Please use this identifier to cite or link to this item: https://hdl.handle.net/10216/128824
Author(s): João Tiago Fernandes Loja
Title: A 10-Year Clinical Analysis of Fungal Keratitis at CHUSJ
Issue Date: 2020-05-29
Abstract: Purpose: To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral center. Methods: A retrospective review of medical records from hospitalised patients treated for fungal keratitis at CHUSJ from 2009 to 2019 was conducted. Results: Overall, 43 patients were included in our study, being the majority aged over 65 years old (60.5%) and 46.5% were men. From the isolates cultured, 21 (48.8%) were filamentous forms and 22 (51.2%) were yeast forms. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.3%), Aspergillus species (n = 4, 9.3%) were the most common isolated species. The most common risk factors were contact lens use (n=24,55.8%), history of keratitis (n=16,37.2%), and previous keratoplasties (n=14,32.6%). The most frequent use treatment was voriconazole, amphotericin B, fluconazole and fortified drops. Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic PKP. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes at BCVA were founded after treatment (p=0.687). When comparing the subgroups of filamentous fungi and yeast fungi, there were no statistically significant differences at the studied variables. Conclusion: Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species had equally prevalent etiologies. In general, our results mirror the difficult task of treating fungal keratitis and reflect the bad outcomes obtained. Therefore, similar studies should be performed in order to formulate better diagnosis and treatment strategies, hence, to improve patients' outcome in the future.
Description: Objetivo: Determinar a microbiologia, fatores de risco, tratamento e intervenções cirúrgicas de queratite fúngica, num centro de referência terciário. Métodos: Um estudo retrospetivo sobre queratite fúngica foi conduzido, em doentes hospitalizados e tratados no CHUSJ, de 2009 a 2019. Resultados: De uma forma geral, 43 doentes foram incluídos no nosso estudo, tendo a maioria mais de 65 anos de idade (60.5%) e 46.5% homens. Dos fungos isolados, 21 (48.8%) foram filamentosos e 22(51.2%) leveduriformes. Candida (n=20, 46.5%), Fusarium (n=19,23.3%), Aspergillus(n=4,9.3%), foram as espécies mais isoladas no nosso estudo. Os fatores de risco mais comuns foram o uso de lentes de contato (n=24,55.8%), história de queratite (n=16,37.2%) e queratoplastias prévias (n=14,32.6%), foram fatores de risco descritos num grande número de doentes. O tratamento médico consistiu maioritariamente em voriconazole, anfotericina B, fluconazole e colírios fortificados. Vinte e quatro casos(55.8%) requereram intervenção cirúrgica, dos quais 23 realizaram queratoplastia penetrante. Complicações oculares, tais como, evisceração, registou-se em 12 doentes (27.9%) e endoftalmite em 5 doentes(11.6%). Não foram encontradas diferenças estatisticamente significativas para a acuidade visual após o tratamento (p=0,687). Quando comparando os fungos filamentosos e leveduriformes, não foram encontradas também diferenças estatisticamente significativas para as diversas variáveis em estudo. Conclusão: Maioria dos doentes diagnosticados com queratites fúngicas têm fatores de risco associados. Os fungos filamentosos e leveduriformes tiveram etiologias igualmente prevalentes. Em suma, os nossos resultados refletem as dificuldades associadas ao tratamento de queratite fúngica, assim como os maus prognósticos que foram obtidos. Assim, estudos semelhantes deverão ser realizados, a fim de otimizar o diagnóstico e as estratégias terapêuticas e, dessa forma, improvisar futuramente o prognóstico dos doentes.
Subject: Medicina clínica
Clinical medicine
Scientific areas: Ciências médicas e da saúde::Medicina clínica
Medical and Health sciences::Clinical medicine
URI: https://hdl.handle.net/10216/128824
Document Type: Dissertação
Rights: openAccess
Appears in Collections:FMUP - Dissertação

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