Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Department Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2023 Feb;71(2):510-514. doi: 10.4103/ijo.IJO_913_22.
To evaluate the knowledge and skills of clinicians in differentiating cases of Pythium from fungal keratitis based on their clinical appearance.
Thirty slit-lamp photographs from culture-proven cases of Pythium and fungal keratitis were selected for conducting a prospective online-based photographic survey. The participants were asked to identify the causative organism and enlist the specific clinical features which helped in reaching the diagnosis. Both cornea specialists and clinical fellows/trainees participated in the survey. Sensitivity, specificity, and predictive values were estimated, and the factors associated with these, including the identification rates of clinical signs, were evaluated using bivariate and multivariate linear regression analyses. The identification rates between the consultants and fellows were compared.
A total of 42 cornea specialists (28 consultants and 14 clinical fellows) participated in the survey. Clinicians were able to differentiate Pythium from fungal etiology in only 56% of cases. The differentiating ability between the consultants and fellows was statistically insignificant. Average sensitivity, specificity, and positive and negative predictive values for differentiating Pythium from fungus were 56%, 65%, 56%, and 66%, respectively. The specific clinical features enlisted by the participants to differentiate Pythium from fungus were the presence of tentacles, peripheral guttering, dot-like infiltrates, and elevated plaques.
Clinical knowledge regarding the signs and symptoms and the microbiological identification of features for Pythium are still lacking among clinicians. As the treatment protocols are distinctly different for both, it is imperative to enhance the knowledge and diagnosing ability to tackle this emerging microorganism which causes high morbidity.
评估临床医生基于临床表现区分嗜热真菌与真菌性角膜炎病例的知识和技能。
选择 30 张经培养证实为嗜热真菌和真菌性角膜炎的裂隙灯照片，进行前瞻性在线摄影调查。要求参与者识别致病生物，并列出有助于诊断的具体临床特征。角膜专家和临床研究员/学员都参与了这项调查。估计了敏感性、特异性和预测值，并使用双变量和多变量线性回归分析评估了与这些因素相关的因素，包括临床体征的识别率。比较了顾问和研究员之间的识别率。
共有 42 名角膜专家（28 名顾问和 14 名临床研究员）参与了调查。临床医生仅能在 56%的病例中区分嗜热真菌与真菌病因。顾问和研究员之间的鉴别能力无统计学意义。鉴别嗜热真菌与真菌的平均敏感性、特异性、阳性和阴性预测值分别为 56%、65%、56%和 66%。参与者列出的用于区分嗜热真菌与真菌的具体临床特征是存在触须、周边沟槽、点状浸润和隆起斑块。
临床医生在嗜热真菌的体征和症状以及微生物学特征识别方面的知识仍然缺乏。由于两者的治疗方案明显不同，因此必须提高知识和诊断能力，以应对这种引起高发病率的新兴微生物。
