Dunlop A A, Wright E D, Howlader S A, Nazrul I, Husain R, McClellan K, Billson F A
Department of Ophthalmology, Torbay Hospital, Lawes Bridge, Torquay, UK.
Aust N Z J Ophthalmol. 1994 May;22(2):105-10. doi: 10.1111/j.1442-9071.1994.tb00775.x.
Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.
化脓性角膜炎是一种重要的可预防致盲原因，在发展中国家尤为如此。本研究分析了转诊至孟加拉国吉大港眼科医院的142例化脓性角膜炎病例。约53.5%的病例为细菌性，35.9%为真菌性。五种最常见的病原体为：铜绿假单胞菌24%、肺炎链球菌17%、曲霉菌13%、镰刀菌7%和弯孢菌6%。革兰氏染色和培养结果在62.6%的病例中一致。先前的抗生素治疗是培养分离失败的一个重要因素，对革兰氏染色失败的影响较小。在革兰氏染色中，55.9%的铜绿假单胞菌病例被漏诊，但真菌病例仅2%被漏诊。总体而言，革兰氏染色对细菌性病例的敏感性为62%，阳性预测值为84%，对真菌性病例的敏感性和阳性预测值分别为98%和94%。真菌性溃疡通常为丝状，但外伤史并不常见。最常见的损伤是由米粒引起的，但接种物似乎是在使用受污染水冲洗眼睛时引入的。铜绿假单胞菌溃疡最常发生在季风季节，镰刀菌病例仅在炎热干燥季节出现。
