Epidemiology of open- and closed-globe trauma presenting to Cairns Base Hospital, Queensland

PURPOSE: To review the epidemiology of serious ocular trauma presenting to Cairns Base Hospital, from the far north Queensland health districts. METHODS: A retrospective study of cases from January 1995 to November 2002 inclusive. Cases were analysed with respect to demographics, cause and nature of injury, method of transport and time to and type of ophthalmic treatment, and visual outcomes. RESULTS: There were 226 cases identified, including 71 open-globe and 155 closed-globe injuries. The annual rate of injury was 3.7 per 100 000 for open-globe and 11.8 per 100 000 in total. The Aboriginal and Torres Strait Islander population from the far north Queensland districts showed a disproportionate incidence, with 38% of the total number of injuries, despite representing only 12.3% of the population. Assault in the Aboriginal and Torres Strait Islander population resulted in 69.6% of injuries in men and 75.8% of injuries in women. Of all assaults 76.2% were alcohol-related. The majority (71.5%) of injuries in the Caucasian population were due to accidental blunt and sharp trauma. In total, 77.4% of injuries occurred in men, with an average age of 31 years. Of all open and closed injuries in the study, a final visual acuity of 6/12 or better was achieved in 47.8% of eyes and a final visual acuity of 6/60 or less occurred in 17.7% of patients, 20.8% patients were lost to follow up. In total, 14.1% of open injuries required enucleation/evisceration. CONCLUSIONS: The incidence of ocular trauma in far north Queensland is equal to other Australian populations. However, there is a disproportionately high incidence in the Aboriginal and Torres Strait Islander population. Alcohol-related assault is a significant cause of visual loss in the Aboriginal and Torres Strait Islander population. Closed-globe injuries are more common than open globe; however, the latter have poorer visual prognosis. Initial visual acuity of all injuries correlated with final visual acuity.     

Aetiology of suppurative corneal ulcers in Ghana and south India,and epidemiology of fungal keratitis

BACKGROUND: A multicentre study was carried out in Ghana and southern India to determine the aetiology of suppurative keratitis in two regions located at similar tropical latitudes. Studies of fungal keratitis from the literature were reviewed. METHODS: Patients presenting at rural and urban eye units with suspected microbial keratitis were recruited to the study. Corneal ulceration was defined as loss of corneal epithelium with clinical evidence of infection with or without hypopyon. Microscopy and culture were performed on all corneal specimens obtained. RESULTS: 1090 patients were recruited with suspected microbial keratitis between June 1999 and May 2001. Overall the principal causative micro-organisms in both regions were filamentous fungi (42%): Fusarium species and Aspergillus species were the commonest fungal isolates. Pseudomonas species were most frequently isolated from cases of bacterial keratitis in Ghana but in India the commonest bacterial isolates were streptococci. CONCLUSION: Infections of the cornea due to filamentous fungi are a frequent cause of corneal damage in developing countries in the tropics and are difficult to treat. Microscopy is an essential tool in the diagnosis of these infections. A knowledge of the "local" aetiology within a region is of value in the management of suppurative keratitis in the event that microscopy cannot be performed.     

Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania

PURPOSE: To report the spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia. METHODS: We reviewed the records of 24 cases of culture-positive fungal keratitis treated from January 1991 to March 1999 at Wills Eye Hospital. Risk factors, fungal identification, antifungal treatment, and outcomes were evaluated. RESULTS: The study included 24 eyes (24 patients). Fourteen patients (58.3%) were female. The mean age was 59 years (range, 19-86 years). Predisposing factors included chronic ocular surface disease (41.7%), contact lens wear (29.2%), atopic disease (16.7%), topical steroid use (16.7%), and ocular trauma (8.3%). Early identification of fungal elements was achieved by staining of corneal scrapings in 18 cases (75%). Half of the cases (12 eyes) had corneal infections caused by yeast, and the other half by filamentous fungi. Candida albicans was the most commonly isolated organism (45.8%), followed by Fusarium sp (25%). Natamycin and amphotericin B were the topical antifungals most frequently used, while systemic treatment commonly used included fluconazole, ketoconazole, or itraconazole. Six patients (25%) had penetrating keratoplasty during the acute stage of infection. After a mean follow-up of nine months, 13 eyes (54.1%) had the best corrected visual acuity 20/100 or better. CONCLUSIONS: In contrast to other studies from the northern United States, we found Fusarium sp the most commonly isolated filamentous fungus. In our series, C. albicans was the most frequent cause of fungal keratitis, and a past history of ocular trauma was uncommon.     

Fungal Keratitis – Improving Diagnostics by Confocal Microscopy

Purpose

Introducing a simple image grading system to support the interpretation of in vivo confocal microscopy (IVCM) images in filamentous fungal keratitis.

Setting

Clinical and confocal studies took place at the Department of Ophthalmology, Aarhus University Hospital, Denmark. Histopathological analysis was performed at the Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark.

Methods

A recent series of consecutive patients with filamentous fungal keratitis is presented to demonstrate the results from in-house IVCM. Based upon our experience with IVCM and previously published images, we composed a grading system for interpreting IVCM images of filamentous fungal keratitis.

Results

A recent case series of filamentous fungal keratitis from 2011 to 2012 was examined. There were 3 male and 3 female patients. Mean age was 44.5 years (range 12–69), 6 out of 17 (35%) cultures were positive and a total of 6/7 (86%) IVCM scans were positive. Three different categories of IVCM results for the grading of diagnostic certainty were formed.

Conclusion

IVCM is a valuable tool for diagnosing filamentous fungal keratitis. In order to improve the reliability of IVCM, we suggest implementing a simple and clinically applicable grading system for aiding the interpretation of IVCM images of filamentous fungal keratitis.Key words: In vivo confocal microscopy, Fungal keratitis, Diagnostics     

Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi

AIM: To assess whether the presence of characteristic clinical features can be used as a diagnostic aid for suppurative keratitis caused by filamentous fungi. METHODS: Patients presenting with suppurative keratitis in India underwent detailed clinical examination followed by microbiological investigation of corneal scrapes. A partial diagnostic score based upon the strength of the association, as estimated by the odds ratio, between reported clinical features and laboratory confirmed diagnoses was devised and subsequently tested using a case series from Ghana. RESULTS: Serrated margins, raised slough, dry texture, satellite lesions and coloration other than yellow occurred more frequently in cases of filamentous fungal keratitis than bacterial keratitis (p<0.05). Hypopyon and fibrinous exudate were observed more frequently in bacterial keratitis (p<0.05). When incorporated into a backwards stepwise logisitic regression model only serrated margins, raised slough, and colour were independently associated with fungal keratitis; these features were used in the scoring system. The probability of fungal infection if one clinical feature was present was 63%, increasing to 83% if all three features were present. CONCLUSIONS: Microbiological investigations should be performed whenever possible; however, where facilities are not available, a rapid presumptive diagnosis of suppurative keratitis may be possible by scoring clinical features.     

真菌性角膜炎患者的临床特征及病原菌分布

目的：：分析真菌性角膜炎的临床特征及病原菌的分布,为临床诊疗提供依据。方法：回顾性分析2012-01/2015-07在长江大学附属第一医院诊治的98例98眼真菌性角膜炎患者的临床资料。结果：真菌性角膜炎最主要由植物外伤引起,其次是糖皮质激素的应用及隐形眼镜的不当使用。几乎所有患者出现菌丝苔被、伪足、免疫环、卫星灶等体征,少数患者出现内皮斑和前房积脓。真菌性角膜炎的致病菌主要以镰刀菌属为主(73.5％),其次为曲霉属(13.2％)、念珠菌属(9.2％),其他菌属4.1％。65例65眼患者在选择5％那他霉素滴眼液后治愈,15例15眼患者病情明显好转,其余18例18眼患者病情无明显好转,联合伏立康唑后13例13眼病情好转,5例5眼病情继续恶化,最终3例3眼羊膜遮盖,2例2眼眼球摘除。。结论：真菌性角膜炎在荆州地区的主要流行菌种为镰刀菌。那他霉素眼液可作为临床预防和治疗真菌性角膜炎首选药物。临床医师应加强对真菌性角膜炎的了解,以便早期诊断和及时治疗。     

Clinical and microbial spectrum of fungal keratitis in Singapore: a 5-year retrospective study

Background: The epidemiology of fungal keratitis varies geographically, but commonly occurs in warm, tropical climates. To determine the microbial and clinical characteristics of this disease in Singapore, we conducted a5-year hospital-based retrospective study. Methods: A retrospective reviewo f culture-positive fungal keratitis at the Singapore National Eye Center and Singapore General Hospital, from January 1991 to December 1995. Results: Twenty-nine consecutive cases of culture-positive fungal keratitis were seen over the study period. The mean age of the cases was 41 years and 23 were males. Amongst the varied occupations, 9 were construction workers. The most common cultured organisms were Fusarium sp. (52%) and Aspergillus flavus (17%). More than half had a history of ocular trauma prior to the development of keratitis, while a quarter had antecedent topical corticosteroid therapy. In contrast, only 2 patients were contact-lens wearers. Despite medical therapy, 10 patients eventually required therapeutic penetrating keratoplasties; of these, 6 were caused by Fusarium species. Conclusion: Fusarium is the commonest cultured organism in fungal keratitis in Singapore and is associated with significant ocular morbidity. This revised version was published online in August 2006 with corrections to the Cover Date.     

Clinical and mycological profile of fungal keratitis from North and North-East India

Purpose:To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary-care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations.Methods:All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts.Results:Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions.Conclusion:The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region-specific clinico-epidemiological profile.     

Candida parapsilosis corneal graft infection from a single eye center: Histopathologic report of 2 cases

Fungal keratitis accounts for 6–53% of all cases of ulcerative keratitis in variable studies. The majority of cases are due to septate fungi. The abnormal cornea in cases of dry eye syndrome, chronic ulceration, erythema multiform and possibly HIV infection is infected more commonly with Candida, most commonly Candida albicans. Candida parapsilosis affects neonates and intensive care unit (ICU) patients and it has been recently found with increasing frequency. In a previous study on mycotic keratitis in our tertiary eye hospital, filamentous fungi were more commonly isolated than yeasts. We are presenting 2 successive cases of corneal graft infection by Candida parapsilosis referred to us from another eye center to attract the attention of ophthalmologists and health workers to such an infection.     

Contact-Lens-Associated Purpureocillium Keratitis: Risk Factors,Microbiologic Characteristics,Clinical Course,and Outcomes

Purpose: To study the risk factors, microbiologic characteristics, clinical course, and outcomes of patients with Purpureocillium keratitis at a tertiary eye care center in south Florida. Materials and Methods: All medical records during a seven-year period starting January 1, 2007, were reviewed. Twenty-eight culture-proven Purpureocillium keratitis cases with complete medical records presenting to our institution were included in this retrospective, observational case series. Data collected included predisposing factors, therapeutic interventions, treatment duration, and visual outcomes. Results: Twenty patients (71.4%) had a history of soft contact lens use, with only two for therapeutic use. Other identified risk factors were trauma and immunosuppression. Fifteen patients (53.6%) received topical corticosteroid treatment prior to the diagnosis of fungal keratitis. Thirteen patients (46.4%) were on Natamycin treatment prior to Purpureocillium identification. As a group, the average best-corrected visual acuity (BCVA) at presentation was 1.1 logMAR; upon the final evaluation, it was 1.0 logMAR. The BCVA on last evaluation for the eight patients presenting to our institution within two weeks of onset of symptoms was 0.3 log MAR, and all patients in this group responded to medical management. The final BCVA for 20 patients presenting two weeks after onset of symptoms was 1.2 logMAR. There was a significant difference in the final BCVA between Group 1 and Group 2 (p?=?0.004), but no difference in steroid use or previous treatments. Previous steroid use tended to extend time to presentation and was significantly associated with a worse final visual outcome (1.2 versus 0.6 logMAR; p?=?0.0474). Previous Natamycin use was significantly associated with a worse final visual outcome (1.4 versus 0.6 logMAR; p?=?0.014). Conclusion: Purpureocillium keratitis can have devastating consequences to visual function and even lead to enucleation. Physicians should make every effort to arrive at an earlier microbiological diagnosis, as this is associated with better outcomes and less need for surgical intervention. The first line use of voriconazole is recommended, and steroid use should be avoided, as their previous use is associated with worse visual outcomes.     

Keratitis Caused by a Rare Fungus, <Emphasis Type="Italic">Malassezia restricta</Emphasis>

Background Malassezia species rarely cause keratitis, and, thus, the clinical manifestations of Malassezia keratitis are not well known. Case We report the clinical findings in a 70-year-old woman who complained of pain in her left eye. Slit-lamp biomicroscopy showed a corneal ulcer with irregular infiltration, which resembled keratitis caused by filamentous fungi. KOH Parker ink stain of a corneal scraping showed mold hyphae and yeast, but cultures on Sabouraud's glucose agar plates and blood agar plates were negative. Treatment with antibacterial agents failed. Observations Polymerase chain reaction (PCR) and DNA typing of the fungal gene between the internal transcribed spacer 2 (ITS2) and the 5.8S ribosomal DNA of the scraping were performed. PCR amplified a band with a sequence that was 99% homologous with Malassezia restricta. Antifungal agents, topical 5% pimaricin ointment and 0.2% miconazole, and oral itraconazole 150 mg/day, were applied, and the corneal ulcer disappeared within 5 weeks. Conclusion Malassezia restricta can cause keratitis, and the clinical findings resemble keratitis caused by filamentous fungi. PCR and DNA typing of ITS2 and 5.8S ribosomal DNA are valuable techniques for detecting and identifying Malassezia species. Proper identification of Malassezia keratitis permits a prompt and successful treatment by antifungal agents. Jpn J Ophthalmol 2007;51:292–294 @ Japanese Ophthalmological Society 2007     

Incidence and microbiological profile of mycotic keratitis in a tertiary care eye hospital: A retrospective analysis

Purpose

To determine the incidence and microbiological profile of mycotic keratitis seen at a tertiary care eye hospital.

Materials and methods

A retrospective review of microbiology records of patients presenting with suspected microbial keratitis seen between January 2006 and December 2009 was performed. Patients with positive fungal cultures were further analyzed for the type of fungus isolated and associated bacterial pathogens.

Results

Microbiology records of 2300 patients with suspected microbial keratitis were reviewed. A microbiological diagnosis of mycotic keratitis was established in 87 (3.8%) patients over a four year period based on positive fungal cultures. The yearly incidence of mycotic keratitis was 3.2% (2006), 4.9% (2007), 3.3% (2008) and 3.6% (2009). Filamentous fungi were isolated more often than yeasts. Aspergillus species followed by Fusarium species and Trichophyton species were the commonest filamentous fungi isolated while Candida albicans was the most frequently encountered yeast. Mixed infections due to fungal and bacterial pathogens were seen in 25/87 (28.7%) patients.

Conclusion

Cumulative incidence of mycotic keratitis was 3.8% over a four year period. Aspergillus species and Candida albicans were the most frequent pathogenic organisms causing mycotic keratitis in this part of the world. Mixed infections were seen in 28.7% of the patients. Knowledge of the “local” etiology within a region may be valuable in the management of mycotic keratitis in instituting an empirical therapy, especially when facilities for microscopy, cultures and antifungal susceptibility are not readily available. The baseline information presented will also be helpful in the planning of a corneal ulcer management strategy and for future studies on mycotic keratitis.     

真菌性角膜炎的致病菌菌属和转归及其影响因素分析

目的：探究真菌性角膜炎致病菌菌属分布情况,分析影响其临床转归的主要因素。

方法：前瞻性研究。选取2018-03/2021-03于我院就诊的真菌性角膜炎患者102例,均先予联合抗真菌药物治疗,药物治疗无效则行手术治疗。治疗前通过真菌培养分析致病菌菌属分布情况及不同致病菌患者手术率,并根据临床转归情况将纳入患者分为临床转归良好组(76例)和临床转归不良组(26例),探究真菌性角膜炎临床转归的影响因素。

结果：纳入患者102例中真菌检查结果呈阳性74例(72.5%),药物治疗无效转手术治疗的患者13例(12.7%),不同致病菌属感染患者手术率比较有显著差异(P<0.05),镰刀菌属致病患者手术率显著高于其他菌属。与临床转归不良组比较,临床转归良好组患者病程更短,溃疡面积、浸润深度、前房积脓更小,居住地多为城镇,致病菌多为除镰刀菌以外者(P<0.05)。Logistic回归分析显示,病程、溃疡面积、浸润深度、前房积脓、致病菌属、居住地是影响临床转归的危险因素(均P<0.05)。

结论：真菌性角膜炎主要致病菌有镰刀菌、曲霉菌等,镰刀菌属致病后药物治疗效果更差,病程、溃疡面积、浸润深度、前房积脓、致病菌属、居住地情况均可影响该病临床转归。     

Clinical characteristics of microbial keratitis in a university hospital in Taiwan

PURPOSE: To analyze the clinical and microbiological characteristics of microbial keratitis at the National Taiwan University Hospital in the preceding 10 years. DESIGN: Retrospective cross-sectional study. METHODS: Medical records were reviewed for all patients with clinically diagnosed microbial keratitis presenting at the National Taiwan University Hospital from January 1992 to December 2001. Risk factors, microbial isolations, clinical patterns, treatment, and outcomes were analyzed. RESULTS: Microbial keratitis was diagnosed for 476 eyes in 453 patients (220 female and 233 male; mean age, 40.7 years). Pseudomonas species were the most commonly isolated organisms (37.7%), followed by fungi (13.5%), staphylococci (8.4%), nontuberculous mycobacteria (7.9%), streptococci (7.6%), and Acanthamoeba (4.4%). Contact-lens wear was the most common predisposing factor (44.3%). Medical treatment was successful for a total of 344 eyes (72.3%), with 132 eyes (27.7%) requiring surgery. The duration from symptom onset to diagnosis of microbial keratitis was statistically significantly shorter for the cases treated medically than the cases treated surgically (7.70 +/- 14.37 and 20.53 +/- 28.85 days, respectively, p =.000000332). Response to medical treatment was more favorable for bacterial infection (except nontuberculous mycobacterial infection) as compared with fungal or Acanthamoeba infection. A total of 84.4% of pseudomonal keratitis cases were cured by medical treatment, while 85% of nontuberculous mycobacterial keratitis cases eventually required surgical treatment to control the infection. CONCLUSION: Contact-lens related pseudomonal keratitis was the most common form of microbial keratitis in Taiwan. Early diagnosis and prompt treatment are important for successful management of microbial keratitis.     

马来西亚东西部感染性角膜炎研究

目的：评估马来西亚东西部三级医院感染性角膜炎流行病学及发病因素。

方法：收集来自马来西亚西部Sungai Buloh医院、吉隆坡综合医院和东部Queen Elizabeth医院、沙捞越州综合医院的感染性角膜炎患者207例。研究记录了危险因素。进行角膜刮片镜检和培养。

结果：马来西亚西部感染性角膜炎最普遍的风险因素是植物性损伤(28.5%)和非植物性损伤(18.3%)。27.7%的创伤病例与工作有关,其中外籍男性工作者占34.2%。马来西亚东部最普遍的风险因素是配戴隐形眼镜(32.9%)。马来西亚东西部绿脓假单胞菌是感染性角膜炎最常见的病菌。马来西亚西部最常见的真菌病原体是镰刀菌,占所有阳性真菌培养物的60%。

结论：马来西亚东西部公立医院细菌性角膜炎检出率较高,而东部隐形眼镜配戴则是常见风险因素(P<0.05),西部真菌性角膜炎检出率高。     

Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade

Purpose:

To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis.

Materials and Methods:

Retrospective analysis of a non-comparative series from the database was done. All the patients presenting with corneal stromal infiltrate underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy.

Results:

Out of 5897 suspected cases of microbial keratitis 3563 (60.4%) were culture-proven (bacterial – 1849, 51.9%; fungal – 1360, 38.2%; Acanthamoeba – 86, 2.4%; mixed – 268, 7.5%). Patients with agriculture-based activities were at 1.33 times (CI 1.16–1.51) greater risk of developing microbial keratitis and patients with ocular trauma were 5.33 times (CI 6.41–6.44) more likely to develop microbial keratitis. Potassium hydroxide with calcofluor white was most sensitive for detecting fungi (90.6%) and Acanthamoeba (84.0%) in corneal scrapings, however, Gram stain had a low sensitivity of 56.6% in detection of bacteria. Majority of the bacterial infections were caused by Staphylococcus epidermidis (42.3%) and Fusarium species (36.6%) was the leading cause of fungal infections. A significantly larger number of patients (691/1360, 50.8%) with fungal keratitis required surgical intervention compared to bacterial (799/1849, 43.2%) and Acanthamoeba (15/86, 17.4%) keratitis. Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively.

Conclusions:

While diagnostic and treatment modalities are well in place the final outcome is suboptimal in fungal keratitis. With more effective treatment available for bacterial and Acanthamoeba keratitis, the treatment of fungal keratitis is truly a challenge.     

Natamycin in the treatment of keratomycosis: correlation of treatment outcome and in vitro susceptibility of fungal isolates

In this study, 60 fungal isolates from 60 patients with fungal keratitis were tested in vitro for their susceptibility to natamycin and the mean minimum inhibitory concentrations of natamycin (MICn) were correlated with clinical outcome. The mean MICn for various groups of fungi from patients with either early (<10 days) or late (≥ 10 days) presentation was correlated with the outcome. Aspergillus flavus showed resistance to natamycin with a high mean MICn (>16 μg/ml). While the clinical response in all patients with early A. flavus keratitis was good it was poor in late cases (5/8 patients, 62.5%). Fusarium species, Acremonium species and dematiaceous fungi were sensitive with low mean MICn (Fusarium: 5.7-7.2 μg/ml, Acremonium: 5.7-6.8 μg/ml, dematiaceous: (1.6-4 μg/ml). However, 46.6% (7/15) patients in Fusarium and 57.1% (4/7) in Acremonium group needed keratoplasty. We conclude that despite susceptibility of most fungal species causing keratitis to natamycin, the treatment outcome is poor in advanced fungal keratitis.     

角膜致病性丝状真菌基因分型与临床意义分析

目的研究丝状真菌性角膜炎致病菌株的基因分型及临床意义。方法收集北京同仁医院眼科中心2006年1—12月经病原学检查诊断为丝状真菌性角膜炎的患者52例,对分离的致病菌株进行rDNAITS基因分型和形态学鉴定与分析,并对患者进行治疗和随访,分析基因分型与临床多因素的关系。结果基因分型与形态学鉴定种的一致率达90．3％。根据rDNAITS基因的亲缘关系,将52株丝状真菌分为4组：第1组22株（20株茄病镰刀菌和2株尖孢镰刀菌）;第2组12株（8株串珠镰刀菌、3株层生镰刀菌和1株雪腐镰刀菌）;第3组5株（4株少见眼部真菌和1株串珠镰刀菌）;第4组13株（10株曲霉菌属和3株链隔孢属）。第1组、第2组与第3组、第4组相比,患者发病时间、诱发因素、溃疡严重程度、抗真菌治疗的疗效比较,差异均有统计学意义（P=0．000,P=0．03,P=0．01,P=0．035）。结论rDNAITS基因分型能够准确地鉴定角膜丝状真菌,对于少见或鉴定困难的菌株具有明显的优势。由于菌株的基因型不同,丝状真菌性角膜炎的临床特点具有一定的差异。     

Microbial Keratitis in South India: Influence of Risk Factors,Climate, and Geographical Variation

Purpose: To determine the influence of risk factors, climate, and geographical variation on the microbial keratitis in South India. Methods: A retrospective analysis of all clinically diagnosed infective keratitis presenting between September 1999 and August 2002 was performed. A standardised form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Corneal scrapes were collected and subjected to culture and microscopy. Results: A total of 3,183 consecutive patients with infective keratitis were evaluated, of which 1,043 (32.77%) were found to be of bacterial aetiology, 1,095 (34.4%) were fungal, 33 (1.04%) were Acanthamoeba, 76 (2.39%) were both fungal and bacterial, and the remaining 936 (29.41%) were found to be culture negative. The predominant bacterial and fungal pathogens isolated were Streptococcus pneumoniae (35.95%) and Fusarium spp. (41.92%), respectively. Most of the patients (66.84%) with fungal keratitis were between 21 and 50 years old, and 60.21% of the patients with bacterial keratitis were older than 50 (p < 0.0001) (95% CI: 5.19–7.19). A majority of patients (64.75%) with fungal keratitis were agricultural workers (p < 0.0001) [odds ratio (OR): 1.4; 95% CI: 1.19–1.61], whereas bacterial keratitis occurred more commonly (57.62%) in nonagricultural workers (p < 0.0001) (OR: 2.88; 95% CI: 2.47–3.36). Corneal injury was identified in 2,256 (70.88%) patients, and it accounted for 92.15% in fungal keratitis (p < 0.0001) (OR: 7.7; 95% CI: 6.12–9.85) and 100% in Acanthamoeba keratitis. Injuries due to vegetative matter (61.28%) were identified as a significant cause for fungal keratitis (p < 0.0001) (OR: 23.6; 95% CI: 19.07–29.3) and due to mud (84.85%) for Acanthamoeba keratitis (p < 0.0001) (OR: 26.01; 95% CI: 3.3–6.7). Coexisting ocular diseases predisposing to bacterial keratitis accounted for 68.17% (p < 0.0001) (OR: 33.99; 95% CI: 27.37–42.21). The incidence of fungal keratitis was higher between June and September, and bacterial keratitis was less during this period. Conclusion: The risk of agricultural predominance and vegetative corneal injury in fungal keratitis and associated ocular diseases in bacterial keratitis increase susceptibility to corneal infection. A hot, windy climate makes fungal keratitis more frequent in tropical zones, whereas bacterial keratitis is independent of seasonal variation and frequent in temperate zones. Microbial pathogens show geographical variation in their prevalence. Thus, the spectrum of microbial keratitis varies with geographical location influenced by the local climate and occupational risk factors.     

Comparative study on the incidence and outcomes of pigmented versus non pigmented keratomycosis

Purpose:

To determine the incidence, outcomes and establish factors determining visual prognosis of keratomycosis due to pigmented fungi in comparison with nonpigmented fungi.

Materials and Methods:

All culture-proven cases of fungal keratitis from January 2006 to August 2008 were drawn from a computerized database and cases with adequate documentation were analyzed for predisposing factors, clinical characteristics, microbiology and treatment methods. Outcomes of keratitis due to pigmented and nonpigmented fungi were compared using t-test and χ² test.

Results:

Of 373 cases of keratomycosis during the study period, pigmented fungi were etiological agents in 117 eyes (31.3%) and nonpigmented fungi in 256 eyes (68.7%). Eyes with nonpigmented keratitis had significantly larger ulcers (14.96 mm² ) and poorer vision (1.42 logMAR) at presentation compared to those with keratomycosis due to pigmented fungi (P=0.01). The characteristic macroscopic pigmentation was seen in only 14.5% in the pigmented keratitis group. Both groups responded favorably to medical therapy (78.1% vs. 69.1%) with scar formation (P=0.32) and showed a significant improvement in mean visual acuity compared with that at presentation (P<0.01). Visual improvement in terms of line gainers and losers in the subgroup of eyes that experienced healing was also similar. Location of the ulcer was the only factor that had significant predictive value for visual outcome (P=0.021).

Conclusion:

Incidence of keratomycosis due to pigmented fungi may be increasing as compared to previous data. These eyes have similar response to medical therapy and similar visual outcome compared to nonpigmented keratitis. Central ulcers have a poor visual outcome.