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Veterinary ophthalmology2019; 23(1); 148-159; doi: 10.1111/vop.12701

Equine infectious keratitis in Finland: Associated microbial isolates and susceptibility profiles.

Abstract: To retrospectively describe laboratory findings, treatment, and outcome associated with equine infectious keratitis in Finland. Unassigned: Medical records of horses diagnosed with infectious keratitis in University of Helsinki Equine Hospital from January 2007 to June 2018 were reviewed. Results: Forty-seven cases were included. Keratomycosis was diagnosed in 27 eyes and bacterial keratitis in 20 eyes. Aspergillus flavus was the most frequent fungal isolate (9/17, 53%), followed by Cylindrocarpon sp. (3/17, 18%) and Aspergillus fumigatus (2/17, 12%). Susceptibility was tested for 10/11 Aspergillus sp. isolates; all were susceptible to voriconazole while only two were susceptible to amphotericin B. Cylindrocarpon sp. isolates were resistant to both agents. Streptococcus equi subsp. zooepidemicus was the most frequent bacterial isolate (9/19, 47%), followed by other streptococci (4/19, 21%). All 13 Streptococcus sp. isolates were susceptible to penicillin, and all tested isolates (n = 11) were also susceptible to chloramphenicol. Mean duration of medical treatment was longer in fungal keratitis (38 days) than in bacterial keratitis (25 days) (P < .001). Twenty-six of the eyes underwent globe-sparing surgery in addition to medical therapy. Recovery was achieved in 66% (31/47) of all cases and in 59% (16/27) and 75% (15/20) (P = .264) of cases with keratomycosis and bacterial keratitis, respectively. Conclusions: Although Aspergillus sp. and S zooepidemicus were the most frequently encountered isolates, cytology, culture, and susceptibility testing are essential to differentiate bacterial and fungal keratitis and guide the clinician to choose the most efficient treatment.
Publication Date: 2019-07-31 PubMed ID: 31364808PubMed Central: PMC7004187DOI: 10.1111/vop.12701Google Scholar: Lookup
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  • Journal Article

Summary

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The research is a retrospective study on the laboratory findings, treatments, and outcomes related to equine infectious keratitis in Finland, utilizing medical records of diagnosed cases from 2007 to 2018 at the University of Helsinki Equine Hospital.

Study Design and Dataset

  • The research was a retrospective study using medical records from the University of Helsinki Equine Hospital.
  • The timespan of the studied records was from January 2007 to June 2018.
  • The study examined 47 cases of equine infectious keratitis.

Findings and Implications

  • Out of the 47 cases studied, 27 were diagnosed with keratomycosis (fungal infection of the eye) and 20 with bacterial keratitis.
  • The most common fungal isolate was Aspergillus flavus, found in 53% of the samples, followed by Cylindrocarpon sp. (18%) and Aspergillus fumigatus (12%).
  • All of the 10 Aspergillus sp. were susceptible to voriconazole, a treatment for fungal infections. Only two were susceptible to a second treatment, amphotericin B. In contrast, Cylindrocarpon sp. was resistant to both treatments.
  • Streptococcus equi subsp. zooepidemicus was the most common bacterial isolate (47%), followed by other streptococci (21%).
  • All 13 Streptococcus sp. isolates tested were susceptible to the antibiotics penicillin and chloramphenicol.
  • Length of treatment was longer for fungal keratitis (38 days) than for bacterial keratitis (25 days).
  • In addition to medical therapy, 26 eyes went through globe-sparing surgery.
  • The recovery rate was 66% for all cases. Breakdown by condition showed a 59% recovery rate for keratomycosis and a 75% rate for bacterial keratitis.

Conclusion of the Research

  • The study indicates that while Aspergillus sp. and Streptococcus zooepidemicus were the most frequently identified isolates, cytology, culture, and susceptibility testing are crucial to differentiate between bacterial and fungal keratitis.
  • This differentiation is vital in helping clinicians choose the most effective treatment for each case, which can lead to better outcomes for the affected horses.

Cite This Article

APA
Mustikka MP, Grönthal TSC, Pietilä EM. (2019). Equine infectious keratitis in Finland: Associated microbial isolates and susceptibility profiles. Vet Ophthalmol, 23(1), 148-159. https://doi.org/10.1111/vop.12701

Publication

ISSN: 1463-5224
NlmUniqueID: 100887377
Country: England
Language: English
Volume: 23
Issue: 1
Pages: 148-159

Researcher Affiliations

Mustikka, Minna P
  • Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland.
Grönthal, Thomas S C
  • Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland.
Pietilä, Elina M
  • Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland.

MeSH Terms

  • Animals
  • Anti-Bacterial Agents
  • Bacteria / drug effects
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology
  • Bacterial Infections / veterinary
  • Drug Resistance, Bacterial
  • Female
  • Finland / epidemiology
  • Horse Diseases / epidemiology
  • Horse Diseases / microbiology
  • Horses
  • Keratitis / epidemiology
  • Keratitis / microbiology
  • Keratitis / veterinary
  • Male
  • Retrospective Studies

References

This article includes 59 references
  1. Brooks DE, Matthews A, Clode AB. Diseases of the cornea. In: Gilger BC, ed. Equine Ophthalmology 3rd edn Ames, Iowa: John Wiley & Sons Inc; 2017;252‐368.
  2. Gilger BC. Equine ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary Ophthalmology. 5th edn Ames, Iowa, John Wiley & Sons Inc; 2013;1561‐1609.
  3. Plummer CE. Corneal Response to Injury and Infection in the Horse.. Vet Clin North Am Equine Pract 2017 Dec;33(3):439-463.
    pubmed: 28985985doi: 10.1016/j.cveq.2017.07.002google scholar: lookup
  4. Lassaline M. Equine Ophthalmology. In: Maggs DJ, Miller PE, Ofri R, eds. Slatter's Fundamentals of Veterinary Ophthalmology. 6th edn St. Louis, Missouri: Elsevier, Inc; 2018;442‐470.
  5. Brooks DE. Equine keratomycosis: An international problem. Equine Vet Educ 2009;21:243‐246.
  6. Reed Z, Thomasy SM, Good KL, Maggs DJ, Magdesian KG, Pusterla N, Hollingsworth SR. Equine keratomycoses in California from 1987 to 2010 (47 cases).. Equine Vet J 2013 May;45(3):361-6.
  7. Brooks DE, Andrew SE, Denis H, Strubbe DT, Biros DJ, Cutler TJ, Samuelson DA, Gelatt KN. Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis.. Vet Ophthalmol 2000;3(2-3):83-86.
  8. Proietto LR, Plummer CE, Maxwell KM, Lamb KE, Brooks DE. A retrospective analysis of environmental risk factors for the diagnosis of deep stromal abscess in 390 horses in North Central Florida from 1991 to 2013.. Vet Ophthalmol 2016 Jul;19(4):291-6.
    pubmed: 26215543doi: 10.1111/vop.12297google scholar: lookup
  9. Andrew SE, Nguyen A, Jones GL, Brooks DE. Seasonal effects on the aerobic bacterial and fungal conjunctival flora of normal thoroughbred brood mares in Florida.. Vet Ophthalmol 2003 Mar;6(1):45-50.
  10. Rosa M, Cardozo LM, da Silva Pereira J, Brooks DE, Martins AL, Florido PS, Stussi JS. Fungal flora of normal eyes of healthy horses from the State of Rio de Janeiro, Brazil.. Vet Ophthalmol 2003 Mar;6(1):51-5.
  11. Nardoni S, Sgorbini M, Barsotti G, Corazza M, Mancianti F. Conjunctival fungal flora in healthy donkeys.. Vet Ophthalmol 2007 Jul-Aug;10(4):207-10.
  12. Johns IC, Baxter K, Booler H, Hicks C, Menzies-Gow N. Conjunctival bacterial and fungal flora in healthy horses in the UK.. Vet Ophthalmol 2011 May;14(3):195-9.
  13. Voelter-Ratson K, Monod M, Unger L, Spiess BM, Pot SA. Evaluation of the conjunctival fungal flora and its susceptibility to antifungal agents in healthy horses in Switzerland.. Vet Ophthalmol 2014 Jul;17 Suppl 1:31-6.
    pubmed: 23910390doi: 10.1111/vop.12088google scholar: lookup
  14. Hampson ECGM, Gibson JS, Barot M, Shapter FM, Greer RM. Identification of bacteria and fungi sampled from the conjunctival surface of normal horses in South-East Queensland, Australia.. Vet Ophthalmol 2019 May;22(3):265-275.
    pubmed: 29963751doi: 10.1111/vop.12587google scholar: lookup
  15. Wada S, Hobo S, Niwa H. Ulcerative keratitis in thoroughbred racehorses in Japan from 1997 to 2008.. Vet Ophthalmol 2010 Mar;13(2):99-105.
  16. Andrew SE, Brooks DE, Smith PJ, Gelatt KN, Chmielewski NT, Whittaker CJ. Equine ulcerative keratomycosis: visual outcome and ocular survival in 39 cases (1987-1996).. Equine Vet J 1998 Mar;30(2):109-16.
  17. Gemensky-Metzler AJ, Wilkie DA, Kowalski JJ, Schmall LM, Willis AM, Yamagata M. Changes in bacterial and fungal ocular flora of clinically normal horses following experimental application of topical antimicrobial or antimicrobial-corticosteroid ophthalmic preparations.. Am J Vet Res 2005 May;66(5):800-11.
    pubmed: 15934607doi: 10.2460/ajvr.2005.66.800google scholar: lookup
  18. Hamilton HI, McLaughlin SA, Whitley EM, Gilger BC, Whitley RD. Histological findings in corneal stromal abscesses of 11 horses: correlation with cultures and cytology.. Equine Vet J 1994 Nov;26(6):448-53.
  19. de Linde Henriksen M, Andersen PH, Thomsen PD, Plummer CE, Mangan B, Heegaard S, Toft N, Brooks DE. Equine deep stromal abscesses (51 cases - 2004-2009)--Part 1: the clinical aspects with attention to the duration of the corneal disease, treatment history, clinical appearance, and microbiology results.. Vet Ophthalmol 2014 Jul;17 Suppl 1:6-13.
    pubmed: 24131726doi: 10.1111/vop.12103google scholar: lookup
  20. Voelter-Ratson K, Pot SA, Florin M, Spiess BM. Equine keratomycosis in Switzerland: a retrospective evaluation of 35 horses (January 2000-August 2011).. Equine Vet J 2013 Sep;45(5):608-12.
    pubmed: 23489138doi: 10.1111/evj.12042google scholar: lookup
  21. Grahn B, Wolfer J, Keller C. Equine keratomycosis: Clinical and laboratory findings in 23 cases. Prog Vet Comp Ophthalmol 1993;3:3‐7.
  22. Moore PA, Dietrich UM, Barton MH. The influence of rainfall and temperature on the frequency of equine fungal keratitis. Assoc Res Vis Ophthalmol Abstracts 2005;46:5067.
  23. Sansom J, Featherstone H, Barnett KC. Keratomycosis in six horses in the United Kingdom.. Vet Rec 2005 Jan 1;156(1):13-7.
    pubmed: 15658562doi: 10.1136/vr.156.1.13google scholar: lookup
  24. Galán A, Martín‐Suárez EM, Gallardo JM, Molleda JM. Clinical findings and progression of 10 cases of equine ulcerative keratomycosis (2004–2007). Equine Vet Educ 2009;21:236‐242.
  25. Aho R, Tala M, Kivalo M. Mycotic keratitis in a horse caused by Aspergillus fumigatus. The first reported case in Finland.. Acta Vet Scand 1991;32(3):373-6.
    pmc: PMC8127900pubmed: 1814187doi: 10.1186/bf03546967google scholar: lookup
  26. Versalovic M, Carroll KC, Funke G. Manual of Clinical Microbiology. 10th edn Washington: ASM Press, 2011; 2630.
  27. CLSI. Performance standards for antimicrobial disk and dilution susceptibility tests for bacteria isolated from animals: Approved standard VET01‐A4. 4th edn Wayne, PA, USA: Clinical and Laboratory Standards Institute; 2013.
  28. European Committee on Antimicrobial Susceptibility Testing. Antifungal agents: Breakpoint tables for interpretation of MICs. Version 9.0, valid from 2018‐02‐12. Switzerland: EUCAST; 2018.
  29. Al-Hatmi AM, Meis JF, de Hoog GS. Fusarium: Molecular Diversity and Intrinsic Drug Resistance.. PLoS Pathog 2016 Apr;12(4):e1005464.
  30. Moore CP, Collins BK, Fales WH. Antibacterial susceptibility patterns for microbial isolates associated with infectious keratitis in horses: 63 cases (1986-1994).. J Am Vet Med Assoc 1995 Oct 1;207(7):928-33.
    pubmed: 7559027
  31. Sherman AB, Clode AB, Gilger BC. Impact of fungal species cultured on outcome in horses with fungal keratitis.. Vet Ophthalmol 2017 Mar;20(2):140-146.
    pubmed: 27061354doi: 10.1111/vop.12381google scholar: lookup
  32. Utter ME, Wotman KL, Armour M, Bagel J. Clinical findings and outcomes of ulcerative keratomycosis in 30 horses in the mid‐Atlantic United States (2006–2007). Equine Vet Educ 2010;22:31‐39.
  33. Wada S, Hobo S, Ode H, Niwa H, Moriyama H. Equine keratomycosis in Japan.. Vet Ophthalmol 2013 Jan;16(1):1-9.
  34. Keller RL, Hendrix DV. Bacterial isolates and antimicrobial susceptibilities in equine bacterial ulcerative keratitis (1993--2004).. Equine Vet J 2005 May;37(3):207-11.
    pubmed: 15892227doi: 10.2746/0425164054530731google scholar: lookup
  35. Suter A, Voelter K, Hartnack S, Spiess BM, Pot SA. Septic keratitis in dogs, cats, and horses in Switzerland: associated bacteria and antibiotic susceptibility.. Vet Ophthalmol 2018 Jan;21(1):66-75.
    pubmed: 28557367doi: 10.1111/vop.12480google scholar: lookup
  36. Sauer P, Andrew SE, Lassaline M, Gelatt KN, Denis HM. Changes in antibiotic resistance in equine bacterial ulcerative keratitis (1991-2000): 65 horses.. Vet Ophthalmol 2003 Dec;6(4):309-13.
  37. Utter ME, Davidson EJ, Wotman KL. Clinical features and outcomes of severe ulcerative keratitis with medical and surgical management in 41 horses (2000–2006). Equine Vet Educ 2009;21:321‐327.
  38. Moore CP, Heller N, Majors LJ, Whitley RD, Burgess EC, Weber J. Prevalence of ocular microorganisms in hospitalized and stabled horses.. Am J Vet Res 1988 Jun;49(6):773-7.
    pubmed: 3400913
  39. Massa KL, Murphy CJ, Hartmann FA, Miller PE, Korsower CS, Young KM. Usefulness of aerobic microbial culture and cytologic evaluation of corneal specimens in the diagnosis of infectious ulcerative keratitis in animals.. J Am Vet Med Assoc 1999 Dec 1;215(11):1671-4.
    pubmed: 14567433
  40. Zeiss C, Neaderland M, Yang FC, Terwilliger G, Compton S. Fungal polymerase chain reaction testing in equine ulcerative keratitis.. Vet Ophthalmol 2013 Sep;16(5):341-51.
    pubmed: 23227970doi: 10.1111/vop.12004google scholar: lookup
  41. Ledbetter EC, Irby NL, Kim SG. In vivo confocal microscopy of equine fungal keratitis.. Vet Ophthalmol 2011 Jan;14(1):1-9.
  42. Ledbetter EC. Antifungal Therapy in Equine Ocular Mycotic Infections.. Vet Clin North Am Equine Pract 2017 Dec;33(3):583-605.
    pubmed: 28958862doi: 10.1016/j.cveq.2017.08.001google scholar: lookup
  43. Ledbetter EC, Patten VH, Scarlett JM, Vermeylen FM. In vitro susceptibility patterns of fungi associated with keratomycosis in horses of the northeastern United States: 68 cases (1987-2006).. J Am Vet Med Assoc 2007 Oct 1;231(7):1086-91.
    pubmed: 17916036doi: 10.2460/javma.231.7.1086google scholar: lookup
  44. Pearce JW, Giuliano EA, Moore CP. In vitro susceptibility patterns of Aspergillus and Fusarium species isolated from equine ulcerative keratomycosis cases in the midwestern and southern United States with inclusion of the new antifungal agent voriconazole.. Vet Ophthalmol 2009 Sep-Oct;12(5):318-24.
  45. Gilger B, Vander Schel IQ, Cotter H. Associations among anti‐fungal susceptibility, multi‐locus sequence analysis and clinical outcome in equine fungal keratitis (abstract). 10th Annual Symposium of the International Equine Ophthalmology Consortium 2018; 33.
  46. Brooks DE, Andrew SE, Dillavou CL, Ellis G, Kubilis PS. Antimicrobial susceptibility patterns of fungi isolated from horses with ulcerative keratomycosis.. Am J Vet Res 1998 Feb;59(2):138-42.
    pubmed: 9492925
  47. Summerbell RC, Schroers HJ. Analysis of phylogenetic relationship of Cylindrocarpon lichenicola and Acremonium falciforme to the Fusarium solani species complex and a review of similarities in the spectrum of opportunistic infections caused by these fungi.. J Clin Microbiol 2002 Aug;40(8):2866-75.
  48. Finnish Meteorological Institute (FMI). Touko‐elokuu oli mittaushistorian lämpimin. Helsinki: FMI; 2018.
  49. Wotman KL, Utter ME, Rankin SC. Antifungal susceptibility testing of Aspergillus species isolated from horses with keratomycosis in Southeast Pennsylvania: 10 cases (2006–2007) (abstract). Vet Ophthalmol 2008;11:413‐429.
  50. Clode AB, Davis JL, Salmon J, Michau TM, Gilger BC. Evaluation of concentration of voriconazole in aqueous humor after topical and oral administration in horses.. Am J Vet Res 2006 Feb;67(2):296-301.
    pubmed: 16454636doi: 10.2460/ajvr.67.2.296google scholar: lookup
  51. Latimer FG, Colitz CM, Campbell NB, Papich MG. Pharmacokinetics of fluconazole following intravenous and oral administration and body fluid concentrations of fluconazole following repeated oral dosing in horses.. Am J Vet Res 2001 Oct;62(10):1606-11.
    pubmed: 11592327doi: 10.2460/ajvr.2001.62.1606google scholar: lookup
  52. Davis JL, Salmon JH, Papich MG. Pharmacokinetics and tissue distribution of itraconazole after oral and intravenous administration to horses.. Am J Vet Res 2005 Oct;66(10):1694-701.
    pubmed: 16273899doi: 10.2460/ajvr.2005.66.1694google scholar: lookup
  53. Lamoth F, Alexander BD. Comparing Etest and Broth Microdilution for Antifungal Susceptibility Testing of the Most-Relevant Pathogenic Molds.. J Clin Microbiol 2015 Oct;53(10):3176-81.
    pmc: PMC4572526pubmed: 26202113doi: 10.1128/jcm.00925-15google scholar: lookup
  54. Brooks DE, Andrew SE, Biros DJ, Denis HM, Cutler TJ, Strubbe DT, Gelatt KN. Ulcerative keratitis caused by beta-hemolytic Streptococcus equi in 11 horses.. Vet Ophthalmol 2000;3(2-3):121-125.
  55. Sweeney CR, Irby NL. Topical treatment of Pseudomonas sp-infected corneal ulcers in horses: 70 cases (1977-1994).. J Am Vet Med Assoc 1996 Sep 1;209(5):954-7.
    pubmed: 8790548
  56. Brooks DE. Inflammatory stromal keratopathies: medical management of stromal keratomalacia, stromal abscesses, eosinophilic keratitis, and band keratopathy in the horse.. Vet Clin North Am Equine Pract 2004 Aug;20(2):345-60, vi.
    pubmed: 15271427doi: 10.1016/j.cveq.2004.04.007google scholar: lookup
  57. Hendrix DV, Brooks DE, Smith PJ, Gelatt KN, Miller TR, Whittaker C, Pellicane C, Chmielewski N. Corneal stromal abscesses in the horse: a review of 24 cases.. Equine Vet J 1995 Nov;27(6):440-7.
  58. de Linde Henriksen M, Andersen PH, Mietelka K, Farina L, Thomsen PD, Plummer CE, Mangan BG, Heegaard S, Coleman JK, Toft N, Brooks DE. Equine deep stromal abscesses (51 cases - 2004-2009)--Part 2: the histopathology and immunohistochemical aspect with attention to the histopathologic diagnosis, vascular response, and infectious agents.. Vet Ophthalmol 2014 Jul;17 Suppl 1:14-22.
    pubmed: 24131662doi: 10.1111/vop.12102google scholar: lookup
  59. Henriksen MDL, Andersen PH, Plummer CE, Mangan B, Brooks DE. Equine corneal stromal abscesses: An evolution in the understanding of pathogenesis and treatment during the past 30 years. Equine Vet Educ 2013;25:315‐323.

Citations

This article has been cited 9 times.
  1. Julien ME, Shih JB, Correa Lopes B, Vallone LV, Suchodolski JS, Pilla R, Scott EM. Alterations of the bacterial ocular surface microbiome are found in both eyes of horses with unilateral ulcerative keratitis. PLoS One 2023;18(9):e0291028.
    doi: 10.1371/journal.pone.0291028pubmed: 37682941google scholar: lookup
  2. Walter H, Verspohl J, Meißner J, Oltmanns H, Geks AK, Busse C. In Vitro Antimicrobial Activity of N-Acetylcysteine against Pathogens Most Commonly Associated with Infectious Keratitis in Dogs and Cats. Antibiotics (Basel) 2023 Mar 11;12(3).
    doi: 10.3390/antibiotics12030559pubmed: 36978427google scholar: lookup
  3. Tahoun A, Elnafarawy HK, Elmahallawy EK, Abdelhady A, Rizk AM, El-Sharkawy H, Youssef MA, El-Khodery S, Ibrahim HMM. Epidemiological and Molecular Investigation of Ocular Fungal Infection in Equine from Egypt. Vet Sci 2020 Sep 8;7(3).
    doi: 10.3390/vetsci7030130pubmed: 32911615google scholar: lookup
  4. Stolle LM, Oltmanns H, Meißner J, Heun F, Schieder AK, Wolff HT, Ohnesorge B, Busse C. Polyhexanide, Povidone-Iodine, and Hypochlorous Acid Show High In Vitro Antimicrobial Efficacy Against Pathogens Commonly Associated With Equine Infectious Keratitis. Vet Ophthalmol 2026 Jan;29(1):e70141.
    doi: 10.1111/vop.70141pubmed: 41552904google scholar: lookup
  5. Heun F, Meißner J, Schieder AK, Ohnesorge B, Busse C. Pantoea agglomerans in Equine Ulcerative Keratitis: Prevalence and Comparative Efficacy of Four Topical Antiseptics. Vet Ophthalmol 2026 Jan;29(1):e70044.
    doi: 10.1111/vop.70044pubmed: 40557447google scholar: lookup
  6. Dieste-Pérez L, Holstege MMC, de Jong JE, Heuvelink AE. Azole resistance in Aspergillus isolates from animals or their direct environment (2013-2023): a systematic review. Front Vet Sci 2025;12:1507997.
    doi: 10.3389/fvets.2025.1507997pubmed: 40182641google scholar: lookup
  7. de Jong JE, Heuvelink AE, Dieste Pérez L, Holstege MMC. Aspergillus spp., aspergillosis and azole usage in animal species in Europe: Results from a multisectoral survey and review of recent literature. Med Mycol 2025 Jan 25;63(2).
    doi: 10.1093/mmy/myaf009pubmed: 39890594google scholar: lookup
  8. Preston JF, Mustikka MP, Priestnall SL, Dunkel B, Fischer MC. Clinical features and outcomes of horses presenting with presumed equine immune mediated keratitis to two veterinary hospitals in the United Kingdom and Finland: 94 cases (2009-2021). Equine Vet J 2025 May;57(3):598-610.
    doi: 10.1111/evj.14213pubmed: 39183684google scholar: lookup
  9. Roberts D, Thomas J, Salmon J, Cubeta MA, Stapelmann K, Gilger BC. Cold atmospheric plasma inactivates Aspergillus flavus and Fusarium keratoplasticum biofilms and conidia in vitro. J Med Microbiol 2024 Jul;73(7).
    doi: 10.1099/jmm.0.001858pubmed: 38985505google scholar: lookup