Clinical and microbiological profile of infectious keratitis in children

Abstract

BackgroundInfectious keratitis is a sight-threatening condition for children. The purpose of this study was to describe the clinical profile, risk factors and microbiological profile of infectious keratitis in children.MethodsRetrospective review of clinical records of patients under 16 years of age with history of microbial keratitis seen at a tertiary referral center. Clinical characteristics, risk factors, visual and surgical outcomes as well as the microbiological profile are analyzed.ResultsForty-one eyes of 41 patients. Mean age was 8.7 years. Time between the onset of symptoms and ophthalmological examination was 12.7 days. Predisposing factors were found in 78%; ocular trauma was the most common (25%). Visual acuity equal or worse than 20/200 at admission correlated positively with a poorer visual outcome, p=0.002. Positivity of cultures was 34%. Gram-positive bacteria were isolated in 78.5%; Staphylococcus epidermidis (28.6%) was the most common microorganism.ConclusionsOur study emphasizes the importance of a prompt diagnosis and treatment of infectious corneal ulcers in children. Trauma and contact lenses were the main predisposing factors. Gram-positive organisms were isolated in the vast majority of cases and visual outcomes are usually poor.

Microbiological and epidemiological study of infectious keratitis in children and adolescents

“…In previous studies, the positivity of polymicrobial cultures has varied from 6.9% to 27% (3,(8)(9)(10)12,14) . As observed in other studies, the inherent difficulty in getting corneal samples from patients, the use of antimicrobials, improper corneal sampling, and microorganisms with slow growth on culture media may account for the low positivity rate observed in our study (3,15) . The presence of Gram-positive bacteria in keratitis in this study was 71.8%, similar to the level previously reported elsewhere (3,8,9,(12)(13)(14)(15)(16)(17)19,20,29) .…”

“…The prevalence of microorganisms responsible for microbial ke ratitis in children and adolescents varies in different regions of the world (3) . Microbial cultures were positive in 40.3% of the study sample, whereas in the literature positivity has ranged from 33% to 87% (3,(8)(9)(10)(12)(13)(14)(15)(16)(17)(18)20,29) . Polymicrobial isolates accounted for 9.5% of positive cultures in our study.…”

“…Childhood keratitis differs from adult keratitis in several respects, including possible reluctance of the child to undergo the clinical examination and sample collection, and the information-gathering regarding triggering factors and inflammation, which is apparently more intense in children (3,15) . Among teenagers, contact lenses are beco ming increasingly popular as a refractive error correction device, for esthetic reasons.…”

“…Trauma has been reported as the major risk factor for keratitis in several published studies, accounting for 21.2% to 58.8% of cases (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)29) . In our study, 18.2% of patients had a history of using contact lenses.…”

“…(4)(5)(6)(7) . Infectious keratitis are more prevalent in tropical developing countries with poor healthcare systems than in developed countries (3,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) . The diagnosis of keratitis is usually clinical and the treatment is empirical, with the application of broad-spectrum topical antimicrobial agents until identification of the etiologic agent is completed.…”