29例念珠菌性角膜炎的临床特点和治疗预后

doi:10.3760/cma.j.cn115909-20210106-00005

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摘要目的：分析念珠菌性角膜炎的发病特征和临床表现，并评估其治疗预后。方法：回顾性系列病例研究。收集2013年1月至2019年12月于山东第一医科大学附属眼科医院明确诊断为念珠菌性角膜炎的患者29例（29眼），其中男18例，女11例，均为单眼发病；1例患者为7月大女婴，其余28例患者年龄为 29～91（59.0±13.5）岁；发病时间为2～90 d，中位数12 d。分析其发病趋势、感染前相关因素、临床表现、角膜激光共聚焦显微镜图像特点、治疗方法和疗效。结果：角膜念珠菌培养阳性共29例（其中白念珠菌10例，近平滑念珠菌6例，其他菌种13例），占同期真菌性角膜炎患者2%。感染前患者最常见的情况是眼部手术史26例（90%），其次是局部糖皮质激素使用史24例（83%）、全身疾病9例（31%）和眼部外伤2例（7%），25例（86%）患者合并2个或更多上述因素。念珠菌性角膜炎结膜充血一般较轻，不伴有典型的伪足、苔被、免疫环等体征。4例早期患者角膜病变表现为单个或多个孤立圆点状病灶，角膜病灶切除联合药物治疗治愈。病变进展后病灶表现多样，最常见为散在多灶性浸润灶（10例，占35%）。最终23例（80%）患者需行手术治疗。结论：念珠菌性角膜炎患者的眼部手术史和局部激素使用史是感染前常见的情况，发病早期特征性表现为孤立圆点状病灶，病灶清除联合药物治疗预后好，晚期病灶表现多样，多数患者需要行角膜移植手术治疗。

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关键词 ： , 念珠菌, 角膜炎, 临床特征, 共聚焦显微镜, 治疗

Abstract： Objective: To analyze the pathogenesis, clinical manifestations and prognosis of candida keratitis. Methods: In this retrospective case series study, a total of 29 patients (29 eyes) who were diagnosed with candida keratitis from January 2013 to December 2019 were recruited. There were 18 males and 11 females, all with monocular disease. One patient was a 7-month-old girl, and the other 28 patients were between 29 and 91(59.0±13.5) years old. The onset time ranged from 2 to 90 days, with a median of 12 days. The incidence trend, the condition before infection, clinical manifestations, image characteristics of confocal microscopy, treatment and curative effect were analyzed. Results: A total of 29 cases were positive for corneal candida culture (10 cases of candida albicans, 6 cases of candida parapsilosis, and 13 other cases), accounting for 2% of all patients with fungal keratitis during the same period. The most common the condition before infection, were ocular surgery in 26 patients (90%), followed by a history of topical glucocorticoid use in 24 patients (83%), systemic disease in 9 patients (31%), and ocular trauma in 2 patients (7%). Twenty-five patients (86%) had two or more risk factors. The conjunctival congestion of patients with candida keratitis was generally mild, without the typical signs of pseudopodia, hyphae moss, or immune ring structure. Four patients with early keratopathy presented with single or multiple isolated, rounded lesions, which were cured by corneal lesion resection combined with drug therapy. After the lesion progression, the lesions showed various manifestations. The most common was scattered multi-focal infiltration (10 cases, 35%), and the final 23 cases (80%) required surgical treatment. Conclusions: A history of ocular surgery and topical glucocorticoid use are common conditions. The early stage of the disease is characterized by isolated, rounded lesions and there is good prognosis if patients are treated with corneal lesion resection combined with drug therapy. Most patients at the late stage require keratoplasty.

Key words： candida keratitis clinical features confocal microscopy treatment

收稿日期: 2021-01-06

PACS:

基金资助: 国家自然科学基金（81870639、81900907）；泰山学者计划（201812150）

通讯作者: 亓晓琳（ORCID：0000-0003-4410-3178），Email：qinglianqxl@163.com

引用本文:

张晓玉王妙霖李晓凤鹿秀海刘敏高华亓晓琳. 29例念珠菌性角膜炎的临床特点和治疗预后[J]. 中华眼视光学与视觉科学杂志, 2021, 23(7): 508-514. Xiaoyu Zhang, Miaolin Wang, Xiaofeng Li, Xiuhai Lu, Min Liu, Hua Gao, Xiaolin Qi. Clinical Features and Treatment Prognosis of 29 Patients with Candida Keratitis. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(7): 508-514. DOI: 10.3760/cma.j.cn115909-20210106-00005

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https://www.cjoovs.com/CN/ 10.3760/cma.j.cn115909-20210106-00005 或 https://www.cjoovs.com/CN/Y2021/V23/I7/508

[1]	Cao J, Yang Y, Yang W, et al. Prevalence of infectious keratitis in Central China. BMC Ophthalmol, 2014, 14: 43. DOI: 10.1186/1471-2415-14-43.
[2]	Xie L, Zhong W, Shi W, et al. Spectrum of fungal keratitis in North China. Ophthalmology, 2006, 113(11): 1943-1948. DOI: 10.1016/j.ophtha.2006.05.035.
[3]	许雪, 黄云丽, 张道军, 等. 念珠菌致真菌性角膜炎3例报告. 中国真菌学杂志, 2014, 9(2): 105-106.
[4]	孙旭光, 赵家良. 念珠菌性眼内炎的诊断和治疗. 中国感染与化疗杂志, 2011, 11(2): 112-113. DOI: 10.16718/j.1009- 7708.2011.02.034.
[5]	Hassan HM, Papanikolaou T, Mariatos G, et al. Candida albicans keratitis in an immunocompromised patient. Clin Ophthalmol, 2010, 4: 1211-1215. DOI: 10.2147/OPTH.S7953.
[6]	Fontana L, Moramarco A, Mandarà E, et al. Interface infectious keratitis after anterior and posterior lamellar keratoplasty. Clinical features and treatment strategies. A review. Br J Ophthalmol, 2019, 103(3): 307-314. DOI: 10.1136/bjophthalmol-2018-312938.
[7]	孔倩倩, 翟华蕾, 程钧, 等. 角膜移植术后植片继发真菌感染的临床特征. 中华眼视光学与视觉科学杂志, 2016, 18(12): 751-756. DOI: 10.3760/cma.j.issn.1674-845X.2016.12.010.
[8]	刘卫卫, 翟华蕾, 程钧, 等. 角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效. 中华眼视光学与视觉科学杂志, 2016, 18(2): 115-120. DOI: 10.3760/cma.j.issn.1674- 845X.2016.02.012.
[9]	张婴元, 汪复. 念珠菌病诊断与治疗: 专家共识. 中国感染与化疗杂志, 2011, 11(2): 81-95. DOI: 10.16718/j.1009- 7708.2011.02.009.
[10]	Keyhani K, Seedor JA, Shah MK, et al. The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty. Cornea, 2005, 24(3): 288-291. DOI: 10.1097/01. ico.0000138832.3486.70.
[11]	Bograd A, Seiler T, Droz S, et al. Bacterial and fungal keratitis:A retrospective analysis at a university hospital in Switzerland. Klin Monbl Augenheilkd, 2019, 236(4): 358-365. DOI: 10.1055/ a-0774-7756.
[12]	Qiao GL, Ling J, Wong T, et al. Candida keratitis: Epidemiology, management, and clinical outcomes. Cornea, 2020, 39(7): 801- 805. DOI: 10.1097/ICO.0000000000002306.
[13]	Galarreta DJ, Tuft SJ, Ramsay A, et al. Fungal keratitis in London: Microbiological and clinical evaluation. Cornea, 2007, 26(9): 1082-1086. DOI: 10.1097/ICO.0b013e318142bff3.
[14]	Bourcier T, Touzeau O, Thomas F, et al. Candida parapsilosis keratitis. Cornea, 2003, 22(1): 51-55. DOI: 10.1097/00003226- 200301000-00012.
[15]	Rumelt S, Bersudsky V, Blum-Hareuveni T, et al. Persistent epithelial defects and ulcers in repeated corneal transplantation: Incidence, causative agents, predisposing factors and treatment outcomes. Graefes Arch Clin Exp Ophthalmol, 2008, 246(8): 1139-1145. DOI: 10.1007/s00417-008-0797-4.
[16]	Arunga S, Kwaga T, Leck A, et al. Bilateral Candida keratitis in an HIV patient with asymptomatic genitourinary candidiasis in Uganda. Med Mycol Case Rep, 2018, 22: 14-17. DOI: 10.1016/ j.mmcr.2018.07.007.
[17]	何键, 程钧, 董燕玲, 等. 真菌性角膜炎1 414 例临床分析. 中华眼科杂志, 2020, 56(4): 286-287. DOI: 10.3760/cma. j.cn112142-20190618-00320.
[18]	李晓凤, 张晓玉, 杜满, 等. 离体及活体念珠菌在共聚焦显微镜下的特征. 中华眼视光学与视觉科学杂志, 2020, 22(11): 809-814. DOI: 10.3760/cma.j.cn115909-20200420-00160.
[19]	Thomas PA. Fungal infections of the cornea. Eye (Lond), 2003, 17(8): 852-862. DOI: 10.1038/sj.eye.6700557.
[20]	Sun RL, Jones DB, Wilhelmus KR. Clinical characteristics and outcome of candida keratitis. Am J Ophthalmol, 2007, 143(6): 1043-1045. DOI: 10.1016/j.ajo.2007.02.016.