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目的:确定真菌性角膜炎的易感因素、致病真菌,以及提高相应的实验室诊断能力。方法:240例240眼临床疑似微生物感染的角膜溃疡患者进入本研究。通过病史回溯及裂隙灯检查获得病例资料。采用标准技术完成角膜刮片检查。取部分刮片样本加入10%的氢氧化钾液后,以及采用革兰氏和吉姆萨染色,在直接在显微镜下观察是否存在真菌、细菌和棘阿米巴。另一部分刮片样本直接接种在血琼脂、麦康基琼脂、巧克力琼脂和萨布罗琼脂表面。结果:在纳入本研究的240例伴有脓性分泌物的角膜溃疡患者中,84例(35%)被确认为真菌感染。其中48例(57.1%)为男性,其余36例(42.9%)为女性。年龄分布从22-80岁。其中60例(71.4%)为农村患者,其余24例(28.6%)为城市居民。18例(21.4%)曾有植物外伤史。病变高发于10月至11月间。在84例确诊为真菌性角膜炎的患眼,致病原因为单纯真菌者74眼(80.10%),其余10眼(11.90%)为真菌合并细菌感染。分离得到的最常见致病微生物为白色念珠菌,在66眼(78.6%)中被发现。结论:在巴基斯坦南部,感染性角膜溃疡中,最常见的是真菌性角膜炎,而白色念珠菌是最常见的致病原。采用加入10%的氢氧化钾液后直接显微镜下观察是此类感染原简单、迅速、价廉及可信的诊断方法。
OBJECTIVES: To identify susceptible factors for fungal keratitis, pathogenic fungi, and to improve appropriate laboratory diagnostic capabilities. Methods: 240 patients (240 eyes) with corneal ulcer were included in this study. Case histories were obtained by reviewing history and slit lamp examination. Corneal scraping is done using standard techniques. A portion of the smear sample was added to 10% potassium hydroxide solution and stained with Gram and Giemsa for the direct observation under microscope of the presence of fungi, bacteria and Acanthamoeba. The other swatches were seeded directly on blood agar, MacConkey agar, chocolate agar, and Sabro agar. RESULTS: Of the 240 patients with corneal ulcer accompanied by purulent secretions included in this study, 84 (35%) were identified as fungal infections. Of these, 48 (57.1%) were males and the remaining 36 (42.9%) were females. The age distribution from 22-80 years old. Of these, 60 (71.4%) were rural patients and the remaining 24 (28.6%) were urban residents. 18 cases (21.4%) had a history of plant trauma. High incidence of lesions in October to November. In 84 eyes diagnosed as fungal keratitis, the cause of the disease was 74 eyes of simple fungi (80.10%), and the other 10 eyes (11.90%) were fungi with bacterial infection. The most common pathogenic microorganism isolated was Candida albicans, found in 66 eyes (78.6%). Conclusion: Fungal keratitis is the most common form of infectious corneal ulcer in southern Pakistan, whereas Candida albicans is the most common causative agent. The use of 10% potassium hydroxide solution directly after the observation under the microscope is such a simple, rapid, cheap and credible diagnostic method.