广东湛江地区真菌性角膜炎病原菌的分离鉴定和分析

目的了解广东湛江地区引起真菌性角膜炎的病原真菌的分布情况. 方法对70例疑患真菌性角膜炎的患者,取病变角膜上皮组织,分别进行真菌直接涂片镜检和真菌培养,并对检查阳性者进行菌种鉴定. 结果70例病眼患者均检出真菌,涂片镜检真菌阳性67份,阳性率为95.7%,真菌培养阳性65份,阳性率92.9%,总一致性为89.6%.检出菌种分属14个属26个种,其中镰刀菌属22株（33.8%）,弯孢霉属20株（30.8%）、曲霉属4株（6.2%）,球孢子菌属4株（6.2%）,其他菌属15株（23.1%）. 结论北热带的广东湛江地区真菌性角膜炎主要致病菌属为镰刀菌属和弯孢霉属,主要菌种以新月弯孢霉最多见.     

外用两性霉素B脂质体治愈茄病镰刀菌所致角膜炎一例报道

真菌性角膜炎是一种少见但严重的感染性角膜病变,具有很高的致盲率,近年来发病率呈上升趋势.镰刀菌属是引起角膜真菌感染常见的致病菌之一.在我国,真菌性角膜炎绝大多数由镰刀菌属所致,其中茄病镰刀菌是最常分离到的致病菌[1].本文报道1例经局部外用两性霉素B脂质体治愈的茄病镰刀菌致真菌性角膜炎的病例.     

外用两性霉素B脂质体治愈茄病镰刀菌所致角膜炎一例报道

真菌性角膜炎是一种少见但严重的感染性角膜病变,具有很高的致盲率,近年来发病率呈上升趋势.镰刀菌属是引起角膜真菌感染常见的致病菌之一.在我国,真菌性角膜炎绝大多数由镰刀菌属所致,其中茄病镰刀菌是最常分离到的致病菌[1].本文报道1例经局部外用两性霉素B脂质体治愈的茄病镰刀菌致真菌性角膜炎的病例.     

镰刀菌致角膜炎2例报告

镰孢菌属在空气中较曲霉菌属更多,可产生真菌霉素,损害免疫系统。镰孢菌属主要从全身感染病人的血中分离出,而在相同临床条件下,曲霉菌则极少从血中分离出。镰孢菌属属致深部感染。在美国很多地区,镰孢菌属已成为最常见的真菌性角膜炎病因。     

真菌性角膜炎12例临床治疗体会

真菌性角膜炎是一种由真菌引起的感染性角膜病变,致盲率极高。常见的致病菌有镰刀菌属、念珠菌属、曲霉菌属、青霉菌属和酵母菌等[1]。收集自2011-2013年共12例真菌性角膜炎患者的资料,将治疗体会报告如下。     

Pathogenic analysis of fungal keratitis: a report of 94 cases.

目的 了解海南地区真菌性角膜炎病原菌的种类和构成情况,分析真菌性角膜炎患者的流行病学特征,并指导临床个体化治疗.方法 对2010年3月至2011年2月在我院眼科门诊就诊的94例刮片镜检阳性的真菌性角膜炎患者的病例进行回顾性分析,细菌培养鉴定菌种.结果 海南地区真菌性角膜炎在10～12月份为高发季节,以镰刀菌感染(61例,64.9％)为主,除此之外还有烟曲霉菌(28例,29.8％)、链格孢霉菌(2例,2.1％)、待鉴定菌种(3例,3.2％).结论 真菌性角膜炎是严重的致盲性眼病,应提高对该病的认识和诊断水平,镰刀菌为目前海南地区真菌性角膜炎的主要致病菌.     

94例真菌性角膜炎患者的病原菌临床分析

目的了解海南地区真菌性角膜炎病原菌的种类和构成情况,分析真菌性角膜炎患者的流行病学特征,并指导临床个体化治疗。方法对2010年3月至2011年2月在我院眼科门诊就诊的94例刮片镜检阳性的真菌性角膜炎患者的病例进行回顾性分析,细菌培养鉴定菌种。结果海南地区真菌性角膜炎在10~12月份为高发季节,以镰刀菌感染(61例,64.9%)为主,除此之外还有烟曲霉菌(28例,29.8%)、链格孢霉菌(2例,2.1%)、待鉴定菌种(3例,3.2%)。结论真菌性角膜炎是严重的致盲性眼病,应提高对该病的认识和诊断水平,镰刀菌为目前海南地区真菌性角膜炎的主要致病菌。     

氢氧化钾涂片镜检法诊断真菌性角膜炎的应用

目的探讨氢氧化钾（KOH）涂片镜检法对真菌性角膜炎的诊断价值,了解真菌性角膜炎的病原学特征。方法取58例真菌性角膜炎患者的角膜溃疡标本,作KOH涂片镜检、真菌培养及菌种鉴定。结果 KOH涂片镜检法和真菌培养法的阳性率分别为58.62%（17/29）、52.94%（9/17）,两者的真菌检出率差异无统计学意义（P〉0.05）。9份培养阳性标本中,共分离出3属3种真菌,其中镰刀菌属、暗色孢科真菌、酵母菌分别占35.29%、11.76%、5.88%。结论 KOH涂片镜检法是早期诊断本病的简单、有效方法,镰刀菌和暗色孢科真菌是宁夏地区真菌性角膜炎的主要致病菌。     

真菌性角膜炎致病菌分布、耐药性及预后不良因素分析

目的 分析真菌性角膜炎病原菌分布、耐药性特点,同时探讨影响其患者预后的主要因素,从而为真菌性角膜炎的防治提供临床依据。方法 回顾性分析2010年6月~2015年6月在笔者医院诊治的195例真菌性角膜炎患者临床资料,分析其病原菌分布、耐药性特点及相关影响预后的主要危险因素。结果 195例眼部标本中,真菌培养阳性152例（77.9%）。主要的致病真菌属为镰刀菌属75例（49.3%）,曲霉属35例（23.0%）,链格孢属23例（15.1%）。常见真菌对那他霉素敏感度最高,总敏感度达到89.5%,对氟康唑敏感度最低,总敏感度62.4%。Logistic回归分析显示,白蛋白水平<35g/L、患病天数≥14天、病灶情况分级为Ⅲ~Ⅳ级及上皮修复时间≥21天为影响真菌性角膜炎患者预后的独立危险因素。结论 镰刀菌属是本地区主要的真菌性角膜炎致病菌属,其对两性霉素B敏感度最高,临床上应根据病原菌分布、药敏试验结果及影响预后的相关危险因素,合理选用抗生素,同时积极采取综合防治措施,改善患者的临床疗效及预后。     

真菌性角膜炎的手术治疗方式及其疗效评价

真菌性角膜炎是一种致盲率非常高的感染性角膜疾病,在我国居感染性角膜炎的首位,占感染性角膜炎的62％。迄今发现70余种真菌可引起角膜感染。在我国真菌性角膜炎致病菌种以曲霉菌和镰刀菌为主,其他尚有白色念珠菌、酵母菌、青霉菌以及头孢霉菌等。农村发病率高于城市,多见于植物外伤后。真菌性角膜炎治疗目前仍以抗真菌药物治疗为主,     

真菌性角膜病在河南地区的流行病学研究

目的 调查河南地区真菌性角膜病的发病情况、流行病学特点、危险因素、主要致病真菌等。为进一步深入细致的基础研究和临床治疗奠定基础。方法 回顾性调查１９９０年７月￣１９９８年１月收入我院病房的２４０例（２４０眼）真菌性角膜病患者。结果 ７年的统计资料表明，真菌性角膜病患病人数呈逐年上升趋势。发病高峰集中在每年的１０￣１２月。中青年患者居多。患病前有明确外伤史（主要是植物外伤史）者占总患病人数的３６％。     

真菌通用引物PCR反应鉴别兔眼真菌性和细菌性角膜溃疡

目的 利用真菌通用引物PCR反应，鉴别兔眼真菌性和细菌性角膜溃疡。方法 根据临床上常见的致病细菌菌株(金葡菌、绿脓菌)，真菌菌株(烟曲霉菌、白念菌、镰刀菌)，制作兔眼角膜溃疡的动物模型，选取一对真菌通用引物，一对寡核苷酸引物B2F(5'ACTITCGTAGGATAG-3')和B4R(5'-TGATCGtcttccataaata-3')，对标本进行聚合酶链反应。结果 在687bp处出现DNA扩增带者为阳性。造模后第3d真菌组出现扩增带阳性的90％，第5d真菌组出现扩增带阳性的96．6％。细菌组始终未出现阳性结果。结论 真菌通用引物PCR反应检测鉴别真菌性与细菌性角膜溃疡有较好的敏感性和特异性。     

Microbial keratitis: aetiological diagnosis and clinical features in patients admitted to Hospital Universiti Sains Malaysia

INTRODUCTION: Corneal ulceration remains one of the major causes of blindness in developing countries, including Malaysia. Our objective is to determine the epidemiological characteristics, clinical features, risk factors and the aetiology of microbial keratitis in patients admitted to Hospital Universiti Sains Malaysia (HUSM). METHODS: All patients with microbial keratitis admitted to our hospital over a 16-month period from January 2004 to April 2005 were included in the study. Sociodemographic data and information pertaining to risk factors were recorded. All patients underwent examination with slit lamp biomicroscopy and corneal scrapings were sent for microbiological diagnosis. RESULTS: 42 patients were included in the study; 26 were male and 16 were female, with mean age of 44.5 (+/- 20.9) years. History of previous corneal trauma was present in 26 (61.9 percent) patients. Central location ulcers were more predominant (69 percent) than peripheral ulcers. Cultures from corneal scrapings were positive in 29 cases (69 percent). Of those individuals with positive cultures, 23 (79.3 percent) had pure bacterial infection, four (13.8 percent) had pure fungal infection and two (6.9 percent) had mixed growth. The most common bacterial pathogen isolated was Pseudomonas aeruginosa (40.5 percent), followed by Streptococcus pneumoniae (7.5 percent). Fungal pathogens which were isolated include Fusarium spp. (4.7 percent) and Aspergillus spp. (2.4 percent). CONCLUSION: Central corneal ulceration is a problem among patients presenting with microbial keratitis in HUSM. It often occurs after corneal trauma. These findings have important public health implications for the treatment and prevention of visual morbidity due to an infective cause.     

Effect of topical application of terbinafine on fungal keratitis

Background Fungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0.25% terbinafine eye drops comparing with 5% natamycin suspension on fungal keratitis. Methods A retrospective clinical trial was performed on 90 patients presenting with direct smear and/or culture positive fungal keratitis at Beijing Tongren Hospital, Beijing, China from January 2006 to May 2008. Corneal ulcers were categorized as mild or severe. Forty-five patients were treated with topical terbinafine and the next 45 cases received topical natamycin hourly. Results Filamentous fungi were found in corneal scrapings among all 90 cases. Fungal cultures were positive in 64 patients （71%）. Species of Fusarium and Aspergillus were the principal isolates. Forty （89%） patients showed favorable response to terbinafine, while forty-two （93%） patients exhibited favorable response to natamycin （P 〉0.05）. The mean course of treatment was significantly showed in the terbinafine treatment group than natamycin group （（26.5±11.2） days versus （19.3±6.4） days; P 〈0.05）. In terbinafine group, twenty patients with ulcers smaller than 4 mm had favorable outcome, while 20 of 25 patients with ulcers more than 4 mm in diameter had favorable response （P 〈0.05）. Twenty-seven patients with depth of infiltration less than half of stroma thickness had favorable response to terbinafine, while 13 of 18 patients with depth of infiltration more than half of stroma responded to terbinafine. This difference was statistically significant （P 〈0.05）. Conclusions Our findings suggest that topical terbinafine is an effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases with smaller and shallower ulcers. Its mean duration of treatment was longer than natamycin.     

药物联合治疗真菌性角膜炎20例分析

目的: 探讨斯皮仁诺、那他霉素滴眼液、抗生素联合应用治疗真菌性角膜炎的效果,并与单纯使用抗真菌药物比较。方法: 8例轻度角膜炎单服斯皮仁诺。12例中、重度角膜炎使用斯皮仁诺、那他霉素滴眼液、抗生素联合治疗。结果: 20例真菌性角膜炎全部治愈,2例并发角膜溃疡穿孔行结膜瓣移植,均保住眼球。结论: 斯皮仁诺、那他霉素滴眼液、抗生素联合用药对真菌性角膜炎治疗效果好。     

腐皮镰刀菌和黄曲霉菌感染小鼠角膜的共焦显微镜研究

目的应用激光共焦显微镜活体观察腐皮镰刀菌、黄曲霉菌感染小鼠角膜的过程,为真菌性角膜炎的临床和基础研究提供影像学资料。方法20只C57BL／6小鼠随机分为两组,右眼分别接种腐皮镰刀菌和黄曲霉菌,采用角膜划痕法制作真菌性角膜炎动物模型,在造模后不同时间点行激光共焦显微镜观察。结果激光共焦显微镜图像显示：在感染早期,腐皮镰刀菌表现为短线状或蚯蚓状结构,中期为长而支挺、分支极少的长线状结构,病变部位角膜形态结构破坏明显;黄曲霉菌在早期为短小、弯曲的蠕虫状结构,中期为走行更加弯曲,分支较多呈树枝状或簇状结构,病变部位角膜形态结构消失。后期均未见真菌结构。结论不同菌种感染所致真菌性角膜炎激光共焦显微镜下菌丝有不同的影像学特点,且同一菌种不同时期在角膜组织中菌丝形态也有较大差异。     

真菌性角膜炎654例感染谱分析

目的 对654例真菌性角膜炎的流行病学特征和实验室检查结果进行分析,以提高临床真菌性角膜炎的诊治效果。方法 对1999年1月至2004年12月间真菌性角膜炎住院患者的人口学特征、疾病危险因素、季节变化、临床特征、实验室结果和治疗策略进行回顾性分析。结果 真菌性角膜炎患者在感染性角膜溃疡住院患者中所占比例最高（61．9％）。角膜损伤（51．4％）特别是植物性物质损伤（25．7％）为最常见的危险因素。真菌性角膜炎的发生率在秋冬季比春夏季更高,并呈逐年递增趋势。氢氧化钾湿片直接镜检法的诊断阳性率为88．7％。分离到的真菌中镰刀菌属最多见（73．3％）。604例（92．4％）患者接受了手术干预,包括穿透性角膜移植399例（66．0％）,板层角膜移植177例（29．3％）。结论 镰刀菌属是真菌性角膜炎中最主要的病原。氢氧化钾湿片直接镜检法以其快速、简便和高特异性值得进一步推广。角膜移植术仍然是治疗严重真菌性角膜炎的最有效方法,建议早期实施。     

Changing indications for lamellar keratoplasty in Shandong, 1993–2008

Background With the advancement of microsurgical techniques, lamellar keratoplasty （LK） has been more valued and performed to treat corneal blindness. This study aimed to evaluate the indications and changing trends for LK during the past 16 years in Shandong Eye Institute, an eye center in China. Methods A total of 1529 eyes, predominantly from male （70.7%） patients undergoing LK between January 1993 and December 2008, were enrolled in this study. Data were collected by reviewing patient medical records for demographic characteristics, clinical diagnosis, laboratory findings and risk factors. Surgical times, initial diagnoses and causes of regrafting were recorded. All LKs were sequentially divided into period 1 （from 1993 to 2000） and period 2 （from 2001 to 2008）. Results Rural-dwelling patients in this study numbered 1089 （71.2%）; in all cases of infectious keratitis, rural patients accounted for 90.5%. The leading indications for LK were infectious keratitis （31.0%）, corneal trauma （21.1%）, keratoconus （18.7%）, corneal dystrophy and degeneration （7.3%）, regrafting （7.1%）, immunologic disorders （6.7%）, congenital abnormalities and corneal tumor （4.1%） and corneal scarring （3.1%）. The most common subcategory of infectious keratitis was fungal keratitis （67.5%）. Fusarium solani was the most morbigenous fungi. Among the patients, 73.1% of thermal burns were caused by hot molten metal, and 47.8% of alkali burns by lime. Dermoid was the most common indication for congenital abnormalities. The two main initial diagnoses from 109 regrafting cases were corneal trauma （45.9%） and Mooren＇s ulcer （27.5%）. The most common cause for regrafting was immune rejection （35.8%）. Infectious keratitis was the most common indication for LK from 16.0% in period 1 to 41.1% in period 2, followed by keratoconus （16.8%） and corneal trauma （14.5%）. Conclusions During the past 16 years, there have been major changes in the constituent ratios of leading indications for LK in Shangdong. Infectious keratitis has become the most common indication for LK. Fungal keratitis was the most common subcategory of infectious keratitis.