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      Distribuição das ceratites infecciosas em hospital terciário no Brasil Translated title: Distribution of infectious keratitis in a tertiary hospital in Brazil

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          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.

          Translated abstract

          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.

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          Most cited references23

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          Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases.

          To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice. A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and treated at the Quinze-Vingts National Center of Ophthalmology, Paris, France, was performed during a 20 month period. A bacterial keratitis was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping and/or that was cured with antibiotic therapy. Risk factors, clinical and microbiological data were collected. 300 cases (291 patients) of presumed bacterial keratitis were included. Potential predisposing factors, usually multiple, were identified in 90.6% of cases. Contact lens wear was the main risk factor (50.3%). Trauma or a history of keratopathy was found in 15% and 21% of cases, respectively. An organism was identified in 201 eyes (68%). 83% of the infections involved Gram positive bacteria, 17% involved Gram negative bacteria, and 2% were polymicrobial. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.004), as well as greater surface of infiltrates (p=0.01). 99% of ulcers resolved with treatment, but only 60% of patients had visual acuity better than the level at admission, and 5% had very poor visual outcome. Contact lens wear is the most important risk factor. Most community acquired bacterial ulcers resolve with appropriate treatment.
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            Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade

            Purpose: To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis. Materials and Methods: Retrospective analysis of a non-comparative series from the database was done. All the patients presenting with corneal stromal infiltrate underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy. Results: Out of 5897 suspected cases of microbial keratitis 3563 (60.4%) were culture-proven (bacterial – 1849, 51.9%; fungal – 1360, 38.2%; Acanthamoeba – 86, 2.4%; mixed – 268, 7.5%). Patients with agriculture-based activities were at 1.33 times (CI 1.16–1.51) greater risk of developing microbial keratitis and patients with ocular trauma were 5.33 times (CI 6.41–6.44) more likely to develop microbial keratitis. Potassium hydroxide with calcofluor white was most sensitive for detecting fungi (90.6%) and Acanthamoeba (84.0%) in corneal scrapings, however, Gram stain had a low sensitivity of 56.6% in detection of bacteria. Majority of the bacterial infections were caused by Staphylococcus epidermidis (42.3%) and Fusarium species (36.6%) was the leading cause of fungal infections. A significantly larger number of patients (691/1360, 50.8%) with fungal keratitis required surgical intervention compared to bacterial (799/1849, 43.2%) and Acanthamoeba (15/86, 17.4%) keratitis. Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively. Conclusions: While diagnostic and treatment modalities are well in place the final outcome is suboptimal in fungal keratitis. With more effective treatment available for bacterial and Acanthamoeba keratitis, the treatment of fungal keratitis is truly a challenge.
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              Incidence of ulcerative keratitis in a defined population from 1950 through 1988.

              To determine the incidence of ulcerative keratitis and to assess trends in risk factors leading to ulcerative keratitis. Retrospective incidence cohort study. General community. Population-based sample of residents of Olmsted County, Minnesota, in the 39-year period between 1950 and 1988. Cases of ulcerative keratitis. One hundred forty-one cases of ulcerative keratitis were diagnosed among 131 residents (64 men and 67 women) of Olmsted County. The mean annual age-adjusted incidence per 100,000 people was 5.3 (95% confidence interval, 4.4 to 6.2). A 435% increase in the incidence of ulcerative keratitis was observed in Olmsted County residents from the 1950s (2.5 per 100,000 people) to the 1980s (11.0 per 100,000 people) (P = .001). The cases of ulcerative keratitis associated with contact lens wear increased from 0% in the 1950s and 1960s to 32% in the 1970s and 52% in the 1980s. The incidence of ulcerative keratitis has increased significantly in this community. Contact lens wear was the most important risk factor for the development of ulcerative keratitis during the last decade.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abo
                Arquivos Brasileiros de Oftalmologia
                Arq. Bras. Oftalmol.
                Conselho Brasileiro de Oftalmologia (São Paulo, SP, Brazil )
                0004-2749
                1678-2925
                December 2013
                : 76
                : 6
                : 370-373
                Affiliations
                [02] orgnameUniversidade Federal de São Paulo orgdiv1Laboratório de Microbiologia Ocular
                [01] São Paulo SP orgnameUniversidade Federal de São Paulo orgdiv1Departamento de Oftalmologia Brasil
                Article
                S0004-27492013000600011
                10.1590/S0004-27492013000600011
                c389d73e-ce37-4c8a-8adb-5f72c6ecc62b

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 21 March 2013
                : 15 July 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 4
                Product

                SciELO Brazil


                Eye infections, bacterial,Cornea,Keratitis,Infecções oculares fúngicas,Infecções oculares bacterianas,Úlcera de córnea,Córnea,Ceratite,Eye infections, fungal,Corneal ulcer

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