Infectious Keratitis Caused by Rare and Emerging Micro-Organisms
Infectious Keratitis Caused by Rare and Emerging Micro-Organisms
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DOI：
10.1080/02713683.2019.1708407
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发表时间：
2020-01-09
影响因子：
2
通讯作者：
Titiyal, Jeewan S.
中科院分区：
文献类型：
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作者：
Sahay, Pranita;Goel, Siddhi;Titiyal, Jeewan S.
目的：对引起感染性角膜炎的罕见和新兴微生物进行全面综述。材料和方法：应用计算机检索PubMed Medline、Cochrane图书馆数据库、EMBASE和Scope(1960年以后)的文献，检索词：罕见病原体引起的角膜炎；真菌性角膜炎；真菌性角膜炎；细菌性角膜炎；感染性角膜炎；非典型真菌性角膜炎；非典型性细菌性角膜炎。所有相关文章均纳入本综述。结果：共有1232篇文章符合我们的检索策略，其中124篇文章纳入了这篇小型综述。引起角膜炎的罕见和新出现的细菌包括非典型分枝杆菌、诺卡氏菌、金杆菌、戴夫氏菌、科丘里氏菌、肠球菌、巴尔通氏杆菌、无色杆菌。还有其他人。引起角膜炎的稀有和新兴真菌包括腐霉属、交链孢属、顶盖霉属、枝孢霉属、弯孢霉属、双极孢属、微孢子虫属、假单胞菌属、炭疽菌属等。这些病例的临床表现各不相同。虽然少数细菌会产生独特的临床特征，但其余的类似于细菌性或真菌性角膜炎，对常规治疗的反应不同。因此，高度怀疑对其诊断至关重要。为了准确鉴定这些微生物，需要进行特别的研究，如聚合酶链式反应、基因测序、质谱学和酶联免疫吸附试验。培养敏感性是非常有用的，因为对常规使用的抗微生物药物的耐药性很常见。角膜炎合并腐霉属、假阿氏杆菌属、节炎杆菌属、紫球藻属、Kociria属的患者预后较差。和Achromobacter spp.结论：在感染病程异常或对标准抗微生物药物反应不佳的情况下，必须怀疑由罕见和新出现的微生物引起的角膜炎。早期诊断和及时治疗是取得良好预后的关键。
Purpose: To provide a comprehensive review of rare and emerging micro-organisms causing infectious keratitis. Material and Methods: A literature search was performed using PubMed Medline, Cochrane Library Database, EMBASE and Scopus (1960 onwards), using the terms: keratitis caused by rare pathogens; mycotic keratitis; fungal keratitis; bacterial keratitis; infectious keratitis; infective keratitis; atypical fungal keratitis; fungal keratitis caused by rare organisms; fungal keratitis caused by rare ocular pathogen; atypical bacterial keratitis; bacterial keratitis caused by rare organisms; bacterial keratitis caused by rare ocular pathogen. All relevant articles were included in this review. Results: A total of 1232 articles matched our search strategy of which 124 articles were included in this mini-review. The rare and emerging bacteria causing keratitis include atypical mycobacteria, Nocardia spp., Chrysebacterium spp., Delftia acidovorans, Kocuria spp., Enterococcus spp., Bartonella henslae, Achromobacter spp. and others. The rare and emerging fungi causing keratitis include Pythium spp., Alternaria spp., Acremonium spp., Cladosporium spp., Curvularia spp., Bipolaris spp., Microsporidia spp., Pseudallescheria spp., Colletotrichum spp., and others. The clinical presentation of these cases is variable. While a few organisms produce characteristic clinical features, rest present similar to bacterial or fungal keratitis with variable response to routine treatment. A strong degree of suspicion is therefore essential for its diagnosis. Special investigations like polymerase chain reaction, gene sequencing, mass spectroscopy and enzyme-linked immunosorbent assay are required for accurate identification of these organisms. Culture-sensitivity is extremely useful as drug resistance to routinely used anti-microbial drugs is common. Prognosis is usually poor for keratitis with Pythium spp., Pseudallescheria spp., Arthrographis spp., Purpureocillium spp., Kociria spp. and Achromobacter spp. Conclusion: Keratitis caused by rare and emerging micro-organisms must be suspected in cases where the infection runs an unusual course or shows a poor response to standard anti-microbial drugs. Early diagnosis and timely treatment hold the key for a good outcome.