Ibrahim Marlon Moraes, Vanini Rafael, Ibrahim Fuad Moraes, Martins Wellington de Paula, Carvalho Rodrigo Teixeira de Campos, Castro Rosane Silvestre de, Rocha Eduardo Melani
Department of Ophthalmology, Ribeirão Preto Medical School, São Paulo University, Avenida Bandeirantes 3900, Ribeirão Preto, SP, Brazil.
Arq Bras Oftalmol. 2011 Jan-Feb;74(1):7-12. doi: 10.1590/s0004-27492011000100002.
The goals of the study were the following: 1) to show the epidemiology of microbial keratitis (MK) in the southeast Brazil, 2) to compare the epidemiological differences between fungal (FK) and bacterial keratitis (BK), and 3) to evaluate the frequency which ophthalmologists accurately differentiate bacterial keratitis from fungal keratitis based on clinical diagnosis.
A retrospective chart analysis of all clinically diagnosed microbial keratitis patients presenting between October, 2003 and September, 2006 was performed. Demographic features, ocular and laboratory findings, and information regarding the risk factors and clinical evolution were recorded.
Among 118 consecutive patients with a clinical diagnosis of microbial keratitis, the positive culture rate was 61%. The predominant bacterial and fungal pathogens isolated were S. epidermidis and Fusarium spp. Prior corneal injury was more frequent among fungal keratitis than bacterial keratitis cases (p<0.0001). Coexisting systemic diseases, ocular diseases, and previous ocular surgery were more frequent among BK cases (p=0.001; p=0.001; p=0.004; respectively). The following clinical findings were more frequent in bacterial keratitis: hypopion, corneal peripheral superficial vascularisation, and ulceration area >20 mm² (p<0.05). The diagnosis was predicted correctly in 81.6% of bacterial keratitis cases and in 48.1% of fungal keratitis cases.
Medical judgment of microbial keratitis agent is possible based on clinical and epidemiological data, but it is more difficult for fungal infection. Thus, such data cannot be the only basis for the diagnosis of suspected microbial keratitis, but oriented clinical suspicion based on these data may be beneficial for guiding antimicrobial treatment and earlier therapy.
本研究的目标如下：1）展示巴西东南部微生物性角膜炎（MK）的流行病学情况；2）比较真菌性角膜炎（FK）和细菌性角膜炎（BK）的流行病学差异；3）评估眼科医生根据临床诊断准确区分细菌性角膜炎和真菌性角膜炎的频率。
对2003年10月至2006年9月期间所有临床诊断为微生物性角膜炎的患者进行回顾性病历分析。记录人口统计学特征、眼部和实验室检查结果以及有关危险因素和临床病程的信息。
在118例临床诊断为微生物性角膜炎的连续患者中，培养阳性率为61%。分离出的主要细菌和真菌病原体分别是表皮葡萄球菌和镰刀菌属。真菌性角膜炎患者先前角膜损伤的发生率高于细菌性角膜炎患者（p<0.0001）。BK病例中并存的全身性疾病、眼部疾病和既往眼部手术更为常见（分别为p=0.001；p=0.001；p=0.004）。以下临床发现在细菌性角膜炎中更为常见：前房积脓、角膜周边浅层血管化和溃疡面积>20mm²（p<0.05）。81.6%的细菌性角膜炎病例和48.1%的真菌性角膜炎病例诊断正确。
基于临床和流行病学数据对微生物性角膜炎病原体进行医学判断是可行的，但对于真菌感染来说更困难。因此，这些数据不能作为疑似微生物性角膜炎诊断的唯一依据，但基于这些数据进行有针对性的临床怀疑可能有助于指导抗菌治疗和早期治疗。
