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Triple infection keratitis.
Eye Contact Lens 2014; 40(3):123-6EC

Abstract

OBJECTIVE

To analyze the demographics, risk factors, and clinical and microbiological characteristics of triple infection keratitis.

DESIGN

Retrospective case series.

PARTICIPANTS

Five patients (five eyes) with triple infection keratitis were identified.

METHODS

Eyes with polymicrobial keratitis were identified from January 2002 to December 2010. Only culture-positive cases and eyes infected by three different organisms were included. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed.

MAIN OUTCOME MEASURES

The size of the corneal infiltrate, presence of hypopyon, pre- and post-treatment best-corrected visual acuity, antibiotic regimen and sensitivity, types of isolated pathogens, duration of infection, and treatment outcomes.

RESULTS

The mean age was 39 years (SD, ±23.4; range, 21-74). Use of topical steroids was the commonest risk factor (80%). Multiple risk factors were identified in four eyes. The average size of corneal infiltrate was 23.5 mm (SD, ±35.2; range, 2.08-85.5), and all eyes developed hypopyon. A total of 15 organisms belonging to 10 species (bacteria=7, fungi=3) were isolated. Pseudomonas aeruginosa and Candida albicans were the most frequently isolated bacteria (n=3) and fungi (n=3), respectively. All patients had at least one type of fungal isolate. Infection resolved with medical treatment in four eyes and one eye had to be eviscerated as the patient developed panophthalmitis. The average time taken for infection to resolve was 30 days (SD, ±19.3; range, 13-61).

CONCLUSIONS

A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Use of topical steroid was the most common risk factor. Prolonged course of disease, relatively large infiltrate, and presence of hypopyon and fungal isolates are typical features of triple infection keratitis.

Authors+Show Affiliations

Department of Ophthalmology (M.R., A.M.T.), National University Health System, Singapore, Singapore; and Yong Loo Lin School of Medicine (M.R., L.C.S.N., A.M.T.), National University of Singapore, National University Health System, Singapore, Singapore.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24681610

Citation

Ray, Manotosh, et al. "Triple Infection Keratitis." Eye & Contact Lens, vol. 40, no. 3, 2014, pp. 123-6.
Ray M, Nigel LC, Tan AM. Triple infection keratitis. Eye Contact Lens. 2014;40(3):123-6.
Ray, M., Nigel, L. C., & Tan, A. M. (2014). Triple infection keratitis. Eye & Contact Lens, 40(3), pp. 123-6. doi:10.1097/ICL.0000000000000022.
Ray M, Nigel LC, Tan AM. Triple Infection Keratitis. Eye Contact Lens. 2014;40(3):123-6. PubMed PMID: 24681610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Triple infection keratitis. AU - Ray,Manotosh, AU - Nigel,Lim Chen Siang, AU - Tan,Anna Marie, PY - 2014/4/1/entrez PY - 2014/4/1/pubmed PY - 2015/1/7/medline SP - 123 EP - 6 JF - Eye & contact lens JO - Eye Contact Lens VL - 40 IS - 3 N2 - OBJECTIVE: To analyze the demographics, risk factors, and clinical and microbiological characteristics of triple infection keratitis. DESIGN: Retrospective case series. PARTICIPANTS: Five patients (five eyes) with triple infection keratitis were identified. METHODS: Eyes with polymicrobial keratitis were identified from January 2002 to December 2010. Only culture-positive cases and eyes infected by three different organisms were included. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed. MAIN OUTCOME MEASURES: The size of the corneal infiltrate, presence of hypopyon, pre- and post-treatment best-corrected visual acuity, antibiotic regimen and sensitivity, types of isolated pathogens, duration of infection, and treatment outcomes. RESULTS: The mean age was 39 years (SD, ±23.4; range, 21-74). Use of topical steroids was the commonest risk factor (80%). Multiple risk factors were identified in four eyes. The average size of corneal infiltrate was 23.5 mm (SD, ±35.2; range, 2.08-85.5), and all eyes developed hypopyon. A total of 15 organisms belonging to 10 species (bacteria=7, fungi=3) were isolated. Pseudomonas aeruginosa and Candida albicans were the most frequently isolated bacteria (n=3) and fungi (n=3), respectively. All patients had at least one type of fungal isolate. Infection resolved with medical treatment in four eyes and one eye had to be eviscerated as the patient developed panophthalmitis. The average time taken for infection to resolve was 30 days (SD, ±19.3; range, 13-61). CONCLUSIONS: A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Use of topical steroid was the most common risk factor. Prolonged course of disease, relatively large infiltrate, and presence of hypopyon and fungal isolates are typical features of triple infection keratitis. SN - 1542-233X UR - https://www.unboundmedicine.com/medline/citation/24681610/Triple_infection_keratitis_ L2 - http://dx.doi.org/10.1097/ICL.0000000000000022 DB - PRIME DP - Unbound Medicine ER -