Thomas P A, Leck A K, Myatt M
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Br J Ophthalmol. 2005 Dec;89(12):1554-8. doi: 10.1136/bjo.2005.076315.
To assess whether the presence of characteristic clinical features can be used as a diagnostic aid for suppurative keratitis caused by filamentous fungi.
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.
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.
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.
评估特征性临床特征是否可作为丝状真菌性化脓性角膜炎的诊断辅助依据。
印度出现化脓性角膜炎的患者接受了详细的临床检查，随后对角膜刮片进行微生物学调查。根据优势比估计的报告临床特征与实验室确诊诊断之间的关联强度，设计了一个部分诊断评分，随后使用来自加纳的病例系列进行测试。
丝状真菌性角膜炎病例中，锯齿状边缘、隆起的腐肉、质地干燥、卫星病灶以及非黄色的色素沉着比细菌性角膜炎更常见（p<0.05）。前房积脓和纤维素性渗出物在细菌性角膜炎中更常见（p<0.05）。当纳入向后逐步逻辑回归模型时，只有锯齿状边缘、隆起的腐肉和颜色与真菌性角膜炎独立相关；这些特征被用于评分系统。如果存在一种临床特征，真菌感染的概率为63%，如果三种特征都存在，则增加到83%。
只要有可能，就应进行微生物学调查；然而，在没有相关设施的情况下，通过对临床特征进行评分，可能对化脓性角膜炎做出快速的初步诊断。
