Mascarenhas J, Lalitha P, Prajna NV, Srinivasan M, Das M, D'Silva SS, Oldenburg CE, Borkar DS, Esterberg EJ, Lietman TM, Keenan JD. Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features. Am J Opthalmol. 2014 Jan;157(1):56-62. doi: 10.1016/j.ajo.2013.08.032


PURPOSE: To determine risk factors and clinical signs that may differentiate between bacterial, fungal, and acanthamoeba keratitis among patients presenting with presumed infectious keratitis. DESIGN: Hospital-based cross-sectional study.

METHODS: We examined the medical records of 115 patients with laboratory-proven bacterial keratitis, 115 patients with laboratory-proven fungal keratitis, and 115 patients with laboratory-proven acanthamoeba keratitis seen at Aravind Eye Hospital, Madurai, India, from 2006-2011. Risk factors and clinical features of the 3 organisms were compared using multinomial logistic regression.

RESULTS: Of 95 patients with bacterial keratitis, 103 patients with fungal keratitis, and 93 patients with acanthamoeba keratitis who had medical records available for review, 287 (99%) did not wear contact lenses. Differentiating features were more common for acanthamoeba keratitis than for bacterial or fungal keratitis. Compared to patients with bacterial or fungal keratitis, patients with acanthamoeba keratitis were more likely to be younger and to have a longer duration of symptoms, and to have a ring infiltrate or disease confined to the epithelium.

CONCLUSIONS: Risk factors and clinical examination findings can be useful for differentiating acanthamoeba keratitis from bacterial and fungal keratitis.

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