CAJ | 학술논문

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.
목적 탐토진균성안내염적치병인소、상견류형급실험실검사결과적특점.방법 회고성계렬병례연구.수집2000년1월지2012년12월년간취진우산동성안과연구소청도안과의원적81례진균배양양성적안내염환자자료,연구진균성안내염적주요치병인소、상견류형화실험실검사결과.결과 외원성진균성안내염점90.1％(73/81),기중43례시계발우진균성각막궤양,27례시각막천통상소치,3례계발우안부기타수술.내원성진균성안내염점9.9％(8/81),기중4례여약물사용유관.공유67례환자진행료도편현미경사균사,양성솔위77.6％(52/67),기중전방적농양성솔위80.0％(16/20),파리체양성솔위76.6％(36/47).81빈안내염환자표본공배양출10개균속18개균충,주요적치병균의차위렴도균속60.5％(49/81)、곡매속21.0％(17/81)화념주균속6.2％(5/81).계발우각막궤양적환자중렴도균점88.4％(38/43),각막천통상환자중곡매균점40.7％(11/27),내원성안내염환자중곡매균점50.0％ (4/8).렴도균화곡매균대복립강서、량성매소B、동강서、이곡강서화불강서적총민감솔분별위84.7％(33/39)、71.8％(28/39)、43.6％(17/39)、17.9％(7/39)화7.7％(3/39).결론 진균성안내염적주요류형시외원성안내염,진균성각막궤양화각막천통상시진균성안내염적주요병인.렴도균、곡매균화념주균시진균성안내염적주요치병균,기중렴도균시계발우진균성각막궤양적안내염적수위치병균,곡매균시천통상후진균성안내염적수위치병균.내원성진균성안내염적주요병인시약물사용,수위치병균시곡매균.전방액화파리체액도편사조균사시진단진균성안내염적유효방법.렴도균속화곡매속대복립강서화량성매소B적민감성고.
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.