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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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Related in: MedlinePlus

Agents causing trauma in patients with microbial keratitis
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Figure 0002: Agents causing trauma in patients with microbial keratitis

Mentions: Patients with outdoor occupation had higher prevalence of keratitis due to trauma as compared to the patients engaged indoors. This observation was significant for bacterial (P < 0.001), fungal (P < 0.001) and Acanthamoeba (P = 0.02) keratitis when all culture-positive trauma and non-trauma cases were considered. In keratitis of pure or polymicrobial origin, physical agents were the most frequent sources of corneal injury than the other two (P < 0.001) as depicted in Fig. 2. Among the systemic factors documented in 296 patients, diabetes mellitus was more frequently noted in keratitis of both pure and polymicrobial etiology, accounting for 69.2% (205/296) cases.


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)

Agents causing trauma in patients with microbial keratitis
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Agents causing trauma in patients with microbial keratitis
Mentions: Patients with outdoor occupation had higher prevalence of keratitis due to trauma as compared to the patients engaged indoors. This observation was significant for bacterial (P < 0.001), fungal (P < 0.001) and Acanthamoeba (P = 0.02) keratitis when all culture-positive trauma and non-trauma cases were considered. In keratitis of pure or polymicrobial origin, physical agents were the most frequent sources of corneal injury than the other two (P < 0.001) as depicted in Fig. 2. Among the systemic factors documented in 296 patients, diabetes mellitus was more frequently noted in keratitis of both pure and polymicrobial etiology, accounting for 69.2% (205/296) cases.

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