PURPOSE: The purpose of this study was to determine whether clinical signs of infectious keratitis can be used to identify the causative organism. METHODS:Eighty photographs of eyes with culture-proven bacterial keratitis or smear-proven fungal keratitis were randomly selected from 2 clinical trials. Fifteen cornea specialists from the F. I. Proctor Foundation and the Aravind Eye Care System assessed the photographs for prespecified clinical signs of keratitis, and they identified the most likely causative organism. RESULTS: Clinicians were able to correctly distinguish bacterial from fungal etiology 66% of the time (P < 0.001). The Gram stain, genus, and species were accurately predicted 46%, 25%, and 10% of the time, respectively. The presence of an irregular/feathery border was associated with fungal keratitis, whereas a wreath infiltrate or an epithelial plaque was associated with bacterial keratitis. CONCLUSIONS: Cornea specialists correctly differentiated bacterial from fungal keratitis more often than chance, but in fewer than 70% of cases. More specific categorization led to less successful clinical distinction. Although certain clinical signs of infectious keratitis may be associated with a bacterial or fungal etiology, this study highlights the importance of obtaining appropriate microbiological testing during the initial clinical encounter.
RCT Entities:
PURPOSE: The purpose of this study was to determine whether clinical signs of infectious keratitis can be used to identify the causative organism. METHODS: Eighty photographs of eyes with culture-proven bacterial keratitis or smear-proven fungal keratitis were randomly selected from 2 clinical trials. Fifteen cornea specialists from the F. I. Proctor Foundation and the Aravind Eye Care System assessed the photographs for prespecified clinical signs of keratitis, and they identified the most likely causative organism. RESULTS: Clinicians were able to correctly distinguish bacterial from fungal etiology 66% of the time (P < 0.001). The Gram stain, genus, and species were accurately predicted 46%, 25%, and 10% of the time, respectively. The presence of an irregular/feathery border was associated with fungal keratitis, whereas a wreath infiltrate or an epithelial plaque was associated with bacterial keratitis. CONCLUSIONS: Cornea specialists correctly differentiated bacterial from fungal keratitis more often than chance, but in fewer than 70% of cases. More specific categorization led to less successful clinical distinction. Although certain clinical signs of infectious keratitis may be associated with a bacterial or fungal etiology, this study highlights the importance of obtaining appropriate microbiological testing during the initial clinical encounter.
Authors: Lisa Keay; Katie Edwards; Thomas Naduvilath; Hugh R Taylor; Grant R Snibson; Kevin Forde; Fiona Stapleton Journal: Ophthalmology Date: 2005-12-19 Impact factor: 12.079
Authors: M Srinivasan; C A Gonzales; C George; V Cevallos; J M Mascarenhas; B Asokan; J Wilkins; G Smolin; J P Whitcher Journal: Br J Ophthalmol Date: 1997-11 Impact factor: 4.638
Authors: Gita Varaprasathan; Kevin Miller; Thomas Lietman; John P Whitcher; Vicky Cevallos; Masao Okumoto; Todd P Margolis; Miao Yinghui; Emmett T Cunningham Journal: Cornea Date: 2004-05 Impact factor: 2.651
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: Martin M Nentwich; M Bordón; D Sánchez di Martino; A Ruiz Campuzano; W Martínez Torres; F Laspina; S Lichi; M Samudio; N Farina; Rosa R Sanabria; Herminia Mino de Kaspar Journal: Int Ophthalmol Date: 2014-05-01 Impact factor: 2.031
Authors: Travis K Redd; N Venkatesh Prajna; Muthiah Srinivasan; Prajna Lalitha; Tiru Krishnan; Revathi Rajaraman; Anitha Venugopal; Brandon Lujan; Nisha Acharya; Gerami D Seitzman; Jennifer Rose-Nussbaumer; Thomas M Lietman; J Peter Campbell; Jeremy D Keenan Journal: Ophthalmology Date: 2021-10-06 Impact factor: 12.079
Authors: Christopher Donovan; Eduardo Arenas; Ramesh S Ayyala; Curtis E Margo; Edgar M Espana Journal: Surv Ophthalmol Date: 2021-08-20 Impact factor: 6.197