This Article Full Text Full Text (PDF) Submit a response Read responses to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thomas, P A Articles by Myatt, M Search for Related Content PubMed PubMed Citation Articles by Thomas, P A Articles by Myatt, M Topic Collections Relevant Article

Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi

¹ Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli, India
² International Centre for Eye Health, Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, UK
³ Division of Epidemiology, Institute of Ophthalmology, London, UK

Correspondence to:
Correspondence to:
Astrid Leck
PhD, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; astrid.leck{at}lshtm.ac.uk

ABSTRACT
Aim: To assess whether the presence of characteristic clinical features can be used as a diagnostic aid for suppurative keratitis caused by filamentous fungi.

Methods: Patients presenting with suppurative keratitis in India underwent detailed clinical examination followed by microbiological investigation of corneal scrapes. A partial diagnostic score based upon the strength of the association, as estimated by the odds ratio, between reported clinical features and laboratory confirmed diagnoses was devised and subsequently tested using a case series from Ghana.

Results: Serrated margins, raised slough, dry texture, satellite lesions and coloration other than yellow occurred more frequently in cases of filamentous fungal keratitis than bacterial keratitis (p<0.05). Hypopyon and fibrinous exudate were observed more frequently in bacterial keratitis (p<0.05). When incorporated into a backwards stepwise logisitic regression model only serrated margins, raised slough, and colour were independently associated with fungal keratitis; these features were used in the scoring system. The probability of fungal infection if one clinical feature was present was 63%, increasing to 83% if all three features were present.

Conclusions: Microbiological investigations should be performed whenever possible; however, where facilities are not available, a rapid presumptive diagnosis of suppurative keratitis may be possible by scoring clinical features.

Keywords: suppurative keratitis; fungal infection

Relevant Article

BJO at a glance

Creig Hoyt
Br. J. Ophthalmol. 2005 89: 1547. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				F. Al-Shakarchi Initial therapy for suppurative microbial keratitis in Iraq Br. J. Ophthalmol., December 1, 2007; 91(12): 1583 - 1587. [Abstract] [Full Text] [PDF]

eLetters: