PT  - JOURNAL ARTICLE
AU  - P A Thomas
AU  - A K Leck
AU  - M Myatt
TI  - Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi
AID  - 10.1136/bjo.2005.076315
DP  - 2005 Dec 01
TA  - British Journal of Ophthalmology
PG  - 1554--1558
VI  - 89
IP  - 12
4099  - http://bjo.bmj.com/content/89/12/1554.short
4100  - http://bjo.bmj.com/content/89/12/1554.full
SO  - Br J Ophthalmol2005 Dec 01; 89
AB  - 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.