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

Abstract

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.

A profile of corneal ulcers – 2 years study from rural hospital, Haryana

“…Pain (87.5%), redness (87.5%), lacrimation (62.5%), hypopyon (37.5%) was most commonly seen in bacterial keratitis. This was comparable with Ibrahim et al 14 (Red eye -Bacterial 89.22% fungal 87%, Pain -Bacterial 90.32 % Fungal 87.55 % ,Photophobia-Bacterial 67.74% Fungal 86.67% ,Poor vision -Bacterial 71.67% Fungal-93.49% , Hypopyon (Bacterial 36% Fungal 16%) and Thomas et al 15 (Serrated margins-fungal 79% bacterial 48%, Hypopyon-fungal 48% bacterial 65%, dry texture-fungal 44% bacterial 28%). Fungal aetiology is mostly presumed with hyphal pattern, serrated margins, raised slough, dry textured slough, and satellite lesions.…”

Prospective comparison between conventional microbial work-up vs PCR in the diagnosis of fungal keratitis

“…Patients who were eligible to contribute corneal specimens for the study included those with a history of corneal trauma with organic matter, use of topical steroids, or a compromised immune system, and clinical findings of presumed fungal infection such as ulcers with dry surface, feathery edge, unleveled hypopyon, pigmented lesion, or endothelial plaque. 13 Exclusion criteria included as follows: patients who were uncooperative, or the inability to give informed consent, and inadequate or contaminated specimens.…”

Management of Fungal Keratitis in Pediatric Patients

“…Only serrated margins and raised slough were independently associated with FK (22) and exudates presented more frequently in cases suffering from filamentous FK, hypopyon, and fibrinous than in bacterial keratitis (22). Other signs are redness of the eye, blepharitis lid edema, satellite lesions, increasing eye pain, or discomfort or foreign body sensation, increased light sensitivity, raised slough, dry eyes, abnormalities and conjunctival congestion, corneal degeneration, and defective vision (4).…”