Sharma Savitri
L.V. Prasad Eye Institute, Laboratory Services, LVPEI-Network , Patia, Bhubaneswar-751024, Odisha , India +91 674 3987129 ; +91 674 3987130 ;
Expert Opin Med Diagn. 2012 Sep;6(5):449-55. doi: 10.1517/17530059.2012.679656. Epub 2012 Apr 16.
Fungal keratitis is prevalent in tropical regions of the world and is being increasingly recognized as an important cause of ocular morbidity. Early diagnosis and appropriate treatment are essential to avoid blindness. Clinical impression is often suggestive but clinical features may vary considerably and no one clinical feature may be pathognomonic of fungal infection.
This review describes a combination of methods for the diagnosis of fungal keratitis. Both in vivo and in vitro techniques are described along with their advantages and limitations. In vivo confocal microscopy has made it easier for ophthalmologists to back up their clinical suspicion. In vitro methods include microscopy and culture for fungi. A wide range of conventional and molecular techniques are currently available that provide rapid diagnosis of fungal keratitis.
Owing to the sensitivity and specificity of over 80%, when available, confocal microscopy could be useful for the diagnosis of fungal keratitis in the clinic. Among the laboratory techniques, a 10% potassium hydroxide wet mount or Gram stain are simple and sensitive enough to be adopted as office methods by ophthalmologists to rule out fungal etiology in patients with microbial keratitis. Empiric antifungal therapy is discouraged and confirmation of the diagnosis prior to institution of treatment is recommended.
真菌性角膜炎在世界热带地区普遍存在，并且越来越被认为是眼部发病的重要原因。早期诊断和恰当治疗对于避免失明至关重要。临床印象常常具有提示作用，但临床特征可能差异很大，且没有任何一个临床特征对于真菌感染具有确诊意义。
本综述描述了诊断真菌性角膜炎的多种方法组合。介绍了体内和体外技术及其优缺点。体内共聚焦显微镜使眼科医生更容易支持其临床怀疑。体外方法包括真菌的显微镜检查和培养。目前有多种传统和分子技术可用于快速诊断真菌性角膜炎。
由于共聚焦显微镜的敏感性和特异性超过80%，在可行时，其可用于临床诊断真菌性角膜炎。在实验室技术中，10%氢氧化钾湿片或革兰氏染色简单且足够敏感，可被眼科医生用作门诊方法以排除微生物性角膜炎患者的真菌病因。不鼓励经验性抗真菌治疗，建议在开始治疗前确诊。
