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

Gopinathan U, Sharma S, Garg P, Rao GN - Indian J Ophthalmol (2009 Jul-Aug)

Bottom Line: Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively.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.

View Article: PubMed Central - PubMed

Affiliation: Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Prasad Marg, Banjara Hills, Hyderabad, India.

ABSTRACT

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.

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Seasonal variation in the occurrence of microbial keratitits (includes pure and mixed cases) in southern India
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Figure 0001: Seasonal variation in the occurrence of microbial keratitits (includes pure and mixed cases) in southern India

Mentions: Of the 5897 clinically suspected cases of infectious keratitis, 4087 (69.3%) were males and 1810 (30.7%) were females, the overall male to female ratio of patients being 2.25:1. Laboratory evidence of microbial infection was established in 3563 (60.4%) of 5897 cases whose corneal scrapings were subjected for smears and culture. The mean (± standard deviation) age was 41.20 (± 20.36) years in patients with bacterial keratitis (1849, 51.9%), 30.90 (± 15.28) years in patients with fungal keratitis (1360, 38.2%), and 34.45 (± 12.54) years in patients with Acanthamoeba keratitis (86, 2.4%), indicating a relatively increased occurrence of corneal infections (irrespective of the etiological agent) in the middle age group. The seasonal variation in the occurrence of all (including mixed) bacterial, fungal and Acanthamoeba keratitis is as depicted in Fig. 1.


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

Gopinathan U, Sharma S, Garg P, Rao GN - Indian J Ophthalmol (2009 Jul-Aug)

Seasonal variation in the occurrence of microbial keratitits (includes pure and mixed cases) in southern India
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2712695&req=5

Figure 0001: Seasonal variation in the occurrence of microbial keratitits (includes pure and mixed cases) in southern India
Mentions: Of the 5897 clinically suspected cases of infectious keratitis, 4087 (69.3%) were males and 1810 (30.7%) were females, the overall male to female ratio of patients being 2.25:1. Laboratory evidence of microbial infection was established in 3563 (60.4%) of 5897 cases whose corneal scrapings were subjected for smears and culture. The mean (± standard deviation) age was 41.20 (± 20.36) years in patients with bacterial keratitis (1849, 51.9%), 30.90 (± 15.28) years in patients with fungal keratitis (1360, 38.2%), and 34.45 (± 12.54) years in patients with Acanthamoeba keratitis (86, 2.4%), indicating a relatively increased occurrence of corneal infections (irrespective of the etiological agent) in the middle age group. The seasonal variation in the occurrence of all (including mixed) bacterial, fungal and Acanthamoeba keratitis is as depicted in Fig. 1.

Bottom Line: Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively.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.

View Article: PubMed Central - PubMed

Affiliation: Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Prasad Marg, Banjara Hills, Hyderabad, India.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus