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

P A Thomas¹, A K Leck² and M Myatt³

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

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

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