P A Thomas1, A K Leck, M Myatt. 1. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Abstract
AIM: To assess whether the presence of characteristic clinical features can be used as a diagnostic aid for suppurative keratitis caused by filamentous fungi. METHODS: Patients presenting with suppurative keratitis in India underwent detailed clinical examination followed by microbiological investigation of corneal scrapes. A partial diagnostic score based upon the strength of the association, as estimated by the odds ratio, between reported clinical features and laboratory confirmed diagnoses was devised and subsequently tested using a case series from Ghana. RESULTS: Serrated margins, raised slough, dry texture, satellite lesions and coloration other than yellow occurred more frequently in cases of filamentous fungal keratitis than bacterial keratitis (p<0.05). Hypopyon and fibrinous exudate were observed more frequently in bacterial keratitis (p<0.05). When incorporated into a backwards stepwise logisitic regression model only serrated margins, raised slough, and colour were independently associated with fungal keratitis; these features were used in the scoring system. The probability of fungal infection if one clinical feature was present was 63%, increasing to 83% if all three features were present. CONCLUSIONS: Microbiological investigations should be performed whenever possible; however, where facilities are not available, a rapid presumptive diagnosis of suppurative keratitis may be possible by scoring clinical features.
AIM: To assess whether the presence of characteristic clinical features can be used as a diagnostic aid for suppurative keratitis caused by filamentous fungi. METHODS:Patients presenting with suppurative keratitis in India underwent detailed clinical examination followed by microbiological investigation of corneal scrapes. A partial diagnostic score based upon the strength of the association, as estimated by the odds ratio, between reported clinical features and laboratory confirmed diagnoses was devised and subsequently tested using a case series from Ghana. RESULTS: Serrated margins, raised slough, dry texture, satellite lesions and coloration other than yellow occurred more frequently in cases of filamentous fungal keratitis than bacterial keratitis (p<0.05). Hypopyon and fibrinous exudate were observed more frequently in bacterial keratitis (p<0.05). When incorporated into a backwards stepwise logisitic regression model only serrated margins, raised slough, and colour were independently associated with fungal keratitis; these features were used in the scoring system. The probability of fungal infection if one clinical feature was present was 63%, increasing to 83% if all three features were present. CONCLUSIONS: Microbiological investigations should be performed whenever possible; however, where facilities are not available, a rapid presumptive diagnosis of suppurative keratitis may be possible by scoring clinical features.
Authors: A K Leck; P A Thomas; M Hagan; J Kaliamurthy; E Ackuaku; M John; M J Newman; F S Codjoe; J A Opintan; C M Kalavathy; V Essuman; C A N Jesudasan; G J Johnson Journal: Br J Ophthalmol Date: 2002-11 Impact factor: 4.638
Authors: Jeena Mascarenhas; Prajna Lalitha; N Venkatesh Prajna; Muthiah Srinivasan; Manoranjan Das; Sean S D'Silva; Catherine E Oldenburg; Durga S Borkar; Elizabeth J Esterberg; Thomas M Lietman; Jeremy D Keenan Journal: Am J Ophthalmol Date: 2013-11-05 Impact factor: 5.258
Authors: Cyril Dalmon; Travis C Porco; Thomas M Lietman; N Venkatesh Prajna; Lalitha Prajna; Mano Ranjan Das; J Arun Kumar; Jeena Mascarenhas; Todd P Margolis; John P Whitcher; Bennie H Jeng; Jeremy D Keenan; Matilda F Chan; Stephen D McLeod; Nisha R Acharya Journal: Invest Ophthalmol Vis Sci Date: 2012-04-02 Impact factor: 4.799