Infectious Keratitis in 2021

Durand, Marlene L.; Barshak, Miriam Baron; Chodosh, James

doi:10.1001/jama.2021.0424

Cited by 23 publications

(24 citation statements)

References 9 publications

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“…Bacterial keratitis (BK) is the most common cause of microbial keratitis. 1 It is an ophthalmic emergency requiring immediate attention as it can progress rapidly. 8,9 BK is one of the most common causes of visual impairment in working age adults.…”

Section: Bacterial Keratitismentioning

confidence: 99%

“…In 2010, the estimated incidence of microbial keratitis cases per 100 000 personyear was 130 among CLW versus 14 non-wearers in the United States. 1…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Infectious keratitis can be classified as microbial keratitis (bacteria, fungi or parasites), or viral keratitis (herpes viruses). 1,2 The number of cases of corneal blindness due to infectious keratitis has decreased from about 1.6 million in 1990 to 1.3 million in 2015, [3][4][5][6] and of vision impairment from 3.3 million to 2.9 million cases during the same period, 4 despite these data being underreported. Infectious keratitis is the most common cause of nontrachomatous corneal opacification and the fifth leading cause of blindness overall causing 3.5% (36 million) of all blind individuals up to 2015.…”

Section: Introductionmentioning

confidence: 99%

“…2,3,6 In the United States, infectious keratitis is responsible for about 1 million visits to health professionals and 58 000 to emergency departments annually costing the US health system 175 million dollars in direct health expenditure. 1,2 The real burden of the disease worldwide is difficult to ascertain; however, poor rural and agricultural populations are likely to be disproportionately affected. 2…”

Section: Introductionmentioning

confidence: 99%

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Infectious keratitis: A review

Cabrera‐Aguas

Khoo

Watson

2022

Clinical Exper Ophthalmology

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Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface disease. Staphylococcus species, Pseudomonas aeruginosa, Fusarium species, Candida species and Acanthamoeba species are the most common causal organisms. Culture of corneal scrapes is the preferred initial test to identify the culprit organism. Polymerase chain reaction (PCR) tests and in vivo confocal microscopy can complement the diagnosis. Empiric therapy is typically commenced with fluoroquinolones, or fortified antibiotics for bacterial keratitis; topical natamycin for fungal keratitis; and polyhexamethylene biguanide or chlorhexidine for acanthamoeba keratitis. Herpes simplex keratitis is mainly diagnosed clinically; however, PCR can also be used to confirm the initial diagnosis and in atypical cases. Antivirals and topical corticosteroids are indicated depending on the corneal layer infected. Vision impairment, blindness and even loss of the eye can occur with a delay in diagnosis and inappropriate antimicrobial therapy.

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Section: Bacterial Keratitismentioning

confidence: 99%

“…In 2010, the estimated incidence of microbial keratitis cases per 100 000 personyear was 130 among CLW versus 14 non-wearers in the United States. 1…”

Section: Predisposing Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Infectious keratitis: A review

Cabrera‐Aguas

Khoo

Watson

2022

Clinical Exper Ophthalmology

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“…Microbes live on/inside our body and play key roles in human physiology turbulence, and immune disorders [ 1 ]. Fungal keratitis (FK), one of the most detrimental ocular diseases caused by a fungal infection, loomed so large to be a key health issue of great importance [ 2 , 3 ]. There are at least 100,000 known species of fungi.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Galectin-3 Impairs Antifungal Immune Response in Fungal Keratitis

Xiao

Yang

et al. 2022

Disease Markers

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Galectin-3 is one of the galectin family members which are master regulators of immune homeostasis, especially in infectious diseases. However, its mechanism of immune regulation in fungal keratitis has not been thoroughly studied. Our study is aimed at clarifying the role of galectin-3 in the fungal keratitis mouse model in vivo, thereby providing a new biomarker of antifungal therapy. In our study, aspergillus, the most common pathogenic fungi of fungal keratitis, was identified and isolated by corneal tissue fungus culture. Then, the RNA expression levels of galectin family members in corneas of the mouse model with aspergillus fumigatus keratitis were screened by transcriptome sequencing (RNA-seq). The expression of the galectin-3 was detected by quantitative real-time Polymerase Chain Reaction (qPCR), enzyme-linked immunosorbent assay (ELISA), and immunofluorescence in the corneal tissue of the fungal keratitis mouse model. Recruitment of neutrophils and the co-immunofluorescence of galectin-3 and related markers in corneal tissue were determined by flow cytometry analysis and immunofluorescence staining. The regulatory role of galectin-3 for proinflammatory cytokines and neutrophils was validated by the knockout mouse model. Galectin-3 knockout deteriorated the condition for the inhibition of galectin-3 was benefecial for fungi to survive and thrive in corneal lesions. These results demonstrated that in the ocular fungal infection, galectin-3 is capable of regulating the pathogenesis of fungal keratitis by modulating neutrophil recruitment. The deterioration of fungal keratitis and increased fungal load in corneal lesions of galectin-3 knockout mice proved the regulatory role of galectin-3 in fungal keratitis. In conclusion, galectin-3 is going to be an essential target to modulate neutrophil recruitment and its related antifungal immune response in fungal keratitis.

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Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection?

Johnson

Liu

Simel

2022

JAMA

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IMPORTANCE Acute infectious conjunctivitis is characterized by ocular redness and discharge, and is a common clinical entity. Evidence-based tools to aid the clinical diagnosis of viral vs bacterial conjunctivitis are lacking and may contribute to overprescribing of topical antibiotics.OBJECTIVE To determine the relative prevalence of viral vs bacterial conjunctivitis in adults and children, and to determine which symptoms or signs are suggestive of a viral vs bacterial etiology.DATA SOURCES A MEDLINE search (January 1946-March 2022) yielded 1891 articles. Included articles were rated using a quality score based on a modified Rational Clinical Examination grading system. Methodological quality levels 1 through 4 required a microbiological reference standard for diagnosis, whereas quality level 5 (the lowest quality) used a clinical reference standard for diagnosis.STUDY SELECTION Consecutive series of patients presenting with acute infectious conjunctivitis and case series of viral or bacterial conjunctivitis alone. Thirty-two studies were included in a meta-analysis to determine prevalence and diagnostic accuracy measures; 27 used a microbiological reference standard for diagnosis and 5 used a clinical reference standard for diagnosis. RESULTSIn studies involving children (5 studies; 881 patients; mean age, 4.7 years [age range, 1 month-18 years]), the prevalence of bacterial conjunctivitis was higher than viral conjunctivitis (71% vs 16%, respectively, P = .01). In the only study of adults (n = 207 patients; mean age, 25.7 years), the prevalence of viral conjunctivitis was higher than bacterial conjunctivitis (78% vs 16%, respectively, P < .001). For the primary analysis of level 1 (n = 6) and level 2 (n = 5) studies (1725 patients total), the clinical findings that best distinguished a viral etiology for conjunctivitis from a bacterial etiology included pharyngitis (sensitivity range, 0.55-0.58; specificity range, 0.89-0.94; positive likelihood ratio [LR] range, 5.4-9.9), preauricular lymphadenopathy (sensitivity range, 0.17-0.31; specificity range, 0.93-0.94; positive LR range, 2.5-5.6), and contact with another person with red eye (

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Infectious Keratitis in 2021

Abstract: This JAMA Insights summarizes the prevalence of keratitis and its association with improper use of contact lenses; and summarizes the types, pathology, diagnosis, and treatment of keratitis.

Cited by 23 publications

References 9 publications

Infectious keratitis: A review

Infectious keratitis: A review

Inhibition of Galectin-3 Impairs Antifungal Immune Response in Fungal Keratitis

Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection?

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