Badiee Parisa, Alborzi Abdolvahab, Nejabat Mahmood
Prof. Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Zand Ave, Nemazi Hospital, 7193711351, Shiraz, Iran.
Int Ophthalmol. 2011 Aug;31(4):291-6. doi: 10.1007/s10792-011-9457-5. Epub 2011 Jul 13.
The incidence of fungal keratitis has increased in recent years. Since accurate and rapid diagnosis is important for the proper management of this infection, we evaluated the use of nested PCR to detect Aspergillus-specific DNA in corneal scrapings for the diagnosis of Aspergillus keratitis. From April 2005 to September 2008, patients with eye findings suspicious for fungal keratitis were enrolled for corneal sampling. After ocular examination, we carried out laboratory testing including direct microscopy and culture examination of corneal scrapings, nested PCR and histopathological examination of the corneal tissues obtained at surgery. Of the 57 infected eyes suspicious for fungal keratitis, 32 (56.14%) were reported as Aspergillus keratitis by PCR assay, from which 12 (37.5%) were positive in culture and direct smear for Aspergillus keratitis, and 20 (62.5%) had clinical signs of fungal keratitis (probable). All PCR-positive cases were judged to have fungal infections, based on their responses to the antifungal treatment. The use of molecular methods in high-risk patients can be helpful in diagnosis of fungal infections and can have important public health implications for both the treatment and prevention of suppurative corneal ulcerations. The significance of this study lies in the analysis of the proven cases in terms of both laboratory findings and responses to the treatment.
近年来，真菌性角膜炎的发病率有所上升。由于准确快速的诊断对于该感染的恰当管理至关重要，我们评估了使用巢式聚合酶链反应（nested PCR）检测角膜刮片中曲霉菌特异性DNA以诊断曲霉菌性角膜炎的情况。2005年4月至2008年9月，将有疑似真菌性角膜炎眼部表现的患者纳入角膜采样。眼部检查后，我们进行了实验室检测，包括角膜刮片的直接显微镜检查和培养检查、巢式PCR以及手术获取的角膜组织的组织病理学检查。在57只疑似真菌性角膜炎的感染眼中，PCR检测报告32只（56.14%）为曲霉菌性角膜炎，其中12只（37.5%）曲霉菌性角膜炎培养和直接涂片呈阳性，20只（62.5%）有真菌性角膜炎的临床体征（可能）。所有PCR阳性病例根据其对抗真菌治疗的反应判断为有真菌感染。在高危患者中使用分子方法有助于真菌感染的诊断，并且对化脓性角膜溃疡的治疗和预防可能具有重要的公共卫生意义。本研究的意义在于从实验室检查结果和治疗反应两方面对确诊病例进行分析。
