摘要
目的 探讨真菌性眼内炎的致病因素、常见类型及实验室检查结果的特点.方法 回顾性系列病例研究.收集2000年1月至2012年12月年间就诊于山东省眼科研究所青岛眼科医院的81例真菌培养阳性的眼内炎患者资料,研究真菌性眼内炎的主要致病因素、常见类型和实验室检查结果.结果 外源性真菌性眼内炎占90.1％（73/81）,其中43例是继发于真菌性角膜溃疡,27例是角膜穿通伤所致,3例继发于眼部其他手术.内源性真菌性眼内炎占9.9％（8/81）,其中4例与药物使用有关.共有67例患者进行了涂片显微镜查菌丝,阳性率为77.6％（52/67）,其中前房积脓阳性率为80.0％（16/20）,玻璃体阳性率为76.6％（36/47）.81份眼内炎患者标本共培养出10个菌属18个菌种,主要的致病菌依次为镰刀菌属60.5％（49/81）、曲霉属21.0％（17/81）和念珠菌属6.2％（5/81）.继发于角膜溃疡的患者中镰刀菌占88.4％（38/43）,角膜穿通伤患者中曲霉菌占40.7％（11/27）,内源性眼内炎患者中曲霉菌占50.0％ （4/8）.镰刀菌和曲霉菌对伏立康唑、两性霉素B、酮康唑、伊曲康唑和氟康唑的总敏感率分别为84.7％（33/39）、71.8％（28/39）、43.6％（17/39）、17.9％（7/39）和7.7％（3/39）.结论 真菌性眼内炎的主要类型是外源性眼内炎,真菌性角膜溃疡和角膜穿通伤是真菌性眼内炎的主要病因.镰刀菌、曲霉菌和念珠菌是真菌性眼内炎的主要致病菌,其中镰刀菌是继发于真菌性角膜溃疡的眼内炎的首位致病菌,曲霉菌是穿通伤后真菌性眼内炎的首位致病菌.内源性真菌性眼内炎的主要病因是药物使用,首位致病菌是曲霉菌.前房液和玻璃体液涂片查找菌丝是诊断真菌性眼内炎的有效方法.镰刀菌属和曲霉属对伏立康唑和两性霉素B的敏感性高.
Objective To evaluate epidemiologic features and laboratory findings of fungal endophthalmitis in north China.Methods Eighty-one patients （81 eyes） were diagnosed with fungal endophthalmitis at our institution from January 2000 to December 2012.Patient history,etiological agents,direct smear examination,fungal culture and pathogen sensitivity to antifungal drug were evaluated.Results The fungal endophthalmitis was exogenous in 73 cases （90.1%）,among which 43 had fungal keratitis in which Fusarium was the first pathogen occupied 88.4% （38 of 43 cases）.Twenty seven of 73 cases （33.3%） occurred after penetrating ocular trauma and Aspergillus was the most common pathogens isolated in these cases （11 of 27 ; 40.7%）.The left 3 cases were associated with ocular surgery.Four of the other eight eyes （9.9%） with endogenous infection had association with drug abuse.Aspergillus was the main isolated pathogens from the endogenous fungal endophthalmitis （4 of 8 cases）.Hyphae were found in 52 （77.6%） of 67 smear samples by direct microscopic examination.Fungal pathogens cultured from 81 samples were identified as 10 genera and 18 species; Fusarium accounted for 60.5% （49 eyes）,Aspergillus for 21.0% （17 eyes） and Candida for 6.2% （5/81）.The total sensitive rate of Fusarium and Aspergillus in vitro to voriconazole,amphotericin B,ketconazole,itraconazole and fluconazole was 84.7%（33/39）,71.8% （28/39）,43.6% （17/39）,17.9% （7/39） and 7.7% （3/39） respectively.Conclusions Fungal endophthalmitis in north China is predominantly exogenous.Fungal keratitis and penetrating trauma are the main common etiological factors.Fusarium ranks first in pathogens,followed by Aspergillus and Candida.Fusarium was the first pathogen of exogenous fungal endophthalmitis caused by fungal keratitis.Aspergillus was the most common isolated pathogens from exogenous fungal endophthalmitis caused by penetrating ocular trauma and it also was the first pathogen of endogenous fungal endophthalmitis.Microscopic detection of hyphae from samples is helpful in the diagnosis.Fusarium ranks first in pathogens,followed by Aspergillus.They both are more sensitive to voriconazole and amphotericin B than ketconazole,fluconazole and itraconazole.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2014年第11期808-813,共6页
Chinese Journal of Ophthalmology
关键词
眼内炎
眼感染
真菌性
抗真菌药
回顾性研究
Endophthalmitis
Eye infections, fungal
Antifungal agents
Retrospective studies
