The Clinical Differentiation of Bacterial and Fungal Keratitis: A Photographic Survey
- 1 April 2012
- journal article
- research article
- Published by Association for Research in Vision and Ophthalmology (ARVO) in Investigative Ophthalmology & Visual Science
- Vol. 53 (4), 1787-91
- https://doi.org/10.1167/iovs.11-8478
Abstract
The purpose of this study was to determine whether clinical signs of infectious keratitis can be used to identify the causative organism. 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. 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. 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.This publication has 20 references indexed in Scilit:
- The Clinical Diagnosis of Microbial KeratitisAmerican Journal of Ophthalmology, 2007
- Microbial Keratitis: Predisposing Factors and MorbidityOphthalmology, 2006
- Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungiBritish Journal of Ophthalmology, 2005
- Trends in the Etiology of Infectious Corneal Ulcers at the F. I. Proctor FoundationCornea, 2004
- Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 casesBritish Journal of Ophthalmology, 2003
- Current diagnosis and treatment of corneal ulcersCurrent Opinion in Opthalmology, 1998
- The Utility of Culturing Corneal Ulcers in a Tertiary Referral Center versus a General Ophthalmology ClinicOphthalmology, 1997
- Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south IndiaBritish Journal of Ophthalmology, 1997
- Incidence of corneal ulceration in Madurai District, South IndiaOphthalmic Epidemiology, 1996
- The Role of Smears, Cultures, and Antibiotic Sensitivity Testing in the Management of Suspected Infectious KeratitisOphthalmology, 1996