Clinical results of topical fluconazole for the treatment of filamentous fungal keratitis.

BACKGROUND: Fungal keratitis is a rare but serious condition that may result in loss of vision. The potentially poor prognosis might be due to a delay in diagnosis and/or to limited treatment options. The aim of this study is to evaluate the clinical outcome of patients treated with topical fluconazole 0.2% for the treatment of filamentous fungal keratitis. METHODS: Retrospective case series. A chart review of all patients evaluated at the Ophthalmology Department of the Hospital de Clínicas in Paraguay from January 1997 to December 2000 identified 25 cases of fungal keratitis. Among these cases, one patient discontinued the treatment and another received amphotericin as the first line drug, resulting in 23 cases available for data analysis. Twelve patients were treated with topical fluconazole 0.2% alone (Group I) and 11 patients received a combination of topical fluconazole 0.2% and oral ketoconazole 200 mg twice daily (Group II). RESULTS: Sixteen of 23 cases showed resolution of the keratitis, 9/12 (75%) in Group I and 7/11 (64%) in Group II. Seven patients (30%) did not respond to medical treatment and required a surgical procedure to preserve eye integrity. Superficial and small ulcers have a significantly better prognosis than do lrge and deep ulcers. Concomitant oral ketoconazole (400 mg/day) did not improve the clinical results. CONCLUSIONS: Our findings of study suggest that topical fluconazole 0.2% is a safe and effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases that are not severe. The addition of oral ketoconazole to topical fluconazole did not improve the clinical outcome.

Normal ocular flora in newborns delivered in two hospital centers in Argentina and Paraguay.

PURPOSE: To determine the spectrum of normal conjunctival flora in newborns in two hospital centers in North Argentina and Paraguay. METHODS: In this prospective observational study, conjunctival specimens were obtained from the right eyes of newborns prior to the application of any topical medications. Culture samples were also obtained from the cervicovaginal secretions of the infants' mothers. All samples were directly inoculated into culture media and all growth were identified and quantified. RESULTS: Among the 190 newborns studied, 126 were delivered vaginally and 64 via caesarean section (C-section). A total of 180 different bacterial strains were acquired from the vaginally delivered infants and 77 from the C-section group (P=0.078, Student's t-test). Conjunctival cultures obtained within one hour of birth showed that 85 out of 101 samples (84%) from both the vaginal and C-section group had positive cultures, compared to 84 out of 89 samples (94%) obtained more than 1 h after birth (P<0.001). Among the vaginally delivered newborns, the most common bacteria isolated were coagulase-negative Staphylococcus (in 69 samples, 38%), Propionibacterium spp (36, 20%) and Corynebacterium spp (29, 16%). In the CES, the most common isolates were coagulase-negative Staphylococcus (39, 51%), Propionibacterium spp (22, 29%) and Staphylococcus aureus (6, 8%). There was a significantly higher proportion of gram-positive rods (P=0.017) isolated from infants delivered vaginally (16%) than from those delivered by C-section (5%). No Neisseria gonorrhoeae were isolated in conjunctival samples. Among the 130 organisms isolated from cervicovaginal secretions in 81 out of 189 mothers, the most common organisms were Lactobacillus spp. (47%), Corynebacterium spp (21%), Gardnerella vaginalis (15%), and Candida spp (14%). No Neisseria gonorrhoeae or Chlamydia trachomatis were found in cervicovaginal samples. CONCLUSION: The most common conjunctival bacteria in newborns delivered by either vaginal birth or C-section were coagulase-negative Staphylococcus. The proportion of positive conjunctival cultures was higher for infants delivered vaginally than for C-section delivery.

Epidemiological characteristics of microbiological results on patients with infectious corneal ulcers: a 13-year survey in Paraguay.

BACKGROUND: This is a retrospective, chart-reviewed study of patients diagnosed with infectious corneal ulcers at the Ophthalmology Department of the National University of Asunción in Paraguay. The microbiological culture results are described, as well risk factors for the development of fungal keratitis. METHODS: After obtaining approval from the Institutional Review Board, an analysis of medical charts from 1988 to 2001 was conducted and 660 patients were identified to have been diagnosed with infectious corneal ulcers due to bacteria or fungi. Demographic data were recorded, including age, gender, occupation and geographic location of their home and work (city or rural). Other information collected included the history of the presenting illness, past and current use of ocular medications and whether or not they had a history of trauma or contact lens use. Each patient had an eye examination performed by an ophthalmologist and corneal scrapings were obtained for cultures in all cases. Microbiologic culture results were analyzed. RESULTS: Twenty-one percent (136/660) of the specimens collected from the patients' conjunctiva and cornea were sterile in all culture media. Of the 524 (79%) positive cultures, 267 were due to bacteria (51%), 136 to fungi (26%), and 121 (23%) cultures yielded both fungi and bacteria. Of the 430 isolated bacteria approximately 25% (103) were coagulase negative Staphylococcus, followed by 23% (94) Staphylococcus aureus, 14% (60) Pseudomonas aeruginosa and 13% (56) Streptococcus pneumoniae. Acremonium species accounted for 40% (79) of all fungi identified, followed by Fusarium species (15%) (41). Approximately two-thirds of the patients were male (n = 435). For those patients for whom a history was available, approximately half had a history of trauma. Of these, half of these again involved foreign bodies. Over-the-counter medications were used commonly, and most of those patients had a delay in diagnosis of over 1 week. Risk factors for fungal keratitis as opposed to bacterial keratitis were male gender, agricultural occupation, age between 30 and 59, history of trauma and self-medication. CONCLUSIONS: The results of this study provide demographic data on patients with infectious corneal ulcers in Paraguay. Common causes of such ulcers are both bacteria and fungi. Most patients had self-medicated, and most had delayed seeking professional medical care.