Correlation between pathogenic species and clinical findings, disease severity, and visual outcome in patients with fungal keratitis

ABSTRACT Purpose: To determine whether a correlation exists between pathogenic species and clinical findings, disease severity, and visual outcome in patients with keratitis and fungal growth in microbiological culture. Methods: A retrospective study of patients with fungal growth in the microbiological culture of corneal scrapings. Patients were treated at an ophthalmologic reference center in Southeastern Brazil from January 1992 to October 2015. Results: Medical records of 181 patients (131 males and 50 females) with a mean age of 47 ± 18 years were analyzed. The three most common etiologies were Fusarium sp. (38.7%), Aspergillus sp. (15%), and Candida sp. (13.2%). Among these, Fusarium sp. was the most frequent in patients aged £50 years (p=0.002) and in those with a recent history of a foreign body and/or ocular trauma (p=0.01). Candida sp. was the most frequent etiology in patients aged >50 years (p=0.002), in those with postoperative ocular surgery (p=0.002); in those with a previous ocular pathology (p=0.0007); and in immunodepressed patients (p=0.0004). Conclusion: Fusarium sp. was predominant in patients aged £50 years and those with a recent history of foreign body and/or ocular trauma, whereas Candida sp. was predominant in older adults, in those with a postoperative ocular surgery, in those with a previous ocular pathology, and in immunodepressed patients.

摘要 研究目的：明确角膜炎且微生物培养检出真菌生长的患者中，致病菌种与临床体征、疾病严重程度及视觉预后之间是否存在相关性。研究方法：本研究为回顾性研究，纳入1992年1月至2015年10月间，于巴西东南部一家眼科专科转诊中心接受治疗的角膜刮片微生物培养检出真菌生长的患者。研究结果：本研究共分析181例患者的病历资料，其中男性131例、女性50例，平均年龄为47±18岁。最常见的三种致病菌种依次为镰孢菌属（Fusarium sp.，占比38.7%）、曲霉属（Aspergillus sp.，占比15%）及念珠菌属（Candida sp.，占比13.2%）。其中，镰孢菌属在≤50岁患者（p=0.002）以及近期有异物史和/或眼外伤史的患者（p=0.01）中最为高发；念珠菌属则在＞50岁患者（p=0.002）、接受过眼部手术的患者（p=0.002）、存在既往眼部病史的患者（p=0.0007）以及免疫功能低下患者（p=0.0004）中最为高发。研究结论：镰孢菌属在≤50岁人群及近期有异物史和/或眼外伤史的患者中占主导地位，而念珠菌属则在老年患者、眼部术后患者、既往有眼部病史者及免疫功能低下患者中占主导地位。