摘要
目的:分析真菌性角膜炎继发感染性眼内炎行眼内容物剜除术患者的临床特点及病原学特点。方法:回顾性系列病例研究。收集2012年1月至2021年12月于山东省眼科医院,因真菌性角膜炎继发感染性眼内炎,而行眼内容物剜除术的所有患者44例(44眼)。分析其病程及发病诱因、眼部及全身病史、临床表现、微生物培养及药物敏感试验结果。结果:纳入的44例患者占同期山东省眼科医院诊断为真菌性角膜炎患者总例数的2.15%。44例患者病程中位数为18.5 d,入院时44眼视力均为无光感,20眼(45%)合并继发性青光眼。44眼均表现为全角膜溃疡,并累及角膜全层及角膜缘处,27眼(61%)合并前房积脓。微生物培养显示39眼(89%)真菌生长,其中镰刀菌属20眼(51%),曲霉菌属8眼(21%),链格孢霉属2眼(5%);其他包括无孢霉4眼(10%),谲诈腐霉菌2眼(5%),尖端赛多孢霉1眼(3%),帚枝霉1眼(3%),多毛拟单孢瓶霉1眼(3%)。培养的菌种对两性霉素B、泊沙康唑、伏立康唑、伊曲康唑、5-氟胞嘧啶、氟康唑、阿尼芬净、米卡芬净、卡泊芬净等的最低抑菌浓度的几何均数依次为1.597、1.338、1.926、3.291、64、189.699、1.36、1.16、1.23μg/ml。结论:真菌性角膜炎继发感染性眼内炎行眼内容物剜除术的患者临床特征常表现为全角膜溃疡,致病菌除常见镰刀菌属、曲霉菌属、链格孢霉属外,其他如无孢霉、谲诈腐霉菌、尖端赛多孢霉等致病侵袭力较强的菌属也较为常见。
Objective:To analyze the clinical and etiological characteristics of patients with fungal keratitis secondary to infectious endophthalmitis who required evisceration.Methods:In this retrospective case series study,a total of 44 patients(44 eyes)who were diagnosed with fungal keratitis secondary to infectious endophthalmitis and underwent evisceration from January 2012 to December 2021 were collected in Shandong Eye Hospital.The course of the disease and its predisposing factors,ocular and systemic history,clinical manifestations,microbial culture and drug sensitivity test results were analyzed.Results:The 44 patients included accounted for 2.15%of the total cases of fungal keratitis diagnosed by Shandong Eye Hospital in the same period.The median course of the disease was 18.5 days.At admission,44 eyes had no light perception,and 20 eyes(45%)were complicated with secondary glaucoma.All 44 eyes showed corneal ulcer,involving the whole corneal layer and limbus,and 27 eyes(61%)complicated with anterior chamber empyema.A total of 39 eyes(89%)of microbial culture had fungal growth,including 20 eyes(51%)of Fusarium,8 eyes(21%)of Aspergillus,2 eyes(5%)of Alternaria,others including 4 eyes(10%)of Nonsporulating molds,2 eyes(5%)of Pythium insidiosum,1 eye(3%)of Scedosporium apiospemum,1 eye(3%)of Sarocladium,1 eye(3%)of Phialemoniopsis pluriloculosa.The geometric mean of the minimum inhibitory concentration values of amphotericin B,posaconazole,voriconazole,itraconazole,5-fuorocytosine,fuconazole,anifensin,micafungin and caspofungin cultivated in this study were 1.597,1.338,1.926,3.291,64,189.699,1.36,1.16,1.23μg/ml.Conclusions:The patients with infectious endophthalmitis secondary to fungal keratitis often present with total corneal ulceration.In addition to the common pathogenic bacteria of Fusarium,Aspergillus and Alternaria,other bacteria with strong pathogenicity and invasiveness such as Nonsporulating molds,Pythium insidiosum and Scedosporium apiospemum are also common.
作者
朱雪靓
毛慧琳
张晓玉
李晓凤
鹿秀海
亓晓琳
Xuejing Zhu;Huilin Mao;Xiaoyu Zhang;Xiaofeng Li;Xiuhai Lu;Xiaolin Qi(The Medical College of Qingdao University,Qingdao 266071,China;Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical Unversity(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,School of Ophthalmology Shandong First Medical University,Jinan 250021,China)
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2023年第2期104-110,共7页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
国家自然科学基金(81900907)。
