">Fusarium</span> keratitis associated with contact lens wear" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.S. Ng" 1 => "W.W. Lau" 2 => "D.K. Yu" 3 => "C.C. Wong" 4 => "C.W. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eye Cont Lens" "fecha" => "2008" "volumen" => "34" "paginaInicial" => "113" "paginaFinal" => "116" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement in the outcome of invasive fusariosis in the last decade" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Nucci" 1 => "K.A. Marr" 2 => "M.J.G.T. Vehreschild" 3 => "C.A. de Souza" 4 => "E. Velasco" 5 => "P. Cappellano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1469-0691.12409" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "580" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24118322" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology and pathogens of fungal endophthalmitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Sun" 1 => "G. Zhao" 2 => "X. Sun" 3 => "Q. Wang" 4 => "B. Yu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chin J Ophthalmol" "fecha" => "2014" "volumen" => "50" "paginaInicial" => "808" "paginaFinal" => "813" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Support of the laboratory in the diagnosis of fungal ocular infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Vanzzini Zago" 1 => "M. Alcantara Castro" 2 => "R. Naranjo Tackman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Int J Inflamm" "fecha" => "2012" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice: combination antifungal therapy for mold infections: much ado about nothing?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. Vazquez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/588475" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "1889" "paginaFinal" => "1901" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18466092" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.J. White" 1 => "S. Bruns" 2 => "S. Lee" 3 => "J. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "PCR protocols: a guide to methods and applications" "fecha" => "1990" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exogenous fungal endophthalmitis: microbiology and clinical outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.C. Wykoff" 1 => "H.W. Flynn" 2 => "D. Miller" 3 => "I.U. Scott" 4 => "E.C. Alfonso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Ophthalmology" "fecha" => "2008" "volumen" => "115" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0260" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antifungal efficacy of voriconazole, itraconazole and amphotericin b in experimental <span class="elsevierStyleItalic">Fusarium solani</span> keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.F. Yavas" 1 => "F. Öztürk" 2 => "T. Küsbeci" 3 => "Z. Çetinkaya" 4 => "S.S. Ermis" 5 => "N. Kiraz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Graefe's Arch Clin Exp Ophthalmol" "fecha" => "2008" "volumen" => "246" "paginaInicial" => "275" "paginaFinal" => "279" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack365882" "titulo" => "Acknowledgments" "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">We thank Hedapen global services for the translation and revision of the paper.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000003500000002/v2_201809080414/S1130140618300160/v2_201809080414/en/main.assets" "Apartado" => array:4 [ "identificador" => "7997" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000003500000002/v2_201809080414/S1130140618300160/v2_201809080414/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140618300160?idApp=UINPBA00004N" ]
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