입원 치료를 시행한 감염각막염의 분석: 미생물학적 원인, 임상 양상 및 위험 인자

박주홍,이상범 대한안과학회 2009 대한안과학회지 Vol.50 No.8

Purpose: To investigate the epidemiological, microbiological, and clinical characteristics of inpatients with infectious keratitis and also to elucidate risk factors for unimproved visual outcomes. Methods: We performed a retrospective chart review of 167 eyes in 167 patients with infectious keratitis hospitalized between January 2005 and December 2007 at Yeungnam University Hospital. Results: Keratitis cases were classified into four groups according to etiology: 92 bacterial, 43 herpes virus, 31 fungal, and 1 acanthamoeba. Culture positivity was 44.6% in bacterial keratitis and 22.6% in fungal keratitis, and KOH positivity of fungus was 48.4%. Of all the 55 isolated pathogens, the most commonly isolated microorganisms were S. epidermidis in Gram-positive bacteria, P. aeruginosa in Gram-negative bacteria, and Candida species in fungus. Epidemiologic characteristics such as male gender (59.9%), an age in the seventh decade (24.6%), farming occupation (40.1%), and trauma with vegetable matter (42.5%) were noted. Many fungal and bacterial keratitis cases were characterized by inadequate use of topical steroid when patients initially presented to our clinic. Visual outcomes were poorer in fungal keratitis than they were in other forms of keratitis. Conclusions: Risk factors for unimproved visual outcomes included an ulcer exceeding 3 mm in size and a fungal source. Therefore, a strong effort should be made to discern a differential diagnosis in infectious keratitis and to determine the appropriate early treatment for a successful treatment outcome. 목적: 입원치료를 시행한 감염각막염의 진단별 발생 빈도, 미생물학적 및 임상적 특징과 시력호전실패의 위험인자를 알아보고자 하였다. 대상과 방법: 2005년 1월부터 2007년 12월까지 영남대학교병원 안과에 입원 치료한 감염각막염 167안(남자 100안, 여자 67안)의 의무 기록을 후향적으로 조사하였다. 결과: 진단별 발생 빈도는 세균 92안, 헤르페스 43안, 진균 31안, 가시아메바 1안이었다. 배양양성률은 세균 44.6%, 진균 22.6%이었고, 진균의 KOH양성률은 48.4%이었다. 동정된 전체 균주 55예 중에서 가장 흔한 그람양성균은 S. epidermidis(13예), 그람음성균은 P. aeruginosa(5예), 진균은 Candida species(4예)이었다. 역학적으로 남자(59.9%), 60대(24.6%), 농부(40.1%), 식물성 외상(42.5%)에서 감염각막염의 발생이 많았다. 진균과 세균각막염에서 내원 전 부적절한 스테로이드 점안제의 사용이 많았고, 치료 성적은 진균각막염에서 가장 불량하였다. 결론: 시력호전실패의 위험인자로는 직경 3 mm 이상의 병변 크기와 진균각막염으로 나타났다. 감염각막염의 감별진단을 위한 임상적 이해와 이에 따른 적절한 약물요법이 치료성공의 중요한 요소로 생각된다.

Delayed onset <i>Mycobacterium intracellulare</i> keratitis after laser in situ keratomileusis : A case report and literature review

Ko, JaeSang,Kim, Se Kyung,Yong, Dong Eun,Kim, Tae-im,Kim, Eung Kweon Wolters Kluwer Health 2017 Medicine Vol.96 No.51

<P><B>Abstract</B></P><P><B>Rationale:</B></P><P>Infectious keratitis is a relatively uncommon but potentially sight-threatening complication of laser in situ keratomileusis (LASIK). Mycobacterial keratitis is usually regarded as late onset keratitis among post-LASIK keratitis. There has been no documented case of <I>Mycobacterium intracellulare</I> post-LASIK keratitis of a long-latent period.</P><P><B>Patient concerns:</B></P><P>A 36-year-old man was referred to our out-patient clinic, for persistent corneal epithelial defect with intrastromal infiltration. He had undergone uneventful bilateral LASIK procedure 4 years before. He complained decreased vision, accompanied by ocular pain, photophobia, and redness in his left eye for 7 months.</P><P><B>Diagnosis:</B></P><P>Lamellar keratectomy was taken using femtosecond laser. Bacterial culture with sequenced bacterial 16s ribosomal DNA confirmed the organism to be <I>M intracellulare</I>.</P><P><B>Interventions:</B></P><P>After 3 months of administration of topical clarithromycin, amikacin, and moxifloxacin, the corneal epithelial defect was resolved and the infiltration was much improved. However, newly developed diffuse haziness with surrounding granular infiltration in the central cornea was noted. Drug toxicity was suspected and topical moxifloxacin was discontinued, resulting in resolution of the diffuse haze with infiltration.</P><P><B>Outcome:</B></P><P>The patient was followed up regularly without medication thereafter and recurrence was not found for 7 years.</P><P><B>Lessons:</B></P><P>This case presents the first case of <I>M intracellulare</I> keratitis after LASIK. LASIK surgeons should aware that post-LASIK keratitis can develop long after the operation and careful suspicion of infectious disease with meticulous diagnostic test is needed.</P>

배양 양성 감염각막염의 임상양상 및 항생제감수성 변화: 10년간의 국내 다기관 연구

유인천(In-Cheon You),이상범(Sang-Bumm Lee),서경률(Kyoung Yul Seo),김미금(Mee Kum Kim),윤경철(Kyung-Chul Yoon),고재웅(Jae Wong Koh),이지은(Ji Eun Lee),김성재(Seong-Jae Kim),KOAIDS 대한안과학회 2021 대한안과학회지 Vol.62 No.4

목적: 최근 10년간 감염각막염 중 배양검사상 균주가 확인된 환자에 대하여 여러 임상양상에 대해 알아보고자 한다. 대상과 방법: 2008년 1월부터 2017년 12월까지 전국 8개 병원에서 균주가 확인된 감염각막염 956명의 의무기록을 후향적으로 분석하여, 선행요인, 원인균, 치료 방법, 예후 등을 분석하였다. 결과: 감염각막염의 가장 흔한 선행요인은 안외상(33.2%)이었다. 초기시력은 안전수지 이하가 449안(47.0%)이었다. 각막궤양은 중심부에서 흔하였고, 크기는 4 mm² 이하가 가장 많았다. 전방축농이 동반된 경우는 295안(30.9%)이었다. 배양된 균주는 총 1,039균으로 그람음성균 443균주(42.6%)가 가장 많았다. 가장 흔한 균은 그람음성균은 녹농균, 그람양성균은 피부포도알균, 진균은 푸사륨이었다. 수술 치료는 201안(21.0%)에서 양막이식술 66안, 안구내용제거술 44안 순이었다. 최종시력은 0.2보다 좋은 시력이 422안(44.1%)이었다. 그람양성균은 목시플록사신과 반코마이신에, 그람음성균은 레보플록사신과 세프타지딤에 높은 감수성을 보였지만 일부 장알균과 슈도모나스 등에서 저항성을 보였다. 결론: 국내 감염각막염은 안외상으로 흔히 발생하였고 그람음성균이 가장 많았다. 대표적인 원인균은 피부포도알균, 녹농균, 푸사륨이었다. 입원 후 약물 및 수술적 치료로 시력이 호전된 경우가 많았지만 일부 저항성을 보이는 세균과 진균에 대해서는 주의가 필요하다. 세균에서 불량한 임상결과에 이르는 위험인자는 초기시력 0.02 미만, 전방축농, 65세 이상 나이, 각막중심부 궤양이었고 진균은 70세 이상 나이였다. Purpose: To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period. Methods: We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 and December 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms, therapeutic outcomes, and prognosis. Results: The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in 449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295 eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species. Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) and evisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible to moxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. An increase in resistance to these antibiotics was detected for Enterococcus and Pseudomonas. Conclusions: In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonas aeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medical and surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimize infection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon, age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years or more was a significant risk factor for poor clinical outcome of fungal keratitis.

복합 세균각막염과 단일 세균각막염의 임상 비교 분석

백승철(Seung Chul Baek),조찬호(Chan-Ho Cho),이상범(Sang-Bumm Lee) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 복합 세균각막염의 균주분포, 선행인자, 임상양상 및 치료 결과를 단일 세균각막염과 비교해 보고자 하였다. 대상과 방법: 2007년부터 2016년까지 감염각막염으로 치료받고 배양검사에서 세균이 동정된 194안을 대상으로 하여 후향적으로 분석하였다. 전체 군을 복합세균감염(polymicrobial bacterial keratitis [PBK], 29안 62균주)과 단일세균감염(monomicrobial bacterial keratitis [MBK], 165안 165균주)으로 나누어 균주분포, 역학, 선행인자, 임상양상 및 치료 결과를 비교하였다. 결과: PBK에서 Enterobacter spp. (24%), MBK에서 Staphylococcus spp. (22%)가 가장 흔했다. 두 군 사이에 안구표면질환, 안수술력, 이전 스테로이드 사용 비율, 상피결손크기 및 전방축농 비율은 차이가 없었다. 나이 ≥60세(PBK vs. MBK, 31% vs. 51%, p=0.048), 증상 내원 기간(4.7일 vs. 8.0일, p=0.009) 및 콘택트렌즈 착용(34% vs. 18%, p=0.036)은 두 군 간에 차이를 보였다. 상피재생기간 ≥10일, 최종 최대교정시력, 수술적 치료 및 불량한 임상결과는 두 군 간 차이가 없었다. 전체 군에서 불량한 임상결과의 위험인자로 초진 최대교정시력 0.1 미만(Z=6.33, two-proportion Z-test), 상피결손크기 5 mm2 이상(Z=4.56) 및 이전 안구표면질환(Z=4.36) 등이 나타났다. 결론: PBK에서 MBK에 비해 비교적 젊은 연령 분포, 콘택트렌즈 착용 및 빠른 내원과 연관된 경우가 많았다. Purpose: We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis. Methods: A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group. Results: The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA <0.1 (Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36). Conclusions: Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

아시네토박터 바우마니 각막염의 임상적 특징

신경윤,조경진 대한안과학회 2015 대한안과학회지 Vol.56 No.4

목적: 아시네토박터 균종은 다형성을 가진 호기성 그람 음성균으로 자연 환경에 흔히 존재하는 균이다. 최근 아시네토박터 바우마니각막염이 보고되고 있으며 다양한 임상적 특징을 보여 이를 알아보고 치료법에 대하여 고찰해 보고자 하였다. 증례요약: 감염결정각막병증 형태로 나타난 환자 2예, 진균과 복합 감염된 환자 2예, 주변부 각막 궤양의 형태로 나타난 환자 1예가있었다. 진균과 동시 감염된 환자 중 치료적 각막 이식술을 시행한 환자가 1예 있었다. 결론: 아시네토박터 바우마니 각막염은 다양한 임상양상을 보일 수 있다. 생체막을 형성하여 치료에 저항성을 나타낼 수 있고 진균과복합 감염을 보일 수 있으며 일반적인 세균성 각막염이 각막 중심부에 흔히 발생하는 것에 반하여 주변부 각막 궤양의 형태로 나타날수도 있다. 아시네토박터 균종은 다재내성 균으로 흔히 알려졌으나 본원의 5예에서 내성 균주가 발견되지는 않았다. 위와 같은 다양한특성으로 인해 각막염으로 내원한 환자에서 아시네토박터 바우마니의 감염을 항상 염두에 두어야 하겠다. Purpose: Acinetobacter species are common aerobic gram-negative bacterium that contain polymorphisms. Acinetobacter baumannii keratitis has recently received attention, and has various clinical features. Therefore, it is crucial to determine the appropriate medical treatment for Acinetobacter baumannii keratitis. Case summary: There were two infectious crystalline keratitis patients, two other patients that were co-infected with fungus, and the last patient who had the peripheral corneal ulcer type of keratitis. Conclusions: Acinetobacter baumannii keratitis demonstrates multiple clinical features. It forms a biofilm that can bring possible resistance to therapy, and it can also co-infect with fungus. In contrast to general bacterial keratitis which occurs in the form of a central corneal ulcer, we found Acinetobacter baumannii to take on the form of a peripheral corneal ulcer in our experiments on the five keratitis patients. Although Acinetobacter species were originally found to be multidrug-resistant, such resistance was not found in our experiments. However, due to the various problems associated with Acinetobacter baumannii, it is always critical for medical staff to take infection of Acinetobacter baumannii into consideration in keratitis patients.

Molecular detection and characterization of Acanthamoeba infection in dogs and its association with keratitis in Korea

이수빈,Badriah Alkathiri,정지승,강난영,Jiyi Hwang,박상은,홍연철,박경미,이승헌 대한기생충학ㆍ열대의학회 2024 The Korean Journal of Parasitology Vol.62 No.1

Acanthamoeba infection is associated with keratitis in humans; however, its associationwith keratitis in dogs remains unclear. To investigate this possibility, we collected 171conjunctival swab samples from dogs with eye-related diseases (65 with keratitis and106 without keratitis) at Chungbuk National University Veterinary Teaching Hospital, Korea, from August 2021 to September 2022. Polymerase chain reaction identified 9 samples (5.3%) as Acanthamoeba positive; of these, 3 were from dogs with keratitis (4.6%)and 6 were from dogs without keratitis (5.7%). Our results indicated no significant association between Acanthamoeba infection and keratitis, season, sex, or age. All Acanthamoeba organisms found in this study had the genotype T4, according to 18S ribosomal RNA analysis. Acanthamoeba infection in dogs might have only a limited association with keratitis.

콘택트렌즈 착용 후 발생한 수지상각막염: 임상 증례 및 문헌고찰

오주상(Joo Sang Oh),조양경(Yang Kyung Cho) 대한안과학회 2021 대한안과학회지 Vol.62 No.4

목적: 저자들은 이전에 각막염으로 치료받은 과거력 없이 콘택트렌즈 사용 후 처음 발생한 수지상각막염의 7안의 증례들을 경험하고 이를 단순포진바이러스각막염으로 진단하고 치료하였기에 문헌고찰과 함께 보고하고자 한다. 대상과 방법: 안과 외래에 2년간 방문한 환자들을 대상으로 콘택트렌즈 착용 후 수지상 각막병변을 보인 환자의 진단 및 치료와 경과 관찰을 시행하였다. 결과: 콘택트렌즈 착용 후 수지상 각막병변을 보인 7안의 환자에 관한 과거력 청취와 임상양상 및 분자생물학적 방법을 통한 진단 및 치료 기간 동안의 경과 관찰을 하였다. 결론: 콘택트렌즈 착용을 한 후 수지상각막염을 보이는 환자의 경우, 통상적인 비감염성 각막침윤이나 세균 및 진균에 의한 각막염이 아닌 단순포진바이러스각막염의 가능성도 있으므로 정확한 과거력 청취 및 임상적, 분자생물학적 진단이 필요하고, 경험적 항바이러스 치료에 대한 반응을 면밀히 살펴볼 필요가 있다. Purpose: We report seven cases of first occurrence of dendritic keratitis associated with contact lens wear without previous keratitis history, based on a literature review. Those cases were finally diagnosed and treated as herpes virus keratitis. Methods: Among patients who visited the ophthalmology outpatient clinic over two years, patients with dendritic corneal lesions associated with contact lens wear were included. Authors performed the diagnosis, treatment and the clinical follow up. Results: Seven Patients with dendritic corneal lesions after wearing contact lens were diagnosed by history taking, clinical findings and molecular biological methods and were observed over the course of treatment. Conclusions: For patients with dendritic keratitis after wearing contact lenses, there is a possibility of herpes keratitis rather than the common lesions associated with non-infectious corneal infiltration or keratitis caused by bacteria and fungus. It is necessary to observe those eyes thoroughly in respect to the exact past history taking, diagnosis by molecular-biological method as well as clinical features and the response to empirical antiviral agents.

진균성 각막염 14예의 임상 및 균학적 관찰

서무규,성열오,윤기성,방장석,조희태,안 영,하경임 대한의진균학회 1998 대한의진균학회지 Vol.3 No.1

Background: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. Objective: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. Methods: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. Results and Conclusion: Mycotic keratitis showed high incidence in fitth (42.9%), sixth(35.7%) and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in myeotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%). [Kor J Med Mycol 3(1): 33∼38]

라식수술 후 발생한 감염성 각막염의 임상적 분석

김선웅,변여주,김응권,김태임.Sun Woong Kim. M.D.. Yeo Jue Byun. M.D. Eung Kweon Kim. M.D. Ph.D.. Tae-im Kim. M.D. 대한안과학회 2007 대한안과학회지 Vol.48 No.2

Purpose: To improve the understanding of infectous keratitis after LASIK by analyzing our clinical experiences. Methods: We retrospectively reviewed the records of 12 eyes of 9 subjects who developed infectious keratitis after LASIK, and compared them in terms of onset of symptoms, microbiologic profile, medical and surgical interventions, and final visual acuities. Results: Among them, one eye was found to have culture-proven bacterial infection, five eyes with non tuberculous mycobacterial infection, one eye with Nocardial infection, one eye with fungal keratitis and four eyes of two subjects with unisolated microorganisms. Bacterial infections included unisolated cases presenting 2 days after LASIK, mycobacteria presented at an average of 14.4 days after LASIK, Nocardia presented 4 months after LASIK (7 days after trauma), and fungus presented 3 days after LASIK. Bacterial infections were diagnosed immediately after onset of symptoms, and resolved 30 days after treatment. Mycobacterial infections were diagnosed 14 days (6-55 days) after onset and resolved after 6.2 months of treatment, which included flap amputation in 4 of 5 eyes. Fungal infections were diagnosed 30 days after onset, and resolved after 2.5 months of treatment. Norcardial infections were diagnosed 17 days after onset, and resolved after 3 months. Final visual acuities were over 0.5 in 4 of 5 cases of bacteria, in 3 of 5 cases of mycobacteria, in the 1 case of Nocardia and light perception in fungal keratitis. Conclusions: Bacterial infections tended to present within two days, whereas mycobacteria presented about 14 days after LASIK. Mycobacterial infections required the longest duration of treatment, however the visual outcome was the worst in fungal keratitis.

키드증후군의 안과 증상 및 감염각막염 치료와 경과에 대한 증례

손기영,백동원,조은혜,신대환,우혜인,정태영,임동희 대한안과학회 2019 대한안과학회지 Vol.60 No.12

목적: 키드증후군(The Keratitis, Ichthyosis, and Deafness syndrome) 환자에서 동반된 안과적 증상 및 감염각막염 치료 경과와 국내에서 처음 발견된 GJB2 유전자 변이에 대해 보고하고자 한다. 증례요약: 유전손발바닥각질피부증, 전신과각화, 난청으로 치료 중인 32개월 남아가 내원하였다. GJB2 유전자의 염기 서열 분석 결과, 유전자 변이가 발견되어 분자유전학적으로 키드증후군이 확진되었다. 양안 각막 윤부 360° 신생혈관화 및 결막화, 양안 중심각막혼탁이 동반되어 있었다. 양안 표층 각막절제술 및 양막이식술을 시행하였고 좌안 각막혼탁이 재발하여 베바시주맙 점안제 사용 및 전층각막이식술을 시행하였다. 전층각막이식술 후 각막실질혼탁이 진행되어, 5% 반코마이신, 5% 세프타지딤 항생제 안약을 점안하였고, 배양검사에서 Methicillin-resistant Staphylococcus aureus 배양되었다. 결론: 키드증후군환자에서 윤부줄기세포 기능부전과 감염 취약성에 대해 주의 깊게 관찰하고, 시력손상을 예방하기 위해 적극적인 항생제 안약 치료가 필요할 것으로 생각된다. Purpose: To report the ocular manifestations and treatment outcomes of infective keratitis in a patient with keratitis-ichthyosis- deafness (KID) syndrome and to report a newly discovered mutation in the GJB2 gene in Korea. Case summary: A 32-month-old boy was referred to the Ophthalmology Clinic for bilateral corneal opacity and glare. The patient showed alopecia, hyperkeratotic skin in both limbs, and hearing loss in both ears. Ocular examination showed loss of eyebrows and eyelashes, hyperkeratotic lesions of the eyelids, mucopurulent discharge in the eyelids, and opacity and scarring with superficial vascularization and conjunctivalization in both corneas. Molecular analysis showed a pathogenic variant in the GJB2 gene and confirmed the diagnosis of KID syndrome. Superficial keratectomy and amniotic membrane transplantation were performed in both eyes. Corneal opacity recurred in the left eye; treatment with bevacizumab eyedrops was instituted and penetrating keratoplasty was performed in the left eye. Corneal stromal opacity relapsed in the left eye; 5% vancomycin and 5% ceftazidime eyedrops were started and methicillin-resistant Staphylococcus aureus was cultured from a corneal scraping specimen. Conclusions: A careful observation of ocular manifestations in KID syndrome is needed to prevent infective keratitis and limbal cell deficiency; intensive antibiotic eyedrop treatment is recommended to prevent permanent visual impairment.