Clinical differentiation of keratitis due to fungus and Pythium: A photographic survey
Loading...
Date
2023-02
Authors
D’cruz, Rakhi P
Mohamed, Ashik
Das, Sujata
Journal Title
Journal ISSN
Volume Title
Publisher
All India Ophthalmological Society
Abstract
Purpose: To evaluate the knowledge and skills of clinicians in differentiating cases of Pythium from fungal keratitis based on their clinical appearance. Methods: Thirty slit?lamp photographs from culture?proven cases of Pythium and fungal keratitis were selected for conducting a prospective online?based photographic survey. The participants were asked to identify the causative organism and enlist the specific clinical features which helped in reaching the diagnosis. Both cornea specialists and clinical fellows/trainees participated in the survey. Sensitivity, specificity, and predictive values were estimated, and the factors associated with these, including the identification rates of clinical signs, were evaluated using bivariate and multivariate linear regression analyses. The identification rates between the consultants and fellows were compared. Results: A total of 42 cornea specialists (28 consultants and 14 clinical fellows) participated in the survey. Clinicians were able to differentiate Pythium from fungal etiology in only 56% of cases. The differentiating ability between the consultants and fellows was statistically insignificant. Average sensitivity, specificity, and positive and negative predictive values for differentiating Pythium from fungus were 56%, 65%, 56%, and 66%, respectively. The specific clinical features enlisted by the participants to differentiate Pythium from fungus were the presence of tentacles, peripheral guttering, dot?like infiltrates, and elevated plaques. Conclusion: Clinical knowledge regarding the signs and symptoms and the microbiological identification of features for Pythium are still lacking among clinicians. As the treatment protocols are distinctly different for both, it is imperative to enhance the knowledge and diagnosing ability to tackle this emerging microorganism which causes high morbidity
Description
Keywords
Fungus, keratitis, Pythium, survey
Citation
D’cruz Rakhi P, Mohamed Ashik, Das Sujata. Clinical differentiation of keratitis due to fungus and Pythium: A photographic survey. Indian Journal of Ophthalmology. 2023 Feb; 71(2): 510-514