The Clinical Differentiation of Bacterial and Fungal Keratitis: A Photographic Survey
The Clinical Differentiation of Bacterial and Fungal Keratitis: A Photographic Survey
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DOI：
10.1167/iovs.11-8478
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发表时间：
2012-04-01
影响因子：
4.4
通讯作者：
Acharya, Nisha R.
中科院分区：
文献类型：
--
作者：
Dalmon, Cyril;Porco, Travis C.;Acharya, Nisha R.
目的。本研究的目的是确定感染性角膜炎的临床症状是否可用于识别致病微生物。方法。从 2 项临床试验中随机选择 80 张患有培养证实的细菌性角膜炎或涂片证实的真菌性角膜炎的眼睛照片。来自 F. I. Proctor 基金会和 Aravind 眼保健系统的 15 名角膜专家评估了照片中预先指定的角膜炎临床症状，并确定了最可能的致病微生物。 结果。 66% 的时间临床医生能够正确区分细菌和真菌病因 (P < 0.001)。革兰氏染色、属和种的准确预测率分别为 46%、25% 和 10%。不规则/羽毛状边缘的存在与真菌性角膜炎相关，而花圈浸润或上皮斑块与细菌性角膜炎相关。结论。角膜专家正确区分细菌性角膜炎和真菌性角膜炎的几率高于偶然，但正确率低于 70%。更具体的分类导致临床区分不太成功。尽管感染性角膜炎的某些临床症状可能与细菌或真菌病因有关，但这项研究强调了在初次临床接触期间获得适当的微生物检测的重要性。 （投资眼科可见科学。2012 年；53：1787-1791）DOI：10.1167/iovs.11-8478
PURPOSE. The purpose of this study was to determine whether clinical signs of infectious keratitis can be used to identify the causative organism.METHODS. Eighty photographs of eyes with culture-proven bacterial keratitis or smear-proven fungal keratitis were randomly selected from 2 clinical trials. Fifteen cornea specialists from the F. I. Proctor Foundation and the Aravind Eye Care System assessed the photographs for prespecified clinical signs of keratitis, and they identified the most likely causative organism.RESULTS. Clinicians were able to correctly distinguish bacterial from fungal etiology 66% of the time (P < 0.001). The Gram stain, genus, and species were accurately predicted 46%, 25%, and 10% of the time, respectively. The presence of an irregular/feathery border was associated with fungal keratitis, whereas a wreath infiltrate or an epithelial plaque was associated with bacterial keratitis.CONCLUSIONS. Cornea specialists correctly differentiated bacterial from fungal keratitis more often than chance, but in fewer than 70% of cases. More specific categorization led to less successful clinical distinction. Although certain clinical signs of infectious keratitis may be associated with a bacterial or fungal etiology, this study highlights the importance of obtaining appropriate microbiological testing during the initial clinical encounter. (Invest Ophthalmol Vis Sci. 2012;53:1787-1791) DOI:10.1167/iovs.11-8478