Galarreta David J, Tuft Stephen J, Ramsay Andrew, Dart John K G
Moorfields Eye Hospital, London, UK.
Cornea. 2007 Oct;26(9):1082-6. doi: 10.1097/ICO.0b013e318142bff3.
To review cases of culture-positive fungal keratitis seen at Moorfields Eye Hospital over a 13-year period to January 2007.
Isolates were identified retrospectively from laboratory reports. The clinical records were reviewed. The fungal type, risk factors for infection, in vitro sensitivity, and clinical outcome were recorded.
There were 66 isolates from 65 patients (men, 53.8%). Forty (60.6%) of the isolates were subspecies of Candida. The average interval from the onset of keratitis to confirmation of fungal infection was 3.4 weeks (median, 1.0 week; range, 0-16 weeks). Prior ocular surface disease (OSD) or a penetrating keratoplasty (PK) was present in 38 (97.4%) patients with Candida infection, and 29 (74.4%) patients with Candida infection were using topical steroid at the time of diagnosis. The principal risk factors for filamentary fungal infection were trauma (8 cases, 30.8%) or cosmetic contact lens wear (8 cases, 30.8%), with OSD or a prior PK each present in 5 (19.2%) cases. The difference in the proportions of risk factors between the 2 fungal groups was statistically significant (P < 0.000). The visual outcome was similar between groups, and at final review, 27 (41.5%) eyes had a visual acuity of < or = 1/60 and 3 (4.6%) eyes were eviscerated. In vitro sensitivity testing showed full or part sensitivity in 100% of 55 isolates tested against econazole, 87.9% of 58 isolates tested against amphotericin, 75% of 40 isolates tested against itraconazole, and 100% of 20 isolates tested against voriconazole.
Candida was the principal isolate, usually from eyes with OSD or a prior PK treated with topical steroids.
回顾截至2007年1月的13年间在摩尔菲尔德眼科医院确诊的培养阳性真菌性角膜炎病例。
从实验室报告中回顾性鉴定分离菌株。查阅临床记录。记录真菌类型、感染危险因素、体外药敏情况及临床转归。
65例患者中共分离出66株菌株（男性占53.8%）。40株（60.6%）分离菌株为念珠菌亚种。从角膜炎发作至确诊真菌感染的平均间隔时间为3.4周（中位数为1.0周；范围为0 - 16周）。38例（97.4%）念珠菌感染患者存在既往眼表疾病（OSD）或穿透性角膜移植术（PK），29例（74.4%）念珠菌感染患者在诊断时正在使用局部类固醇药物。丝状真菌感染的主要危险因素为外伤（8例，30.8%）或使用美容隐形眼镜（8例，30.8%），各有5例（19.2%）存在OSD或既往PK。两组真菌危险因素比例差异有统计学意义（P < 0.000）。两组的视力转归相似，末次复查时，27只眼（41.5%）视力≤1/60，3只眼（4.6%）已行眼球摘除术。体外药敏试验显示，55株测试菌株中有100%对益康唑完全或部分敏感，58株测试菌株中有87.9%对两性霉素敏感，40株测试菌株中有75%对伊曲康唑敏感，20株测试菌株中有100%对伏立康唑敏感。
念珠菌是主要分离菌株，通常来自接受局部类固醇治疗的OSD或既往PK患者的眼睛。
