ABSTRACT
Background Studies have determined that nucleotide binding oligomerization domain 2 (NOD2) plays a key role in innate immune response.However,whether NOD2 participates in the nature defense of fungal keratitis is unclear.Objective This study was to investigate the expression and significance of NOD2 on cornea in the initial of Aspergillus fumigatus keratitis (AFK) in rats.Methods Seventy-two adult clean Wistar rats were randomized into the normal control group,only corneal epithelial scraped group and AFK model group,and the AFK models were established by incubating Aspergillus fumigatus to cornea after corneal epithelium was scraped.All the operations were performed in the right eyes of rats.Reverse transcription PCR (RT-PCR) was carried out to detect the expression of NOD2 mRNA in corneal epithelium 4,8,16,24 hours after operation.Twenty-four hours after operation,the expression of NOD2 protein in rat corneas was examined by immunochemistry and immnunofluorescence technology.Also,the rat corneas were obtained for regular histopathological examination.The use and care of the animals complied with Institutional Animal Care and Use Committee Guidebook by NIH.Results All the models were made successfully.RT-PCR revealed that a fewer NOD2 mRNA were expressed on cornea in the normal control group,but the expressing levels of NOD2 mRNA were increased in the only corneal epithelial scraped group and AFK model group.Compared with only corneal epithelial scraped group,the elevated values of NOD2 mRNA expression in the AFK model group were statistically significant at 4,8,16 and 24 hours after operation (t =-0.409,-0.439,-0.534,-0.618,all at P=0.000).The histopathological examination displayed that the cornel tissue had intact structure in the normal control group,and partly corneal epithelial deficiency,slight corneal swelling and fewer neutrophil granulocytes were seen in the only corneal epithelial scraped group.However,corneal ulcer,severe corneal edema and a lot of neutrophil granulocytes were exhibited in the AFK model group.Immunochemistry and immnunofluorescence staining evidenced that weaker expression of NOD2 was visualized in the corneal epithelial and endothelial layers,and obviously enhanced staining was seen in the AFK model group.The expressing levels (absorbancy) were 0.045 ± 0.005,0.050 ± 0.005 and 0.092 ± 0.006 in the normal control group,only corneal epithelial scraped group and AFK model group,respectively,showing a significant increase in the AFK model group compared with the only corneal epithelial scraped group (t =0.042,P =0.000).Conclusions Expression of NOD2 is upregulated in the corneas with AFK,suggesting that NOD2 participates the natural defense in the initial of fungal keratitis.NOD2 may play an important role in the process of anti-fungal innate immune response in cornea.
ABSTRACT
PURPOSES: Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment. The objective of this study is to describe the clinical characteristics and outcomes of patients with presumed microbial keratitis admitted to The Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel. METHODS: A cross-sectional study was conducted, in which the medical records of patients with presumed microbial keratitis admitted during a period of 3 years were reviewed. RESULTS: Keratitis was diagnosed in 276 patients (51% males and 48.9% females). The mean age was 39.29 ± 22.30 years. The hospital length of stay ranged from 1 to 65 days (mean 5.69 ± 5.508). Fortified antibiotics were still used at discharge in 72% of the cases. Overall visual acuity improved significantly from the time of admission to the 1st-week follow up visit showing a p<0.001 on the Wilcoxon signed ranks test. Contact lens wearing was present in 36.1% of the patients, although there was no significant relation with severity of the presentation and visual outcome (p>0.05). The degree of hypopyon and cells in the anterior chamber was significantly related to the hospital length of stay (r Spearman=0.31; p<0.001 and r Spearman=0.21; p<.001, respectively) as well as to a worse visual outcome (r Spearman=0.32; p<0.01 and r Spearman=0.18; p=0.01, respectively). Of all patients, 2.3% required an urgent therapeutic penetrating keratoplasty, and 1% underwent evisceration. There was no enucleation. CONCLUSION: Treating keratitis aggressively and assuring patient compliance is imperative for a good final visual outcome. Inpatient treatment may have a positive impact on this outcome.
OBJETIVOS: Ceratite microbiana é comumente diagnosticada em todo mundo e ainda continua a causar uma significante morbidade ocular. É necessário tratá-la de forma imediata e apropriada. O objetivo deste estudo é descrever as características clínicas e os desfechos dos pacientes com ceratite microbiana presumida que foram internados no Goldschlager Eye Institute, Sheba Medical Center, Tel Aviv University, Israel. MÉTODOS: Um estudo transversal foi realizado onde arquivos hospitalares dos pacientes internados com ceratite microbiana presumida durante um periodo de três anos foram analisados e revisados. RESULTADOS: Ceratite foi diagnosticada em 276 pacientes (51% masculinos e 48,9% femininos). A média de idade foi 39,29 ± 22,30 anos. A duração da internação foi de 1 a 65 dias (média 5,69 ± 5,508). Antibióticos fortificados permaneceram usados na alta em 72% dos casos. A acuidade visual do seguimento da primeira semana após a alta em relação a internação melhorou na media de forma estatisticamente significativa (p<0,001 usando Wilcoxon signed ranks test). O uso de lentes de contato estava presente em 36,1% dos pacientes, porém não houve relação estatisticamente significativa entre a gravidade da apresentação clínica e a acuidade visual nestes pacientes (p>0,05). O grau de hipópio e células na câmara anterior foram estatisticamente significativos em relação ao tempo de internação (r Spearman=0,0.31; p<0,001 and r Spearman=0,21; p<0,001, respectivamente) e para a acuidade visual (r Spearman=0,32; p<0,01 e r Spearman=0,18; p=0,01, respectivamente). De todos os pacientes, apenas 2,3% necessitaram ceratoplastia penetrante urgente e 1% necessitaram evisceração. Não houve enucleações. CONCLUSÕES: Tratar a ceratite de forma agressiva e garantir a aderência do paciente ao tratamento é imperativo para o bom resultado visual final. O tratamento internado pode ter um impacto positivo neste desfecho.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Keratitis/diagnosis , Keratitis/therapy , Contact Lenses , Cross-Sectional Studies , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/therapy , Israel , Keratitis/microbiology , Length of Stay , Tertiary Care Centers , Time Factors , Treatment Outcome , Visual AcuityABSTRACT
INTRODUÇÃO: A ceratite fúngica é uma importante causa de infecção corneana, principalmente em países tropicais. Com alta morbidade devido à demora no diagnóstico, o exame laboratorial torna-se obrigatório nesses casos. Dificuldades técnicas na obtenção das amostras, porém, geram um grande número de exames falso-negativos. Nesses casos, uma detalhada avaliação do paciente em busca de características específicas dessa entidade pode auxiliar na elucidação diagnóstica. OBJETIVOS: Formar um perfil epidemiológico dos portadores de ceratomicose para auxiliar no diagnóstico e tratamento precoces. MÉTODOS: Realizou-se estudo retrospectivo em base de dados de portadores de úlceras corneanas em busca de pacientes com diagnóstico de ceratomicose. Foram coletadas informações a respeito de sexo, situação do domicílio, grau de instrução, profissão, idade, fatores desencadeantes e predisponentes (oculares e sistêmicos), hipótese etiológica inicial, resultado laboratorial, tempo de cicatrização, complicações e tratamentos adjuvantes. RESULTADOS: Dos 599 pacientes atendidos por úlcera de córnea, 150 (25%) foram diagnosticados como de etiologia fúngica. Houve maior prevalência em homens em idade produtiva e baixo nível de escolaridade. Trauma com material vegetal esteve presente em 74 (49,33%) casos. Demais fatores identificados como trabalhadores e moradores de áreas rurais também suportam o trauma vegetal como principal fator de risco identificado no estudo. CONCLUSÕES: Com base nos dados do estudo foi possível formar um perfil dos portadores de úlceras fúngicas atendidos pelo HC-UNICAMP.
BACKGROUND: Fungal keratitis is an important cause of corneal infection mainly in tropical countries. With high morbidity due to delay in diagnosis, laboratory examination is mandatory in these cases. However, technical difficulties in obtaining samples generate a large number of false negatives. In these cases a detailed patient assessment for specific characteristics of this entity may help in diagnosis. PURPOSE: To create an epidemiological profile of patients with keratomycosis to assist in early diagnosis and treatment. METHODS: A retrospective study was performed by searching patients with keratomycosis diagnostic on the corneal ulcers database. Information about gender, household location, educational level, occupation, age, predisposing and precipitating factors (ocular and systemic), initial etiological hypothesis, laboratory results, healing time, complications, and adjuvant treatments were collected. RESULTS: Of 599 patients with corneal ulcer, 150 (25%) were diagnosed as fungal infection. There was a higher prevalence in males of working age and low educational level. Trauma with plant material was involved in 74 (49.33%) cases. Other factors such as workers and residents of rural areas also supports trauma with vegetal as the main risk factor identified in the study. CONCLUSIONS: Based on the collected data, it was possible to form a profile of patients with fungal ulcers treated by HC-UNICAMP.