真菌性眼内炎27例分析

发布时间：2018-10-18 07:04

【摘要】：目的探讨真菌性眼内炎的主要致病因素,常见致病真菌菌种及治疗结果,为真菌性眼内炎的诊治提供参考。方法回顾分析2007年1月至2012年12月的27例真菌培养阳性的眼内炎患者(27眼)临床资料、致病因素、标本涂片的显微镜检和培养结果以及治疗过程和疗效。结果 27例眼内炎患者中外源性感染21例(77.8%),其中20例是眼部穿通伤所致,1例白内障术后感染;内源性感染6例(22.2%),3例近期使用大剂量激素,1例流产术后,1例继发于骨盆骨折,1例长期应用免疫抑制剂。27例患者进行了玻璃体涂片显微镜查菌丝,阳性率为63.0%(17/27)。27例患者共培养出8个菌属12个菌种,主要病原菌属为曲霉属11例(40.7%)、镰刀属8例(29.6%)和念珠菌属3例(11.1%)。曲霉属主要是黄曲霉6例(22.2%)和烟曲霉5例(18.5%);镰刀属主要为串珠镰刀4例(14.8%)和尖孢镰刀3例(11.1%)。25例患者接受了玻璃体切割手术、玻璃体腔注射抗真菌药物以及穿透角膜移植等一种或多种治疗措施,22例保留住眼球,3例经上述治疗无效行眼内容剜除术;2例患者因病情严重直接行眼内容剜除术。结论真菌性眼内炎主要是外源性眼内炎。眼穿通伤是外源性眼内炎最常见的致病因素,曲霉和镰刀霉是主要病原菌。大量使用激素是内源性眼内炎的主要病因。标本涂片查找菌丝和真菌培养是诊断真菌性眼内炎的有效方法。玻璃体切割手术联合玻璃体腔注射抗真菌药物是治疗真菌性眼内炎的有效方法。
[Abstract]:Objective to explore the main pathogenic factors of fungal endophthalmitis, common pathogenic fungi and treatment results, and to provide reference for the diagnosis and treatment of fungal endophthalmitis. Methods from January 2007 to December 2012, 27 cases (27 eyes) of endophthalmitis with positive fungal culture were retrospectively analyzed, including clinical data, pathogenic factors, microscopical examination and culture results of specimen smears, treatment process and curative effect. Results among the 27 patients with endophthalmitis, 21 cases (77.8%) were exogenous infection, among which 20 cases were caused by ocular perforation injury, and 1 case was infected after cataract surgery. There were 6 cases (22.2%) of endogenous infection, 3 cases were treated with high dose hormone, 1 case was after abortion, 1 case was secondary to pelvic fracture, 1 case was treated with immunosuppressive agent for a long time, 27 cases were examined by vitreous smear microscope. The positive rate was 63.0% (17 / 27). 12 strains of 8 genera were cultured in 27 patients. The main pathogens were Aspergillus in 11 cases (40.7%), Fusarium in 8 cases (29.6%) and Candida in 3 cases (11.1%). Aspergillus mainly included Aspergillus flavus in 6 cases (22.2%) and Aspergillus fumigatus in 5 cases (18.5%), Fusarium sp. in 4 cases (14.8%) and Fusarium in 3 cases (11.1%). Vitrectomy was performed in 25 cases. One or more treatment measures, such as intravitreous injection of antifungal drugs and penetrating keratoplasty, were performed in 22 cases of enucleation of the eyeball, 3 cases of enucleation of the eyeball and 2 cases of enucleation of the eye. Conclusion fungal endophthalmitis is mainly exogenous endophthalmitis. Eye penetrating injury is the most common pathogenic factor of exogenous endophthalmitis. Aspergillus and Fusarium are the main pathogens. Heavy use of hormones is the main cause of endophthalmitis. It is an effective method to diagnose fungal endophthalmitis by looking up mycelium and fungal culture on specimen smear. Vitrectomy combined with intravitreal injection of antifungal drugs is an effective method for the treatment of fungal endophthalmitis.
【作者单位】：青岛大学医学院附属医院检验科;山东省医学科学院
【分类号】：R771

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