Merle Fernandes1, Divya Vira2, Mrinmoy Dey2, Tanuja Tanzin2, Nagendra Kumar3, Savitri Sharma4. 1. Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India. Electronic address: merle@lvpei.org. 2. Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India. 3. Ocular Microbiology Service, L. V. Prasad Eye Institute, Visakhapatnam, India. 4. Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Hyderabad, India.
Abstract
PURPOSE: To compare the clinical features, risk factors, and outcome of polymicrobial keratitis with monomicrobial keratitis due to fungus. DESIGN: Retrospective, comparative interventional case series. METHODS: Consecutive cases of microbial keratitis with significant growth of more than 1 organism in culture and culture-proven fungal keratitis treated with natamycin alone were retrieved from the microbiology department. Complete success was defined as resolution of the infiltrate with scar formation on medical treatment, partial success as resolution following tissue adhesive application, and failure as inadequate response to medical therapy with increasing infiltrate size, corneal melting, and/or perforation necessitating therapeutic penetrating keratoplasty (PKP) or evisceration. RESULTS: There were 34 eyes of 34 patients with polymicrobial keratitis and 60 cases of fungal keratitis. Compared to patients with fungal keratitis, patients with polymicrobial keratitis were significantly older (50.03 ± 9.81 years vs 42.79 ± 12.15 years, P = .0038), with larger infiltrates at presentation (61.8% vs 24.1%, P = .0007), a higher association with endophthalmitis (11.8% vs 0%, P = .03), previous history of corneal graft (20.6% vs 0%, P = .0012), and prior topical corticosteroid use (23.5% vs 5%, P = .019). In the polymicrobial group, a combination of bacteria and fungus was more frequently isolated (23, 67.6%), among which filamentous fungi (25, 39.1%) and coagulase-negative staphylococci (14, 21.9%) comprised a majority. Complete success was significantly lower in the polymicrobial group compared to the fungal keratitis group (39.3% vs 73.7%, P = .0045). In multivariate logistic regression analysis comparing factors affecting the outcome between the 2 groups, older age (P = .027) and ulcers larger than 6 mm (P = .001) at presentation adversely affected outcome. CONCLUSIONS: Polymicrobial keratitis with fungus and bacteria was more common and more challenging to treat, with a poorer outcome than fungal keratitis. Medical treatment may be effective; however, therapeutic PKP provided globe salvage at best. Early PKP may be advocated for larger ulcers at presentation.
PURPOSE: To compare the clinical features, risk factors, and outcome of polymicrobial keratitis with monomicrobial keratitis due to fungus. DESIGN: Retrospective, comparative interventional case series. METHODS: Consecutive cases of microbial keratitis with significant growth of more than 1 organism in culture and culture-proven fungal keratitis treated with natamycin alone were retrieved from the microbiology department. Complete success was defined as resolution of the infiltrate with scar formation on medical treatment, partial success as resolution following tissue adhesive application, and failure as inadequate response to medical therapy with increasing infiltrate size, corneal melting, and/or perforation necessitating therapeutic penetrating keratoplasty (PKP) or evisceration. RESULTS: There were 34 eyes of 34 patients with polymicrobial keratitis and 60 cases of fungal keratitis. Compared to patients with fungal keratitis, patients with polymicrobial keratitis were significantly older (50.03 ± 9.81 years vs 42.79 ± 12.15 years, P = .0038), with larger infiltrates at presentation (61.8% vs 24.1%, P = .0007), a higher association with endophthalmitis (11.8% vs 0%, P = .03), previous history of corneal graft (20.6% vs 0%, P = .0012), and prior topical corticosteroid use (23.5% vs 5%, P = .019). In the polymicrobial group, a combination of bacteria and fungus was more frequently isolated (23, 67.6%), among which filamentous fungi (25, 39.1%) and coagulase-negative staphylococci (14, 21.9%) comprised a majority. Complete success was significantly lower in the polymicrobial group compared to the fungal keratitis group (39.3% vs 73.7%, P = .0045). In multivariate logistic regression analysis comparing factors affecting the outcome between the 2 groups, older age (P = .027) and ulcers larger than 6 mm (P = .001) at presentation adversely affected outcome. CONCLUSIONS:Polymicrobial keratitis with fungus and bacteria was more common and more challenging to treat, with a poorer outcome than fungal keratitis. Medical treatment may be effective; however, therapeutic PKP provided globe salvage at best. Early PKP may be advocated for larger ulcers at presentation.
Authors: Maria Luiza Carneiro Buchele; Débora Borgert Wopereis; Fabiana Casara; Jefferson Peres de Macedo; Marilise Brittes Rott; Fabíola Branco Filippin Monteiro; Maria Luiza Bazzo; Fernando Dos Reis Spada; Jairo Ivo Dos Santos; Karin Silva Caumo Journal: Parasitol Res Date: 2018-08-10 Impact factor: 2.289
Authors: Tapan P Patel; N Venkatesh Prajna; Sina Farsiu; Nita G Valikodath; Leslie M Niziol; Lakshey Dudeja; Kyeong Hwan Kim; Maria A Woodward Journal: Cornea Date: 2018-03 Impact factor: 2.651
Authors: Darren Shu Jeng Ting; Mohamed Galal; Bina Kulkarni; Mohamed S Elalfy; Damian Lake; Samer Hamada; Dalia G Said; Harminder S Dua Journal: J Fungi (Basel) Date: 2021-11-12