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Yousef Cruz-Inigo, Sanjay Patel, Leo Maguire, Joaquin Garcia, Diva Salomao; Clinical and Pathologic Findings in Patients with Suspected Infectious Keratitis: A Single Institution Experience. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2908.
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To compare culture and histopathologic results collected during the same procedure in patients with suspected infectious keratitis.
Computer-based search of Mayo Clinic’s pathology database identified all corneal specimens submitted to both pathology and microbiology laboratories for patients with suspected infectious keratitis from January 1, 1994 to July 1, 2012. The medical record of each patient was retrospectively reviewed to determine the clinical indication, biopsy and culture results, and clinical outcome.
We identified 109 eyes (108 patients) from which 131 simultaneous corneal biopsy and culture specimens were retrieved. Mean age was 53 ± 25 years (± SD; range, 2 - 97 years), and 57 patients were female (53%). The most common indication was ulcerative keratitis (90 specimens). Microorganisms were identified in 67 specimens; by culture alone (28/67, 21%), by histopathology alone (17/67, 25%), or by both techniques (22/67, 33%). Microorganisms identified by culture alone were most commonly bacteria (22), whereas microorganisms identified by histopathology alone were typically Acanthamoeba (8) or fungi (6). There were 10 instances of polymicrobial infection, usually detected by culture (7 specimens); three of these cases resulted in evisceration. In 64 specimens (57 patients), no microorganisms were identified by either culture or histopathology. Histopathology of these cases showed acute inflammation consistent with acute keratitis in 77% (49/64), ulceration in 58% specimens (37/64), and stromal fibrosis consistent with scarring in 13% (8/64). In this group, repeat biopsies revealed bacteria in only 2 of 6 patients.
Histopathology and laboratory culture provide complementary information to ophthalmologists in cases of suspected infectious keratitis. Bacteria were frequently identified by culture even when not visible in histopathologic sections, while some cases of fungi and Acanthamoeba were only seen in the histopathologic examination.
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