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2010 OMIG, Abstract 5

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Clinical differentiation of bacterial and fungal corneal ulcers
C. Dalmon1,T. Porco1, T. Lietman1, L. Prajna2, M. Ranjan Das2, J.A. Kumar2, J. Mascarenhas2, T. Margolis1, J. Whitcher1, B.H. Jeng1, J. Keenan1, M. Chan1, S. McLeod1, N.R. Acharya1
1F. I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, 2Aravind Eye Hospital, Madurai, South India

Purpose: To determine whether clinical features of keratitis can be used to identify the etiology.
Methods: Eighty photographs, representing corneal ulcers with laboratory confirmation of etiology were randomly selected from the Steroids for Corneal Ulcers Treatment (SCUT) and the preliminary Mycotic Ulcer Treatment Trial (MUTT) database.  A survey was presented that asked clinicians to predict culture results and identify the presence of certain traits. Two groups of clinicians were asked to evaluate the photographs and complete the survey: 8 clinicians from the Proctor Foundation and 7 clinicians from the Aravind Eye Hospital.
Results: Seventy-nine of 80 photographs were included for analysis.  One photograph was excluded as it was a mixed infection. Overall, clinicians were able to accurately distinguish bacterial from fungal etiology 66% (95% CI, 63 to 68) of the time (P<0.001).  The gram stain, genus, and species were accurately predicted 45% (95% CI, 39 to 50), 25% (95% CI, 21 to 29), and 20% (95% CI, 14 to 25) of the time, respectively.  The presence of an irregular/feathery border was most associated with fungal keratitis, while a wreath infiltrate was associated with Nocardia spp (P<0.001). 
Conclusions: Corneal specialists correctly differentiated bacterial from fungal corneal ulcers better than chance, although still less than 70% of the time. More specific categorization led to less successful clinical distinction.  An irregular/feathery border and a wreath infiltrate were found to have an association with underlying etiology.  This study highlights the importance of obtaining appropriate microbiological testing during the initial clinical encounter.

Disclosure Code: N; NIH funding U10-EY015114-01

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