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Mikrobiyal keratit olgularının demografik, laboratuvar ve klinik bulguları

Year 2019, Volume: 44 Issue: 3, 891 - 897, 30.09.2019

Abstract

Amaç: Bu çalışmada, kliniğimizde mikrobiyal keratit tanısı ile yatırarak takip ettiğimiz hastaların epidemiyolojik özelliklerini, klinik bulgularını, risk faktörlerini, direkt bakı ve kültür sonuçlarını inceleyip, bölgemizdeki etken mikroorganizmaları ve risk faktörlerini değerlendirerek ampirik tedavi protokolümüzü gözden geçirmeyi amaçladık.

Gereç ve Yöntem: Haziran 2017 ile Haziran 2018 tarihleri arasında kliniğimizde keratit tanısı ile yatırarak takip ettiğimiz hastaların dosyaları retrospektif olarak incelendi. Klinik bulgular, risk faktörleri, mikrobiyolojik bulgular, ampirik tedavi ve tedaviye alınan yanıtlar değerlendirildi.

Bulgular: 9 erkek, 9 kadın olmak üzere 18 hastanın 18 gözü değerlendirildi.(ort.yaş 67.8) Olguların %27.8’inde mikrobiyolojik bulguya rastlanıldı. %27.9’unda predispozan faktör olduğu görüldü. Tedavi öncesi görme keskinlikleri değerlendirildiğinde %11.1’i ışık hissi negatif, %16.7’si ışık hissi pozitif, %38,9’u el hareketleri pozitif, %16.7’si parmak sayma, %16.7’si 0.05 ve üzeriydi. Tedaviye alınan klinik yanıt değerlendirildiğinde hastaların % 72.2 sinde olumlu yanıt görüldü. Tedavi sonrası görme keskinliklerine baktığımızda, %11.1’i ışık hissi negatif, %5.6’sı ışık hissi pozitif, %33.3’ü el hareketleri, %27.8’i parmak sayma, %22.2’si 0.05 ve üzerindeydi. Taburculuk esnasındaki en yüksek görme keskinliği 0.1’di.

Sonuç: Keratitler tek taraflı körlüğün önde gelen sebeplerindendir. Erken tanı ve tedavisinin prognozu belirlemedeki rolü büyüktür. Bölgesel risk faktörleri ve o bölgede en sık saptanan patojenler göz önüne alınarak uygun ampirik tedavi ile başarı sağlanabilir. Kültür-antibiyogram ve direkt mikroskobik bakı ise tedaviye yanıt alınamayan olgularda ciddi destek sağlamaktadır.


References

  • 1. Austin A, Schallhorn J, Geske M, et al. Empiric treatment of bacterialkeratitis: an international survey of corneal specialists. BMJ Ophthalmol. 2016;2: e000047.
  • 2. Sharma S. Keratitis. Biosci R ep,2001;21(4):419–444.,
  • 3. Klotz SA, Penn CC, Negvesky GJ, Butrus SI. Fungal and parasitic infections of the eye. Clin Microbiol Rev, 2000;13(4):662–685.
  • 4. Stretton S, Naduvilath TJ, Rao GN. Microbial keratitis in prospective studies of extendedwear with disposable hydrogel contact lenses. Cornea 2005;24:156-61.
  • 5. Mah-Sadorra JH, Yavuz SG, Najjar DM, Laibson PR, Rapuano CJ, Cohen EJ. Trends in contact lensrelated corneal ulcers. Cornea 2005;24:51-8.
  • 6. Najjor DM, Aktan SG, Rapuano CJ, Laibson PR, Cohen EJ. Contact lens-related corneal ulcers in compliant patients. Am J Ophthalmol 2004;137:170-2.
  • 7. Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: A prospective clinical and microbiological study. Br JOphthalmol 2001;85: 842-847.
  • 8. Vajpayee RB, Dada T, Saxena R, Vajpayee M, Taylor HR Venkatesh P, et al. Study of the first contact management profile of cases of infectious dermatitis: a hospital-based study. Cornea 2000;19: 52-6.
  • 9. Mah-Sadorra JH, Yavuz SG, Najjar DM, et al. Trends in contact lensrelated corneal ulcers.Cornea. 2005;24:51–58.
  • 10. Cruciani F, Cuozzo G, Di Pillo S, et al. Predisposing factors, clinical and microbiological aspects of bacterial keratitis: a clinical study. Clin Ter. 2009;160:207–210.
  • 11. Lam DS, Houang E, Fan DS. Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye 2002; 16: 608-618.
  • 12. Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 1997;81:965-71.
  • 13. Bharathi MI, Ramakrishnan R, Vasu S,Meenakshi R, Shivkumar S, Palaniappan R. Epidemiological of bacterial keratitis in a referral centre in South Đndia. Indian J Med Microbiol 2003;21:239-45.
  • 14. Upadhyay MP, Karmacharya PC, Koirala S, Tuladhar N, Bryan LE, Smolin G, et al. Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal. Am J Ophthalmol1991;111:92-9.
  • 15. Bourcier T, Thomas F,Borderie V et al: Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases, Br J Ophthalmol 2003;87: 834-838
  • 16. Koller T,Mrochen M,Seiler T. Complication and failure rates after corneal crosslinking. J.Catract Refract Surg. 2009;35:1358-62.
  • 17. Sharma N, Maharana P, Singh G, Titiyal JS. Pseudomanas keratitis after collagen croslinking for keratoconus: Case report and rewiev of literature.J Cataract Refract Surg. 2010;36:517-20.
  • 18. Tewari A, Nidhi S, Vegad M, Mehta D. Epidemiological and microbiological profile of infective keratitis in Ahmedabad. Indian J of Ophthalmology 2012; 60: 4.
  • 19. Morgan PB, Efron N, Hill EA, Raynor MK, Whiting MA, Tullo AB. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol, 2005; 89(4):430–436.
  • 20. Green M, Apel A, Stapleton F. A longitudinal study of trends in keratitis in Australia. Cornea 2008;27(1):33–39.
  • 21. Pepose JS, Wilhelmus KR. Divergent approaches to the management of corneal ülser, Am J Ophhalmol 1992;114:630-632.
  • 22. Tuft SJ. Suppurative keratitis, Br J Ophthalmol 2003;87: 127.
  • 23. Kornea enfeksiyonlarının tanısında direkt yayma, kültür-antibiyogramın önemi. MN Oftalmoloji1998;5:42-6.
  • 24. Karakas N, Aksünger A, Mercan Đ, Gül K, Sak A. Bakteriyel korneal ülserlerde predispozanrisk faktörleri ve fortifiye antibiyotik tedavisi. Turkiye Klinikleri Ophthalmol 1996;5:325-7.

Demographic, laboratory and clinical features of patients with microbial keratitis

Year 2019, Volume: 44 Issue: 3, 891 - 897, 30.09.2019

Abstract

Purpose: In this study, we investigated epidemiological properties, clinical findings, risk factors, direct microscopy and culture results in the inpatients diagnosed with microbial keratitis. Our objective is to revise our empirical treatment procedure after evaluating causative microorganisms in our region and risk factors. 

Materials and Methods: We examined the hospital records of inpatients with microbial keratitis between June 2017 and June 2018, retrospectively. Also, clinical findings, risk factors, microbiological results, empirical treatment and treatment response were evaluated.

Results: Eighteen eyes of 18 patients were examined, 9 female and 9 male, mean age was 67.8. The 27.8 percentage of the eyes had microbiologic finding. The risk factors found in 27.9% of patients. The vision acuities  (VA) before the treatment were : light perception (LP) negative 11.1 %; LP positive 16.7 %; hand motion (HM) 38.9 %; counting fingers 16.7 %, 0.05 and above 16.7 %. The empirical treatment was started for all of the patients. The clinical response of empirical antimicrobial therapy was detected in 72.2 % of the patients. The vision acuities  (VA) after the treatment were: light perception (LP) negative 11.1 %; LP positive 5.6 %; hand motion (HM)  33.3 % ; counting fingers 27.8 %, 0.05 and above 22.2 %. The highest vision acuity was 0.1.

Conclusion: The keratitis is a common cause of  unilateral blindness. Early diagnosis and treatment of the keratitis is a significant role on the prognosis. The success of the therapy can be provided starting empirical antimicrobial therapy by taking into consideration of  the regional risk factors and common pathogens. On the other hand, direct microscopy and culture-antibiogram provide serious support in cases where the treatment response is not available. 


References

  • 1. Austin A, Schallhorn J, Geske M, et al. Empiric treatment of bacterialkeratitis: an international survey of corneal specialists. BMJ Ophthalmol. 2016;2: e000047.
  • 2. Sharma S. Keratitis. Biosci R ep,2001;21(4):419–444.,
  • 3. Klotz SA, Penn CC, Negvesky GJ, Butrus SI. Fungal and parasitic infections of the eye. Clin Microbiol Rev, 2000;13(4):662–685.
  • 4. Stretton S, Naduvilath TJ, Rao GN. Microbial keratitis in prospective studies of extendedwear with disposable hydrogel contact lenses. Cornea 2005;24:156-61.
  • 5. Mah-Sadorra JH, Yavuz SG, Najjar DM, Laibson PR, Rapuano CJ, Cohen EJ. Trends in contact lensrelated corneal ulcers. Cornea 2005;24:51-8.
  • 6. Najjor DM, Aktan SG, Rapuano CJ, Laibson PR, Cohen EJ. Contact lens-related corneal ulcers in compliant patients. Am J Ophthalmol 2004;137:170-2.
  • 7. Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: A prospective clinical and microbiological study. Br JOphthalmol 2001;85: 842-847.
  • 8. Vajpayee RB, Dada T, Saxena R, Vajpayee M, Taylor HR Venkatesh P, et al. Study of the first contact management profile of cases of infectious dermatitis: a hospital-based study. Cornea 2000;19: 52-6.
  • 9. Mah-Sadorra JH, Yavuz SG, Najjar DM, et al. Trends in contact lensrelated corneal ulcers.Cornea. 2005;24:51–58.
  • 10. Cruciani F, Cuozzo G, Di Pillo S, et al. Predisposing factors, clinical and microbiological aspects of bacterial keratitis: a clinical study. Clin Ter. 2009;160:207–210.
  • 11. Lam DS, Houang E, Fan DS. Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye 2002; 16: 608-618.
  • 12. Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 1997;81:965-71.
  • 13. Bharathi MI, Ramakrishnan R, Vasu S,Meenakshi R, Shivkumar S, Palaniappan R. Epidemiological of bacterial keratitis in a referral centre in South Đndia. Indian J Med Microbiol 2003;21:239-45.
  • 14. Upadhyay MP, Karmacharya PC, Koirala S, Tuladhar N, Bryan LE, Smolin G, et al. Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal. Am J Ophthalmol1991;111:92-9.
  • 15. Bourcier T, Thomas F,Borderie V et al: Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases, Br J Ophthalmol 2003;87: 834-838
  • 16. Koller T,Mrochen M,Seiler T. Complication and failure rates after corneal crosslinking. J.Catract Refract Surg. 2009;35:1358-62.
  • 17. Sharma N, Maharana P, Singh G, Titiyal JS. Pseudomanas keratitis after collagen croslinking for keratoconus: Case report and rewiev of literature.J Cataract Refract Surg. 2010;36:517-20.
  • 18. Tewari A, Nidhi S, Vegad M, Mehta D. Epidemiological and microbiological profile of infective keratitis in Ahmedabad. Indian J of Ophthalmology 2012; 60: 4.
  • 19. Morgan PB, Efron N, Hill EA, Raynor MK, Whiting MA, Tullo AB. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol, 2005; 89(4):430–436.
  • 20. Green M, Apel A, Stapleton F. A longitudinal study of trends in keratitis in Australia. Cornea 2008;27(1):33–39.
  • 21. Pepose JS, Wilhelmus KR. Divergent approaches to the management of corneal ülser, Am J Ophhalmol 1992;114:630-632.
  • 22. Tuft SJ. Suppurative keratitis, Br J Ophthalmol 2003;87: 127.
  • 23. Kornea enfeksiyonlarının tanısında direkt yayma, kültür-antibiyogramın önemi. MN Oftalmoloji1998;5:42-6.
  • 24. Karakas N, Aksünger A, Mercan Đ, Gül K, Sak A. Bakteriyel korneal ülserlerde predispozanrisk faktörleri ve fortifiye antibiyotik tedavisi. Turkiye Klinikleri Ophthalmol 1996;5:325-7.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research
Authors

Mübeccel Bulut 0000-0003-1311-2282

Abdurrahman Bilen This is me 0000-0002-5028-6479

Şerife Şule Çınar 0000-0001-8377-0753

Ayşe Sevgi Karadağ 0000-0001-8377-0753

Publication Date September 30, 2019
Acceptance Date January 23, 2019
Published in Issue Year 2019 Volume: 44 Issue: 3

Cite

MLA Bulut, Mübeccel et al. “Mikrobiyal Keratit olgularının Demografik, Laboratuvar Ve Klinik Bulguları”. Cukurova Medical Journal, vol. 44, no. 3, 2019, pp. 891-7.