Ovodenko Boris, Seedor John A, Ritterband David C, Shah Mahendra, Yang Renee, Koplin Richard S
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY 10003, USA.
Cornea. 2009 Jan;28(1):36-9. doi: 10.1097/ICO.0b013e3181839b1a.
To study the prevalence, pathogenicity, and virulence of Propionibacterium acnes keratitis.
All cases of infectious keratitis submitted to the microbiologic laboratory of the New York Eye and Ear Infirmary between January 1, 2003, and April 6, 2006, were reviewed. Those cases in which P. acnes was recovered from culture were collected, and the medical records studied in depth.
Of 1555 cultures submitted to the microbiology laboratory, 1329 (85.5%) were positive for growth. One hundred twenty four (9.3%) of the 1329 cases yielded P. acnes in at least 1 culture medium. Seventy eight (62.9%) of 124 cases had not been pretreated with antibiotics before culture, and 66.7% of the nonpretreated ulcers were monomicrobial (P. acnes only). Fifty one (65.4%) of 78 cases of the nonpretreated corneal ulcers presented with a cellular reaction in anterior chamber, 12 (15.4%) with a hypopyon (6 were monomicrobial), 21 (26.9%) had stromal thinning (12 of which were monomicrobial), and 2 (2.6%) progressed to perforation (both polymicrobial). Corneal ulcers associated with P. acnes tended to be small (66.7%) and were widely distributed: central (n = 17, 21.8%), paracentral (n = 44, 56.4%), and peripheral (n = 17, 21.8%). The most common risk factors were contact lens wear and previous history of ocular surgery. Three of the 78 nonpretreated patients were unresponsive to medical treatment and required surgery for keratitis.
This study provides evidence that P. acnes is a frequent cause of bacterial keratitis and may cause significant morbidity.
研究痤疮丙酸杆菌性角膜炎的患病率、致病性和毒力。
回顾了2003年1月1日至2006年4月6日期间送至纽约眼耳医院微生物实验室的所有感染性角膜炎病例。收集那些从培养物中分离出痤疮丙酸杆菌的病例，并对病历进行深入研究。
在送至微生物实验室的1555份培养物中，1329份（85.5%）生长阳性。1329例病例中有124例（9.3%）在至少一种培养基中培养出痤疮丙酸杆菌。124例病例中的78例（62.9%）在培养前未接受过抗生素预处理，未预处理溃疡中有66.7%为单一微生物感染（仅痤疮丙酸杆菌）。78例未预处理角膜溃疡病例中有51例（65.4%）前房出现细胞反应，12例（15.4%）出现前房积脓（6例为单一微生物感染），21例（26.9%）有基质变薄（其中12例为单一微生物感染），2例（2.6%）进展为穿孔（均为混合微生物感染）。与痤疮丙酸杆菌相关的角膜溃疡往往较小（66.7%）且分布广泛：中央（n = 17，21.8%）、旁中央（n = 44，56.4%）和周边（n = 17，21.8%）。最常见的危险因素是佩戴隐形眼镜和既往眼部手术史。78例未预处理患者中有3例药物治疗无效，需要进行角膜炎手术。
本研究提供了证据表明痤疮丙酸杆菌是细菌性角膜炎的常见病因，且可能导致严重的发病情况。
