The clinical diagnosis of microbial keratitis.

The clinical diagnosis of microbial keratitis. Research Abstract Details 

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The clinical diagnosis of microbial keratitis. Abstract Text:

Matthew A Dahlgren,Ahila Lingappan,Kirk R Wilhelmus,

PURPOSE: To evaluate the ability of ophthalmologists to predict the laboratory results of presumed microbial keratitis and to explore which findings may influence diagnostic prognostication. DESIGN: Prospective, cross-sectional study. METHODS: Fifteen ophthalmologists completed study forms at the initial presentation of patients with presumed microbial keratitis. After predicting the category of microbial recovery, clinicians submitted corneal scrapings for masked laboratory processing. The relative effects of ocular inflammatory signs on correct microbial diagnosis were explored with Poisson regression. RESULTS: Clinical examiners correctly predicted the presence or absence of microbial recovery in 79 (76%) of 104 ulcerative keratitis cases and successfully distinguished among bacterial, fungal, and amebic keratitis for 54 (73%) of 74 culture-positive infections, although only 31 (42%) were subcategorized properly. The positive predictive value of clinical diagnosis was 65% (95% confidence interval [CI], 43% to 84%) for 20 eyes with Pseudomonas keratitis cases, 48% (95% CI, 32% to 63%) for 38 other bacterial keratitis, 45% (95% CI, 17% to 77%) for 13 fungal keratitis, and 89% (95% CI, 52% to 100%) for nine Acanthamoeba keratitis cases. The recognition of Pseudomonas keratitis significantly improved by the occurrence of a larger infiltrate (P = .02), and correctly predicting Acanthamoeba keratitis was enhanced by observing a ring infiltrate (P < .001). Antimicrobial use before referral significantly attenuated clinical diagnosis (P = .03) and hampered microbial recovery (P = .004). CONCLUSIONS: Established Pseudomonas keratitis and Acanthamoeba keratitis can be suspected before laboratory confirmation, but overlapping inflammatory features and recent empiric antimicrobial treatment limits etiologic recognition of most microbial corneal infections.

The clinical diagnosis of microbial keratitis. Publishing Authors By Initials

MA Dahlgren,A Lingappan,KR Wilhelmus,

For similar investigative techniques: epidemiologic methods: statistics as topic: sensitivity and specificity research abstracts see: investigative techniques: epidemiologic methods: statistics as topic: sensitivity and specificity research

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The clinical diagnosis of microbial keratitis. Journal Published:

PUBLICATION TYPE: Research Support, Non-U.S. Gov

Journal: American journal of ophthalmology

VOLUME: 143

Page Numbers: 940-944

Journal Abbreviation: Am. J. Ophthalmol.

ISSN: 0002-9394

DAY: 3

MONTH: 04

YEAR: 2007

The clinical diagnosis of microbial keratitis. Information

Number of References:

LANGUAGE: eng

NlmUniqueID: 370500

The clinical diagnosis of microbial keratitis. Keywords Mesh Terms:

KEYWORDS: Sensitivity and Specificity

MESH TERMS: isolation & purification

Chemical & Substance for Abstract: The clinical diagnosis of microbial keratitis. Information

Substance Name: Anti-Bacterial Agents

Registry Number: 0

Grant and Affiliation Information for The clinical diagnosis of microbial keratitis.

AFFILIATION: Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA.

Country: United States

AGENCY: United States NEI

GRANT: EY02520

ACRONYM: EY

MEDLINETA: Am J Ophthalmol

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