Clinical aspects and prognosis of polymicrobial keratitis caused by different microbial combinations: a retrospective comparative case study

Harbiyeli, İbrahim İnan; Oruz, Oğuzhan; Erdem, Elif; Çam, Burcu; Demirkazik, Mehtap; Acikalin, Arbil; Kibar, Filiz; İlkit, Macit; Yarkın, Fügen; Yaǵmur, Meltem

doi:10.1007/s10792-021-01955-2

Cited by 7 publications

(8 citation statements)

References 28 publications

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“…The most frequent predisposing factor related to infectious keratitis in the current research was corneal trauma, with 14 (46.6%) cases, followed by steroid use, with 6 (20%), and DM, with 3 (10%). This came in agreement with a study conducted by Harbiyeli et al [27], Alekhya et al [28], and Mahmoud et al [29]. On the other hand, other publications showed different results as a study conducted by Gorski et al [30] who found that among 155 patients with microbial keratitis, contact lens wear was (39%) followed by corneal trauma (8%).…”

Section: Discussionsupporting

confidence: 89%

Rapid diagnosis of fungal keratitis in patients with corneal ulcer using Calcofluor White stain

Anwar

Allah²,

Saber³

et al. 2022

Microbes and Infectious Diseases

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Background:The prevalence of fungal keratitis has risen in recent years significantly. To avoid additional complications, diagnosing and treating fungal keratitis is crucial. This study aims to measure the efficacy of a calcofluor white (CFW) stain for the quick diagnosis of fungal keratitis and to contrast the positive rates, sensitivity, and specificity with a 10% potassium hydroxide (KOH)-based smear and culture technique. Methods: From individuals with clinically suspected corneal ulcers, 30 corneal scrapings had been collected. Data on demographics had been analyzed. Results: Of the 30 patients, 40% were women and 60% were men. There was a 1.5:1 man-to-woman ratio. The age of patients ranged from 29 to 71 years (mean 46.67 ± 10.90). The age presentation of those between the ages of 41 and 50 years was the most frequent (36.7%). The majority of cases were farmers (43.3%). Trauma was the most common predisposing factor (46.6%). Twenty-four (80%) cases were culture positive. Eleven (36.7%) were fungal, 13 (43.3%) were bacterial and 6 (20%) showed no growth. Fusarium was the most common fungal isolate (36.4%), followed by Aspergillus (27.3%). While Staphylococcus aureus was the most common bacterial isolate (46.2%), followed by Pseudomonas (38.4%). The sensitivity of KOH wet mount and CFW stain was 72.7% and 90.9%, respectively. The specificity of both KOH wet mount and CFW stain was 100%. Conclusion: The early diagnosis of fungal keratitis can be made rapidly by direct microscopic examination of fungal elements using CFW stain. When diagnosing fungal keratitis, CFW has higher sensitivity to KOH.

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Section: Discussionsupporting

confidence: 89%

Rapid diagnosis of fungal keratitis in patients with corneal ulcer using Calcofluor White stain

Anwar

Allah²,

Saber³

et al. 2022

Microbes and Infectious Diseases

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“…Various studies have reported PMK after collagen crosslinking and refractive surgery or CL use. 5,9,12,13,16,17 However, in the current study, none of the cases were associated with recent surgery or CL use. Previous data from our institute noted male sex and outdoor occupation, especially agriculture and manual labor, along with history of ocular trauma and uncontrolled DM forming a majority among those who presented with microbial keratitis over the decade ranging from 1991 to 2001.…”

Section: Discussioncontrasting

confidence: 62%

“…1 Although monomicrobial keratitis due to fungal and bacterial etiologies is common, mixed infectious or polymicrobial keratitis (PMK) caused by more than one microorganism is relatively rare with an incidence ranging from 1.9% to 15.8%. [2][3][4][5][8][9][10][11][12][13][14] Various combinations of organisms are known to cause mixed infectious keratitis, of which mixed bacterial and fungal etiology is most frequently encountered. 2,3 By definition, PMK does not include secondary infection but represents rapidly occurring simultaneous infections.…”

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confidence: 99%

Clinical and Microbiological Spectra and Therapeutic Outcomes of Polymicrobial Keratitis

Rathi

Ramazanova

Murthy

et al. 2022

Cornea

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The aim of this study was to evaluate the risk factors, microbiology, and treatment outcomes of polymicrobial keratitis (PMK).Methods: We retrospectively analyzed 65 patients diagnosed with PMK between 2016 and 2019. The clinical and microbiological characteristics and outcomes were evaluated. The primary outcome measure was clinical resolution of keratitis. Absolute success (group A) was defined as resolution of infection with medical treatment, qualified success (group B) was resolution with medical therapy and additional minor procedures, and failure (group C) was defined as worsening of infection and presence of corneal melting or perforation requiring therapeutic penetrating keratoplasty or evisceration.Results: Of 4764 cases of microbial keratitis, PMK was identified in 65 eyes of 65 patients (1.36%). Infiltrate was central in 60% (39 eyes). Predisposing factors were higher in group C and included uncontrolled diabetes mellitus in 25% (7/28), history of trauma/foreign body in 57.1% (16/28), and poor presenting visual acuity (0.9 for group A vs. 1.79 for group B vs. 3.00 logarithm of the minimum angle of resolution for group C; P = 0.02). Microbiological profiling revealed that a majority (95%: 62/65) had bacterial with fungal keratitis. High fluoroquinolone resistance was noted (57%; 34/59). Absolute success was achieved in 28.3% (17/60), qualified success in 16.6% (10/60), and treatment failure was noted in 55% (33/60). The final best corrected visual acuity in group A was significantly better than that in group B and C (0.44 vs. 3.00 vs. 2.78; P , 0.001).Conclusions: PMK is extremely rare but responds poorly to medical therapy. Bacterial with fungal etiology is predominant. Early surgical intervention to improve overall outcome is advocated.

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“…Of the remaining 65 patients, 27 (41.5%) had polymicrobial etiology and were reported in a previous study. 9 As a result, 38 cases of fungal keratitis not accompanied by another type of microbial agent were included in this study. The mean age of the patients was 44.9±19.0 years (range: 2-80).…”

Section: Resultsmentioning

confidence: 99%

Clinical and Mycological Features of Fungal Keratitis: A Retrospective Single-Center Study (2012-2018)

Harbiyeli¹,

Erdem²,

Görkemli³

et al. 2022

tjo

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Objectives: To present the demographic, etiological, clinical, and mycological characteristics and treatment results of fungal keratitis patients admitted to our clinic. Materials and Methods: The medical records of patients diagnosed with fungal keratitis between October 2012 and 2018 were reviewed. The diagnosis of fungal keratitis was confirmed mycologically and/or cytologically. Treatment response was defined as complete infiltrate resolution and re-epithelization with medical treatment and minor surgical interventions. Patients who underwent penetrating keratoplasty or evisceration due to clinical deterioration despite treatment were classified as treatment nonresponders and were compared with responders in terms of demographic, etiological, and clinical characteristics. Results: Seventy-two (12.8%) of 559 patients diagnosed with microbial keratitis in the 6-year period were fungal keratitis. Of these, 38 cases (38 eyes) without polymicrobial etiology were included in the study. The patients' mean age was 44.9±19.0 years (range: 2-80) and males predominated (14 females [36.8%], 24 males [63.2%]). Trauma (63.6%) was the most common predisposing factor in patients younger than 40 years old, whereas pathologies impairing ocular surface immunity were the leading risk factor (48.1%) in patients older than 40 years. Filamentous fungi were detected in 34 (89.5%) cases, while yeasts were found in 4 (10.5%) cases. Among 26 cases with positive cultures, Aspergillus species were the most common pathogens (42.3%). Infiltrate size before treatment was larger in nonresponders (14/38, 36.8%) compared to treatment responders (19/38, 50%) (p=0.049). In addition, rates of treatment response were higher in cases in which the infiltrate was located paracentrally compared to other cases (p=0.036). Conclusion: Fungal keratitis is an important public health problem in our region. Ocular trauma is a leading etiology in men under the age of 40 years. In the 6-year period, we observed that the main causes of fungal keratitis were filamentous fungi, and most commonly Aspergillus species. In cases presenting with large and central lesions, aggressive treatment options should be considered and these patients should be followed up more closely.

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Clinical aspects and prognosis of polymicrobial keratitis caused by different microbial combinations: a retrospective comparative case study

Cited by 7 publications

References 28 publications

Rapid diagnosis of fungal keratitis in patients with corneal ulcer using Calcofluor White stain

Rapid diagnosis of fungal keratitis in patients with corneal ulcer using Calcofluor White stain

Clinical and Microbiological Spectra and Therapeutic Outcomes of Polymicrobial Keratitis

Clinical and Mycological Features of Fungal Keratitis: A Retrospective Single-Center Study (2012-2018)

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