Microbial Keratitis in East Africa: Why are the Outcomes so Poor?
| Autor: | Anthony Hall, Emily Okello, Jason Pithuwa, Jecinta J. Onyango, Francesca Oates, Issac Afwamba, Caroline Chevallier, Matthew J. Burton |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Visual acuity Epidemiology medicine.medical_treatment Visual Acuity Tanzania Eye Infections Bacterial Cornea 0302 clinical medicine Risk Factors Child Evisceration (ophthalmology) Aged 80 and over 0303 health sciences biology Middle Aged Anti-Bacterial Agents 3. Good health Treatment Outcome Child Preschool Female Health Services Research medicine.symptom Eye Infections Fungal Adult medicine.medical_specialty Adolescent Article Keratitis 03 medical and health sciences Internal medicine medicine Humans Corneal Ulcer Aged Retrospective Studies 030304 developmental biology Bacteria business.industry Fungi Infant Retrospective cohort study Eye infection medicine.disease corneal ulcer biology.organism_classification Surgery Ophthalmology 030221 ophthalmology & optometry business |
| Zdroj: | Ophthalmic Epidemiology. 18:158-163 |
| ISSN: | 1744-5086 0928-6586 |
| DOI: | 10.3109/09286586.2011.595041 |
| Popis: | PURPOSE: Microbial keratitis (MK) is a major cause of blindness in Africa. This study reports the epidemiology, causative organism, management and outcome of MK in people admitted to a large referral hospital in Northern Tanzania, and explores why the outcomes are so poor for this condition. METHODS: A retrospective review of all admissions for MK during a 27-month period. Information was collected on: demographics, history, examination, microbiology, treatment and outcome. RESULTS: A total of 170 patients with MK were identified. Presentation was often delayed (median 14 days), and more delayed if another health facility was visited first (median 21 days). Appropriate intensive antibiotic treatment was prescribed in 19% before admission. Lesions were often severe (41% >5mm). Filamentary fungi were detected in 25% of all specimens (51% of specimens with a positive result). At discharge, 66% of affected eyes had a visual acuity of less than 6/60. Perforations developed in 30% and evisceration was necessary in 8%. Perforation was associated with large lesions and visiting another health facility. HIV infection was diagnosed in 16% of individuals tested, which is approximately twice the prevalence found in the wider population. CONCLUSIONS: Microbial keratitis is a significant clinical problem in this region, which generally has a very poor outcome. Delayed presentation is a critical issue. Fungal keratitis is a prominent cause and there is an indication that HIV may increase susceptibility. Prompt recognition and appropriate treatment in primary/secondary health facilities and rapid referral when needed may reduce the burden of blindness from this disease. |
| Databáze: | OpenAIRE |
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