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1.
Rev. bras. oftalmol ; 79(5): 315-319, set.-out. 2020. tab, graf
Article in English | LILACS | ID: biblio-1137981

ABSTRACT

Abstract Purpose: To report etiological diagnosis, predisposing risk factors, therapeutic strategies and visual outcome of patients treated at the Department of Ophthalmology of Federal University of São Paulo. Methods: This is a retrospective, descriptive, and observational study from medical and laboratory records of the Department of Ophthalmology of Federal University of São Paulo, including all patients with culture proven fungal keratitis in 5 years, from October 2012 through October 2017. Results: There were 2260 fungi microbiologic test requests. Of these, 140 samples had positive cultures for fungi and sixty-six patients were followed at our clinic. Forty-five patients (68.2%) were men, and the mean age was 48.06 (±17.39) years. Fusarium spp. was the most frequently isolated fungus (32 cases; 48.5%), followed by Candida parapsilosis (12 cases; 18.2%). Thirty-four patients (51.5%) underwent intracameral injection of amphotericin B (5 µg per 0.1 ml). In 11 patients (32.3%), infection was eradicated after intracameral amphotericin B associated to topical antifungal treatment and, in 23 patients (67.7%), therapeutic keratoplasty was needed. No complication related to intracameral amphotericin B injection was observed in this series. Forty-three patients (65.1%) ended up with therapeutic keratoplasty. Three patients (4.5%) evolved to evisceration or enucleation. At the last follow-up visit, 53 patients (80.3%) had visual acuity worse than 20/200. Conclusion: Despite current antifungals drugs and distinct administration strategies, fungal keratitis remains challenging. Delayed antifungal therapy may explain poor clinical outcomes. Intracameral amphotericin B associated to topical antfungal treatment seems to be a safe and helpful alternative for non-responsive fungal keratitis. But it is important to formulate other treatment strategies, hence to improve patients' outcomes, since most patients ended-up with significant visual impairment even after current treatment.


Resumo Objetivo: Descrever diagnósticos etiológicos, fatores de risco, estratégias terapêuticas e resultados visuais de pacientes com ceratite fúngica tratados no Departamento de Oftalmologia da Universidade Federal de São Paulo. Métodos: Trata-se de um estudo retrospectivo, descritivo e observacional, a partir da análise de prontuários médicos e laboratoriais do Departamento de Oftalmologia da Universidade Federal de São Paulo, incluindo todos os pacientes com ceratite fúngica comprovada por cultura no período de outubro de 2012 a outubro de 2017. Resultados: Foram realizadas 2260 solicitações de testes microbiológicos. Destas, 140 amostras apresentaram culturas positivas para fungos, e 66 pacientes foram acompanhados em nosso serviço. Quarenta e cinco pacientes (68,2%) eram do sexo masculino, e a média de idade foi de 48,06 (± 17,39) anos. Fusarium spp. foi o fungo mais freqüentemente isolado (32 casos; 48,5%), seguido por Candida parapsilosis (12 casos; 18,2%). Trinta e quatro pacientes (51,5%) foram submetidos à injeção intracameral de anfotericina B (5 µg por 0,1 ml). Destes, 11 pacientes (32,3%) tiveram a infecção erradicada. Nos outros 23 pacientes (67,7%), o transplante terapêutico foi necessário. Nenhuma complicação relacionada à injeção intracameral de anfotericina B foi observada neste estudo. No total, 43 pacientes (65,1%) evoluíram para transplante terapêutico, e 3 pacientes (4,5%) foram submetidos à evisceração ou enucleação. Cinquenta e três pacientes (80,3%) apresentaram acuidade visual final pior que 20/200. Conclusões: Apesar dos diversos medicamentos antifúngicos atuais e vias de administração, o tratamento das ceratites fúngicas permanece desafiador. O atraso no início do tratamento adequado pode justificar o desfecho clínico desfavorável de grande parte dos pacientes. A injeção intracameral de anfotericina B mostrou-se uma alternativa terapêutica segura para ceratites fúngicas refratárias. Mas outras estratégias de tratamento devem ser formuladas, visando melhorar os resultados visuais dos pacientes.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Eye Infections, Fungal/drug therapy , Amphotericin B/therapeutic use , Corneal Transplantation , Candida parapsilosis/isolation & purification , Fusarium/isolation & purification , Keratitis/microbiology , Antifungal Agents/therapeutic use , Brazil , Medical Records , Epidemiology, Descriptive , Retrospective Studies , Observational Study
2.
Arq. bras. oftalmol ; 83(1): 65-68, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088960

ABSTRACT

ABSTRACT We describe a case of keratomycosis caused by Arthographis kalrae after excimer laser keratomileusis. A 38-year-old female developed stromal keratitis eight weeks after refractive surgery. She developed severe corneal stromal infiltration and mild anterior segment inflammation, which could not be treated with topical voriconazole 1%, but topical natamycin 5% ameliorated her condition. A reactivation of keratomycosis symptoms was observed; therefore, longer treatment was administered to the patient. It has been reported that A. kalrae keratomycosis is associated with exposure to soil and contact lens usage. However, the patient, who lived in a rural location, was neither involved in gardening activities nor had a history of wearing contact lenses. This is the first case of post-refractive A. kalrae keratomycosis.


RESUMO Descrevemos um caso de ceratomicose por Arthographis kalrae após ceratomileusis por excimer laser. Uma mulher de 38 anos desenvolveu ceratite estromal oito semanas após a cirurgia refrativa. Ela desenvolveu infiltração estromal grave da córnea e uma leve inflamação do segmento anterior, que não pode ser tratada com voriconazol tópico a 1%, mas a natamicina tópica a 5% melhorou sua condição. Uma reativação dos síntomas de ceratomicose foi observada; portanto, tratamento mais prolongado foi administrado a paciente. Tem sido relatado que a ceratomicose por A. kalrae está associada à exposição ao solo e ao uso de lentes de contato. No entanto, a paciente, que vivía em um local rural, não estava envolvida em atividades de jardinagem e nem tinha histórico de uso de lentes de contato. Este é o primeiro caso de ceratomicose pós-refrativa por A. kalrae.


Subject(s)
Humans , Female , Adult , Eye Infections, Fungal/microbiology , Keratitis/microbiology , Ascomycota/isolation & purification , Eye Infections, Fungal/drug therapy , Natamycin/therapeutic use , Keratomileusis, Laser In Situ/adverse effects , Voriconazole/therapeutic use , Keratitis/drug therapy
3.
Braz. j. infect. dis ; 23(3): 197-199, May-June 2019. graf
Article in English | LILACS | ID: biblio-1019556

ABSTRACT

ABSTRACT We report a patient with fungal keratitis caused by a multiresistant Fusarium solani in a tertiary care hospital located in southern Brazil. A 55-year-old man with a history of ocular trauma presented with keratitis in left eye. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, and required eye enucleation. Despite multiple topical, intraocular and systemic antifungal treatments, hyphal infiltration persisted in the corneal transplant causing continuous recurrences. The cultures of corneal biopsy scrapings were positive for Fusarium spp. The organism was identified to species level by multi-locus sequencing for translation elongation factor 1 alpha (EF-1α), and RNA polymerase II subunit (RPB2). In vitro antifungal susceptibility testing of the isolate by the broth microdilution method, according to CLSI M38-A2, disclosed susceptibility to natamycin and resistance to amphotericin B, voriconazole, itraconazole and fluconazole. Considering previous unsuccessful antifungal treatments due to multiple drug resistance, the eye was enucleated. Our case report illustrates that management of fungal keratitis remains a therapeutic challenge. Optimal treatment for F. solani infection has not yet been established and should include susceptibility testing for different antifungal agents.


Subject(s)
Humans , Male , Middle Aged , Fusarium/drug effects , Keratitis/microbiology , Antifungal Agents/administration & dosage , Severity of Illness Index , Eye Enucleation , Microbial Sensitivity Tests , Treatment Failure , Keratitis/surgery , Antifungal Agents/pharmacology
4.
Arq. bras. oftalmol ; 82(2): 152-154, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-989405

ABSTRACT

ABSTRACT - We describe here a case of a 21-year-old woman who presented with low visual acuity, pain, and hyperemia in the left eye for 45 days. Her eye had extensive corneal infiltrate, with melting and a central perforation that was glued with cyanoacrylate, but with Seidel (+). She underwent tectonic corneal transplantation, and anterior chamber lavage with subconjunctival infiltration with voriconazole, as well as intracameral injections of amphotericin B. Laboratory tests revealed Paecilomyces lilacinus as the infectious agent. The patient was then maintained with oral voriconazole and eye drops for three months, after which the infection was considered cured. However, in the sixth postoperative month she presented with endothelial rejection, and two weeks later signs of recurrence of the fungal infection. She was treated with two further washes of the anterior chamber and subconjunctival injection of voriconazole, followed by intravenous voriconazole that was replaced with drops after ten days. The infection initially worsened, but then regressed, and at last follow-up, the patient was still infection-free.


RESUMO - Descrevemos aqui um caso de uma mulher de 21 anos que apresentou baixa acuidade visual, dor e hiperemia no olho esquerdo por 45 dias. O olho apresentava infiltrado corneano extenso, com fusão e perfuração central colada com cianoacrilato, mas com Seidel (+). Ela foi submetida a transplante de córnea tectônica e lavagem de câmara anterior com infiltração subconjuntival com voriconazol, além de injeções intracamerais de anfoterecina B. Testes laboratoriais revelaram Paecilomyces lilacinus como agente infeccioso. A paciente foi então mantida com voriconazol oral e colírio por período de três meses, após o qual a infecção foi considerada curada. No entanto, no sexto mês de pós-operatório, ela apresentou rejeição endotelial e, duas semanas após, sinais de recidiva de infecção fúngica. Ela foi tratada com mais duas lavagens de câmara anterior e injeção subconjuntival de voriconazol, seguida por voriconazol intravenoso que foi substituído por gotas após 10 dias. A infecção piorou inicialmente, mas depois regrediu e, no último seguimento, o paciente ainda estava livre de infecção.


Subject(s)
Humans , Female , Young Adult , Paecilomyces/isolation & purification , Eye Infections, Fungal/drug therapy , Voriconazole/therapeutic use , Keratitis/microbiology , Keratitis/drug therapy , Antifungal Agents/therapeutic use , Eye Infections, Fungal/surgery , Corneal Transplantation/methods , Treatment Outcome , Injections, Intraocular , Keratitis/surgery
5.
Medwave ; 18(8): e7387, 2018.
Article in English, Spanish | LILACS | ID: biblio-969322

ABSTRACT

INTRODUCCIÓN: La queratitis infecciosa de origen fúngico afecta principalmente a personas de países tropicales y subtropicales, y constituye una importante causa de ceguera prevenible. Los antifúngicos tópicos, en particular la natamicina y el voriconazol, se consideran efectivos, pero no está claro cuál de ellos constituye la mejor alternativa de tratamiento. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron tres estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que natamicina probablemente se asocia a mejor agudeza visual tras la infección, y que previene la perforación corneal y/o la necesidad de realizar queratoplastia terapéutica en comparación a voriconazol en queratitis fúngica.


INTRODUCTION: Infectious keratitis of fungal origin mainly affects people in tropical and subtropical countries, and is an important cause of preventable blindness. Topical antifungals, particularly natamycin and voriconazole, are considered effective, but it is not clear which one is the best treatment alternative. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including three studies overall,all of which were randomized trials. We concluded natamycin probably is associated with better visual acuity after infection, and it prevents corneal perforation and/or need to perform therapeutic keratoplasty compared to voriconazole in fungal keratitis.


Subject(s)
Humans , Eye Infections, Fungal/drug therapy , Natamycin/administration & dosage , Voriconazole/administration & dosage , Keratitis/drug therapy , Eye Infections, Fungal/microbiology , Randomized Controlled Trials as Topic , Databases, Factual , Keratitis/microbiology , Antifungal Agents/administration & dosage
6.
Braz. j. microbiol ; 49(supl.1): 205-212, 2018. tab, graf
Article in English | LILACS | ID: biblio-974346

ABSTRACT

Abstract This study compares patients with and without non-viral microbial keratitis in relation to sociodemographic variables, clinical aspects, and involved causative agent. Clinical aspects, etiology and therapeutic procedures were assessed in patients with and without keratitis that were diagnosed in an Eye Care Center in Campo Grande, MS, Brazil. Patients were divided into two groups: (a) cases: 64 patients with non-viral microbial keratitis diagnosed at biomicroscopy; and (b) controls: 47 patients with other eye disorders that were not keratitis. Labor activity related to agriculture, cattle raising, and contact lens use were all linked to keratitis occurrence (p < 0.005). In patients with keratitis, the most common symptoms were pain and photophobia, and the most frequently used medicines were fourth-generation fluoroquinolones (34.4%), amphotericin B (31.3%), and natamycin (28.1%). Microbial keratitis evolved to corneal perforation in 15.6% of cases; transplant was indicated in 10.9% of cases. Regarding the etiology of this condition, 23 (42.2%) keratitis cases were caused by bacteria (Pseudomonas aeruginosa, 12.5%), 17 (39.1%) by fungi (Fusarium spp., 14.1% and Aspergillus spp., 4.7%), and 4 (6.3%) by Acanthamoeba. Patients with keratitis present with a poorer prognosis. Rapid identification of the etiologic agent is indispensable and depends on appropriate ophthalmological collection and microbiological techniques.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Bacteria/isolation & purification , Bacterial Infections/microbiology , Fungi/isolation & purification , Keratitis/microbiology , Mycoses/microbiology , Bacteria/classification , Bacteria/drug effects , Bacteria/genetics , Bacterial Infections/drug therapy , Brazil , Fungi/classification , Fungi/drug effects , Fungi/genetics , Keratitis/drug therapy , Middle Aged , Anti-Bacterial Agents/pharmacology , Mycoses/drug therapy , Antifungal Agents/pharmacology
7.
Arq. bras. oftalmol ; 80(2): 84-87, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-838786

ABSTRACT

ABSTRACT Objective: Bacterial keratitis occurs worldwide, and despite recent developments, it remains a potentially blinding condition. This study assesses the presence of herpes simplex virus (HSV-1 and -2) and varicella zoster virus (VZV) by quantitative real-time polymerase chain reaction (qPCR) in corneal scrapings from patients with bacterial keratitis. Methods: A total of 65 patients with clinical diagnoses of infectious corneal ulcers prospectively underwent clinical eye examinations. Corneal scrapings were investigated by Gram staining, Giemsa staining, culture, and qPCR (the study group). Risk factors and epidemiological data were recorded. The control group comprising 25 eyes with typical herpes dendritic keratitis was also analyzed by qPCR. Results: From the study group (n=65), nine patients (13.8%) had negative smears, cultures, and qPCR findings. Fifty-six (86.2%) patients had positive cultures: 51 for bacteria, 4 for fungi, and 1 for amoebae. Of the patients who had positive bacterial cultures, qPCR identified 10 patients who were also positive for virus: one for VZV and nine for HSV-1. Of the 25 patients in the control group, 21 tested positive for HSV-1 by qPCR analysis. Conclusions: Herpes may be present in patients with bacterial corneal ulcers, and qPCR may be useful in its detection.


RESUMO Objetivo: Ceratites bacterianas ocorrem mundialmente e apesar dos novos desenvolvimentos permanece como uma condição que pode levar à cegueira. Avaliar a presença de herpes simples (-1 e -2) e vírus varicella zoster (VZV) por reação em cadeia quantitativa de polimerase em tempo real (qPCR) em raspados corneanos de pacientes com ceratite bacteriana. Métodos: Sessenta e cinco pacientes com ceratite infecciosa foram submetidos a raspados corneanos estudados para gram, Giemsa, cultura e qPCR (grupo de estudo). Foram avaliados fatores de risco e epidemiológicos. O grupo controle foi composto por 25 casos de úlcera dendrítica típica por herpes analisados por qPCR. Resultados: Do grupo de estudo (n=65), nove pacientes (13,8%) apresentaram cultura, qPCR e raspado negativos. Cinquenta e seis (86,2%) pacientes apresentaram cultura positiva, 51 para bacteria, 4 para fungo e 1 para ameba. A qPCR identificou 10 pacientes do grupo de cultura positiva para bactéria que também foram positivos para vírus, um VZV e 9 para HSV-1. Dos 25 pacientes que compunham o grupo controle, 21 apresentaram qPCR positivo para HSV-1. Conclusão: Herpes pode estar presente em pacientes com úlceras de córnea bacterianas e a qPCR pode ser útil na sua detecção.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Keratitis, Dendritic/microbiology , Herpesvirus 2, Human/isolation & purification , Herpesvirus 1, Human/isolation & purification , Herpesvirus 3, Human/isolation & purification , Cornea/virology , Real-Time Polymerase Chain Reaction/methods , Keratitis/microbiology , DNA Probes , Eye Infections, Bacterial/microbiology , Keratitis, Dendritic/diagnosis , Keratitis, Dendritic/virology , Prospective Studies , Keratitis/diagnosis , Keratitis/virology
8.
Arq. bras. oftalmol ; 79(5): 289-293, Sept.-Oct. 2016. tab
Article in English | LILACS | ID: biblio-827970

ABSTRACT

ABSTRACT Purpose: To analyze epidemiological and microbiological aspects of microbial keratitis in children and adolescents. Methods: This retrospective cohort study was conducted at the Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, between July 15, 1975, and December 31, 2010. We analyzed corneal samples from 859 patients with clinical suspicion of infectious keratitis, comparing epidemiological and microbiological characteristics of bacterial keratitis with those of non-bacterial and non-viral keratitis. We also compared Gram-positive and Gram-negative pathogens in patients with bacterial keratitis. We created a susceptibility profile of the bacterial microorganisms studied. Results: Of the 859 patients, 346 (40.3%) showed positive culture results for non-viral microorganisms. Teenagers (13-18 years) made up the group with the highest number of patients with keratitis (164, 47.4%). The most frequent risk factors for keratitis were trauma (33.5%) and previous ocular surgery (24.9%). Gram-positive bacteria (71.8%) were the most often isolated, with coagulase-negative Staphylococcus (23.8%) the most prevalent microorganism. Logistic regression analysis showed age (p=0.002), topical antimicrobial drug use (p=0.01), and trauma due to non-chemical burns (p=0.005) were risk factors for non-bacterial keratitis. Age (p=0.01) was also a risk factor for Gram-negative bacterial keratitis. Conclusion: Our study showed that in the age range studied, the prevalence of keratitis caused by Gram-negative bacteria or by the non-viral microorganisms evaluated increases with age. Previous use of topical antimicrobial drug and trauma due to non-chemical burns are associated with non-bacterial keratitis. Knowledge of the risk factors and the microorganisms involved may help improve treatment of keratitis in children and adolescents and minimize visual impairment.


RESUMO Objetivos: Descrever o perfil epidemiológico e microbiológico de ceratite microbiana em crianças e adolescentes. Métodos: Estudo retrospectivo tipo coorte, utilizando fichas laboratoriais de pacientes, atendidos no Departamento de Oftalmologia e Ciências Visuais - Escola Paulista de Medicina - Universidade Federal de São Paulo, entre 15 de julho de 1975 a 31 de dezembro de 2010. Foram comparados pacientes com ceratite bacteriana e não bacteriana (não viral). Entre os pacientes com ceratite bacteriana, foram comparados aqueles em que a ceratite foi causada por bactérias Gram positivas e Gram negativas. O perfil de sensibilidade dos microrganismos bacterianos aos antimicrobianos também foi estudado. Resultados: Foram analisadas amostras corneanas de 859 pacientes com suspeita clínica de ceratite infecciosa, na faixa etária estudada. Destes, 346 (40,3%) apresentaram resultados de culturas positivas para microrganismos não virais. Adolescentes (13 a 18 anos) compuseram o grupo com maior número de pacientes com ceratite (164-47,4%). Os principais fatores de risco foram trauma (33,5%) e cirurgias oculares prévias (24,9%). Bactérias Gram positivas foram isoladas com maior frequência (71,8%), sendo prevalente o patógeno Staphylococcus coagulase negativo (23,8%). De acordo com a análise de regressão logística, idade (p=0,002), uso tópico de drogas antimicrobianas (p=0,01) e trauma por queimadura não química (p=0,005) foram fatores predisponentes para ceratite não bacteriana. Idade (p=0,01) também foi fator de risco para ceratite causada por bactérias Gram negativas. Conclusões: Nosso estudo mostrou que quanto maior a idade, na faixa etária estudada, maior a probabilidade da ceratite ser causada por bactérias Gram negativas e/ou por outros microrganismos não virais avaliados. O uso tópico de drogas antimicrobianas prévias e trauma devido à queimadura não química predispõe à ceratite não bacteriana. O conhecimento dos fatores de risco e dos microrganismos envolvidos resultarão em tratamento específico da ceratite em crianças e adolescentes, com menores danos visuais.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cornea/microbiology , Keratitis/microbiology , Keratitis/epidemiology , Reference Values , Brazil/epidemiology , Acanthamoeba/isolation & purification , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/epidemiology , Prevalence , Multivariate Analysis , Retrospective Studies , Risk Factors , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification
9.
Rev. cuba. oftalmol ; 29(3): 465-473, jul.-set. 2016. tab
Article in Spanish | LILACS | ID: biblio-830481

ABSTRACT

Objetivo: describir la asociación entre aspectos clinicoepidemiológicos y los resultados microbiológicos en pacientes con queratitis infecciosa ingresados en el Servicio de Córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período 2010-2014. Métodos: se realizó un estudio observacional descriptivo, de corte transversal, de 39 ojos. Se estudiaron las variables edad, sexo, tiempo de evolución, tratamiento previo con antibióticos, factores predisponentes y concordancia del tratamiento empírico. Se utilizaron medidas de resumen para variables cualitativas y cuantitativas, prueba no paramétrica de probabilidad exacta de Fisher, prueba de Chi cuadrado de Pearson y Prueba U de Mann Whitney. Resultados: en los aislamientos de bacterias, el 42,3 por ciento de los pacientes eran menores de 30 años; 53,8 por ciento pertenecían al sexo femenino y el tiempo de evolución promedio fue de 7 días. Los factores predisponentes fueron: enfermedad ocular previa (23,1 %), uso de lentes de contacto (30,8 por ciento) y enfermedades sistémicas (11,5 por ciento). Los mayores de 69 años (46,5 por ciento), el sexo masculino (92,3 por ciento); el tiempo de evolución promedio de 14,5 días y el antecedente de traumatismo ocular no quirúrgico (15,4 por ciento) se observaron en aislamientos micóticos. La perforación corneal se produjo en el 7,7 por ciento de los crecimientos bacterianos; en crecimientos micóticos el 15,4 por ciento desarrolló descemetocele y el 23,1 por ciento perforación corneal. Se realizó queratoplastia penetrante en el 30,8 por ciento(AU) Conclusiones: los aislamientos bacterianos son más frecuentes en pacientes jóvenes, del sexo femenino y con antecedentes de enfermedad ocular previa y uso de lentes de contacto, mientras que la etiología micótica se produce en pacientes del sexo masculino, mayores de 60 años y con antecedentes de trauma corneal no quirúrgico


Objective: to describe the association of clinical and epidemiological aspects with the microbiological results of patients with infectious keratitis, who were admitted to the corneal service of "Ramon Pando Ferrer" Cuban Institute of Ophthalmology in the period of 2010 to 2014. Methods: cross-sectional, descriptive and observational study of 39 eyes. The analyzed variables were age, sex, time of progression, previous antibiotic treatment, predisposing factors and agreement of the empirical treatment. Summary measures for qualitative and quantitative variables; non-parametric Fisher´s exact probability test, Pearson´s Chi square test, and Mann Whitney's U test. Results: in the bacterial isolates, 42.3 percent of patients were younger than 30 years; 53.8 percent were females and average time of progression of disease was 7 days. The predisposing factors were previous eye disease (23.1 percent), use of contact lenses (30.8 percent) and systemic diseases (11.5 percent). Regarding mycotic isolates, patients aged over 69 years (46.5 percent), males (92.3 percent), average time of progression of 14.5 percent and history of non surgical ocular trauma (15.4 percent) predominated. The corneal perforation occurred in 7.7 percent of bacterial infection whereas 15.4 percent developed descemetocele and 23.1 percent corneal perforation in the mycotic infection group. Penetrating keratoplasty was performed in 30.8 percent of patients. Conclusions: bacterial isolates were more frequent in young female patients with a history of previous ocular diseases and contact lenses whereas mycotic etiology was more commonly observed in males over 60 years and history of non surgical corneal trauma(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Anti-Bacterial Agents/therapeutic use , Corneal Ulcer/diagnosis , Eye Infections, Fungal/epidemiology , Keratitis/epidemiology , Keratoplasty, Penetrating/methods , Corneal Ulcer/epidemiology , Cross-Sectional Studies , Epidemiology, Descriptive , Eye Infections, Bacterial/therapy , Eye Infections, Fungal/therapy , Keratitis/microbiology , Observational Study
10.
Arq. bras. oftalmol ; 79(1): 50-52, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-771914

ABSTRACT

ABSTRACT Infectious keratitis is rare following laser vision correction. We present a case of aggressive fungal keratitis caused by Aspergillus flavus, following laser in situ keratomileusis (LASIK) in the setting of a unique environmental risk factor. We describe the key features of the acute case presentation, which guided empirical medical and surgical treatment, resulting in the most favorable outcome found in the literature, to date.


RESUMO Ceratites infecciosas são raras após a correção da visão a laser. Apresentamos um relato de caso de uma ceratite fúngica agressivo por Aspergillus flavus, após ceratomileuse a laser "in situ" (LASIK) em situação peculiar de fator de risco ambiental. Nós descrevemos as principais características da apresentação caso agudo, que orientou tratamento médico e cirúrgico empírico, demonstrando resultado mais favorável do que o encontrado na literatura até o momento.


Subject(s)
Female , Humans , Young Adult , Aspergillus flavus , Eye Infections, Fungal/therapy , Keratitis/microbiology , Keratitis/therapy , Keratomileusis, Laser In Situ/adverse effects , Antifungal Agents/therapeutic use , Cornea/microbiology , Cornea/pathology , Cornea/surgery , Eye Infections, Fungal/microbiology , Keratitis/pathology , Microbial Sensitivity Tests , Postoperative Complications , Surgical Flaps/microbiology , Treatment Outcome
11.
Bahrain Medical Bulletin. 2016; 38 (1): 59-61
in English | IMEMR | ID: emr-175713

ABSTRACT

An eighty-five-year-old female presented with preexisting conditions of benign essential hypertension, dyslipidemia, chronic renal failure and diabetes mellitus type 2. She had gastroenteritis, pain and redness in right [blind] eye with corneal decompensation, scarring and right-eye corneal ulcer with hypopyon. Corneal scrapings sent for culture report revealed growth of Morganella Morganii and Enterococci Corneal ulcer was successfully treated with topical and oral antibiotics


Subject(s)
Aged, 80 and over , Female , Humans , Keratitis/microbiology , Keratitis/complications , Morganella morganii/pathogenicity , Enterococcus , Keratitis/therapy , Anti-Bacterial Agents
12.
Arq. bras. oftalmol ; 76(6): 370-373, nov.-dez. 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-701290

ABSTRACT

OBJETIVO: Investigar sazonalidade de ceratities infecciosas em serviço terciário no Brasil. MÉTODOS: Estudo retrospectivo de dados coletados do Laboratório de Microbiologia Ocular do Departamento de Oftalmologia da Universidade Federal de São Paulo de 2005 a 2009. Foram definidas como ceratites infecciosas aquelas com cultura positiva para o agente. Dados foram distribuídos de acordo com os meses do ano e modelos de regressão linear com variáveis "dummy" foram utilizados para testar sazonalidade. RESULTADOS: Foram diagnosticados 1.468 casos de ceratite infecciosa durante o período do estudo. Bactérias foram responsáveis por 80,3% dos casos seguidas por fungos (7%), Acanthamoeba (6%) e casos mistos (6,7%). Testes estatísticos não mostraram sazonalidade para bactérias (p=0,064), fungos (p=0,379), Acanthamoeba (p=0,062) ou casos mistos (p=0,441). CONCLUSÃO: Não foi observada sazonalidade nas ceratites infecciosas em nossa amostra.


PURPOSE: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil. METHODS: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of Sao Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends. RESULTS: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were reponsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441). Conclusions: No seasonal trends for infectious keratitis were observed in our sample.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Eye Infections, Bacterial/epidemiology , Eye Infections, Fungal/epidemiology , Eye Infections, Parasitic/epidemiology , Keratitis/epidemiology , Tertiary Care Centers/statistics & numerical data , Acanthamoeba/pathogenicity , Brazil/epidemiology , Eye Infections, Bacterial/microbiology , Eye Infections, Fungal/microbiology , Eye Infections, Parasitic/microbiology , Keratitis/microbiology , Retrospective Studies , Seasons , Time Factors
13.
Bol. micol. (Valparaiso En linea) ; 28(2): 48-52, dic. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-708086

ABSTRACT

Introducción: La queratitits micótica puede ser provocada por una amplia variedad de especies, tanto por hongos filamentosos como levaduras. Objetivo: Conocer las especies involucradas en queratitits micótica durante el decenio 2003-2013 en la ciudad de Valparaíso. Materiales y método: Se revisaron los casos de queratitis micótica diagnosticados durante el periodo 2003-2013 en la cátedra de Micología de la Universidad de Valparaíso. Las muestras fueron tomadas con tórulas estériles, las cuales fueron sembradas en agar sabouraud y una vez obtenido el desarrollo de las especies se traspasaron a medios de cultivo especiales. La identificación se realizó por morfofisiología y en el caso de Candida además por pruebas bioquímicas. Resultados: Se diagnosticaron 10 pacientes con queratitis micótica, de ellos 6 fueron hombres. 8 pacientes tenían el antecedente de lesión traumática corneal. Las especies más frecuentes fueron Aspergillus fumigatus y Fusarium oxysporum. También se aislaron especies como Fusarium dimerumy Exophiala jeanselmei. Conclusión: De los 10 casos de queratitis micótica diagnosticados, la mayoría tenía el antecedente de lesión traumática corneal. Los géneros más aislados fueron Aspergillus y Fusarium.


Introduction: Fungal keratitis can be caused by a wide variety of species, either filamentous as yeast fungi. Objective: To determine the species involved in fungal keratitis during the decade 2003-2013 in the city of Valparaiso. Materials and Methods: The cases of fungal keratitis diagnosed in the depar tment of Mycology, University of Valparaiso, were reviewed for the period 2003-2013. Samples were taken with sterile swabs, which were seeded in Sabouraud agar and after obtaining the development of species, were transferred to special culture media. Identification was performed by morphophysiology and in the case of Candida further biochemical tests. Results: 10 patients were diagnosed with fungal keratitis, of which 6 were men. 8 patients had a history of traumatic corneal injury. The most frequent species were Aspergillus fumigatus and Fusarium oxysporum. Species Fusarium dimerum and Exophiala jeanselmei were also isolated. Conclusion: Of the 10 cases of fungal keratitis diagnosed, most had a history of traumatic corneal injury. The most isolated genus were Aspergillus and Fusarium.


Subject(s)
Humans , Male , Adult , Agar , Aspergillus fumigatus/pathogenicity , Candida , Candida/pathogenicity , Cornea/microbiology , Cornea/pathology , Fusarium/pathogenicity , Keratitis/diagnosis , Keratitis/microbiology , Chile , Environment , Fungi/pathogenicity
14.
Arq. bras. oftalmol ; 76(3): 175-179, maio-jun. 2013. ilus, tab
Article in English | LILACS | ID: lil-681851

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 Acuity
15.
Saudi Medical Journal. 2013; 34 (11): 1156-1160
in English | IMEMR | ID: emr-140891

ABSTRACT

To study the incidence and risk factors of the bacteria causing infectious keratitis among patients in Qassim province of Saudi Arabia. This is a cross sectional study conducted at the Department of Optometry, College of Applied Medical Sciences, Qassim University, Qassim, Kingdom of Saudi Arabia from December 2010 to May 2011. One hundred patients suspected of keratitis were subjected to clinical examinations. A total of 115 corneal swabs from these cases were collected under aseptic conditions for bacteriological examinations. Culture of the corneal swabs revealed Pseudomonas aeruginosa [25.2%], Staphylococcus aureus [15.7%], and unclassified bacteria [13.9%]. However, 52 swabs of infectious keratitis cases [45.2%] were negative to bacteria. Contact lens wearing [44.4%] was the most common risk factor among the examined patients, followed by corneal trauma [21.7%], ocular surface disease [11.3%], and corneal surgery [7%]. No significant correlation was observed between systemic risk factor and clinical presentation. It could be concluded that infectious keratitis was mostly due to Pseudomonas aeruginosa and Staphylococcus aureus. Therefore, strict measures are recommended to control and treat infectious keratitis to avoid visual complications


Subject(s)
Humans , Male , Female , Keratitis/microbiology , Bacteria , Incidence , Risk Factors , Cross-Sectional Studies , Pseudomonas aeruginosa , Staphylococcus aureus
16.
Arq. bras. oftalmol ; 75(6): 423-426, nov.-dez. 2012. ilus, graf, tab
Article in English | LILACS | ID: lil-675627

ABSTRACT

PURPOSE: To assess S. aureus in vitro viability after the exposure to ultraviolet light A (UVA) and riboflavin (B2). METHODS: Samples of S. aureus in 96 well plates (in triplicate) were exposed to riboflavin (B2) and ultraviolet light A (365 nm wavelength) at a power density of 3 mW/cm², 8 mm spot diameter, for 30 minutes. Control groups were prepared as well in triplicate: blank control, ultraviolet light A only, riboflavin only and dead bacteria Control. The bacterial viability was measured using fluorescent microscopy. In order to investigate the occurrence of "viable but non-culturable" microorganisms after treatment, the cell viability was also investigated by plate culture procedure onto a broth medium. Statistical analysis was performed using the triplicate values from each experimental condition. RESULTS: No difference was observed among the treatment group and the control samples (p=1). CONCLUSION: The combination of riboflavin 0.1% and ultraviolet light A at 365 nm did not exhibit antimicrobial activity against oxacillin susceptible S. aureus.


OBJETIVO: Avaliar a viabilidade celular de S. aureus in vitro após a exposição de riboflavina (B2) e luz ultravioleta A (UVA). MÉTODOS: Amostras de S. aureus colocadas em uma placa de 96 poços (em triplicata) foram expostas a riboflavina 0,1% (B2) e luz ultravioleta (comprimento de onda de 365 nm) poder de 3 mW/cm², 8 mm de diâmetro, por 30 minutos. Grupos controles foram também preparados em triplicata: controle branco, somente luz ultravioleta A, somente riboflavina e controle morto. A viabilidade bacteriana foi analisada usando microscópio de fluorescência. Para investigar a ocorrência de micro-organismos "viáveis porem não cultiváveis" a viabilidade celular foi avaliada utilizando-se placas de meio de cultivo bacteriano. Analise estatística foi realizada utilizando-se os valores obtidos em triplicata de cada grupo experimental. RESULTADOS: Nenhuma diferença foi observada entre o grupo tratamento e os grupos controle (p=1). CONCLUSÃO: A combinação riboflavina 0,1% e luz ultravioleta 365 nm de comprimento de onda não demonstrou atividade antimicrobiana contra S. aureus oxacilina sensível.


Subject(s)
Anti-Bacterial Agents/pharmacology , Keratitis/microbiology , Photosensitizing Agents/pharmacology , Riboflavin/pharmacology , Staphylococcal Infections/microbiology , Staphylococcus aureus/radiation effects , Ultraviolet Rays , Anti-Bacterial Agents/therapeutic use , Colony Count, Microbial , Keratitis/drug therapy , Microbial Viability , Photochemotherapy/methods , Photosensitizing Agents/therapeutic use , Riboflavin/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Vitamin B Complex/therapeutic use
17.
Braz. j. microbiol ; 43(4): 1355-1364, Oct.-Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-665820

ABSTRACT

By using agar well diffusion assay, antifungal activity of aqueous extract prepared from Egyptian garlic (Allium sativum L.) was evaluated in vitro against two strains of Aspergillus flavus (OC1 and OC10) causing human ocular infection. The recorded minimum inhibitory concentration (MIC) for growth inhibition of both strains was 3.60 mg/ml. Aqueous garlic extract (AGE) was used in successive in vivo tests as an attempt to cure rabbit's fungal keratitis caused by A. flavus OC1. Findings showed that diluted preparation of AGE was effective topical antifungal agent and succeeded to cure severe A. flavus keratitis in a time course less than 10 days without any observable side effects. Microscopic examination showed that AGE induced deleterious cyto-morphological aberrations inA. flavus target cells. AGE applied to Czapek's broth via contact method was more effective on growth, spores and aflatoxin B1 production than AGE applied to the same broth at the same concentration via fumigation method.


Subject(s)
Humans , Aspergillosis , Aflatoxin B1/analysis , Antifungal Agents/analysis , Aspergillus flavus/isolation & purification , Keratitis/microbiology , Spores, Fungal/isolation & purification , Plant Extracts/analysis , Fumigation/methods , In Vitro Techniques , Efficacy , Garlic , Methods , Patients
18.
Indian J Ophthalmol ; 2012 Jul-Aug; 60(4): 267-272
Article in English | IMSEAR | ID: sea-144851

ABSTRACT

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.


Subject(s)
Corneal Ulcer/epidemiology , Corneal Ulcer/etiology , Corneal Ulcer/microbiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/etiology , Eye Infections, Bacterial/microbiology , Eye Injuries/epidemiology , Eye Injuries/etiology , Eye Injuries/microbiology , Humans , India/epidemiology , Keratitis/epidemiology , Keratitis/etiology , Keratitis/microbiology , Pseudomonas Infections/epidemiology , Pseudomonas Infections/etiology , Pseudomonas Infections/microbiology , Staphylococcal Infections/epidemiology , Staphylococcal Infections/etiology , Staphylococcal Infections/microbiology
19.
Braz. j. infect. dis ; 16(2): 204-208, May-Apr. 2012. ilus
Article in English | LILACS | ID: lil-622744

ABSTRACT

Atypical fast-growing Mycobacterium species are usually identified after laser-assisted in situ keratomileusis, cosmetic surgeries, and catheter-related, pulmonary or soft tissue infections. We herein present the case of a 56-year-old man with purulent discharge, redness, and foreign body sensation in his left eye. He underwent two surgeries that partially controlled the infection but were not curative. Corneal transplantation was performed, and a biopsy of the excised cornea indicated Mycobacterium aurum infection, which was confirmed by polymerase chain reaction-restriction fragment length polymorphism analysis. This appears to be the first documented case of keratitis attributable to the non-tuberculous mycobateria M. aurum. The intractable extra-ocular progression of the disease in the absence of general signs or symptoms was notable. We suggest considering non-tuberculous mycobacteria among the probable causes of complicated keratitis or keratitis that does not respond to drug treatment, especially in regions where tuberculosis is endemic.


Subject(s)
Humans , Male , Middle Aged , Keratitis/microbiology , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium/genetics , Keratitis/diagnosis , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium/classification , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length
20.
Indian J Pathol Microbiol ; 2012 Apr-Jun 55(2): 248-249
Article in English | IMSEAR | ID: sea-142235

ABSTRACT

We report a case of keratomycosis caused by Exserohilum rostratum. A 46-year-old farmer presented with history of pain, watery discharge and redness of the right eye for the past 2 weeks following trauma with vegetable matter. On ocular examination, a central corneal ulcer of about 8 mm with a greyish-white slough, feathery edges and diffuse corneal edema was seen in the right eye. KOH examination of corneal scrapings revealed thick, brown, branched, septate hyphae. Culture of corneal scrapings on Sabouraud dextrose agar showed velvety greenish-black colony with a black pigment on the reverse. The culture was identified as E. rostratum on the basis of microscopic morphology. The patient responded well to treatment with topical natamycin and oral itraconazole.


Subject(s)
Antifungal Agents/administration & dosage , Ascomycota/cytology , Ascomycota/isolation & purification , Culture Media/chemistry , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/pathology , Humans , Itraconazole/administration & dosage , Keratitis/diagnosis , Keratitis/drug therapy , Keratitis/microbiology , Keratitis/pathology , Male , Microscopy , Middle Aged , Mycology/methods , Natamycin/administration & dosage , Treatment Outcome , Wounds and Injuries/complications
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