Term
| Clinical term for fungal infection of cornea |
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Definition
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Term
| 4 predisposing factors for fungal infection |
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Definition
Trauma (esp. with vegatative matter)
Extended Wear CL
Immunosuppression
Steroid misuse |
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Term
Infect normal eyes of healthy individuals who have sustained trauma
Filamentous or non-filamentous |
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Definition
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Term
Cause opportunistic keratitis in compromised corneas with decreased host defenses
Filamentous or non-filamentous? |
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Definition
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Term
| Name three genus of fungi that are filamentous and multicellular (mold) |
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Definition
Fusarium
Aspergillus
Cephalosporium |
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Term
| Of the three types of filamentous fungi discussed, which is the most virulent? |
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Definition
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Term
| What type of non-filamentous, unicellular fungi did we discuss and what type of regions does it live in? |
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Definition
| Candida, found in colder regions |
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Term
| What is one occupation that is especially at risk for Fusarium exposure? |
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Definition
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Term
| What CL solution was connected with Fusarium outbreaks in 2006? |
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Definition
| B&L ReNu MPS with MoistureLoc |
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Term
| What is the most common cause of fungal keratitis worldwide? |
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Definition
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Term
| 3 locations that aspergillus is commonly isolated from |
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Definition
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Term
| What is the most common Candida infection site? |
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Definition
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Term
| What is the most frequent cause of endogenous fungal endophthalmitis |
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Definition
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Term
| How long does it generally take for symptoms of a fungal infection to develop? |
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Definition
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Term
| Fungal corneal ulcers look a LOT like ........ |
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Definition
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Term
| Describe the opacity associated with filamentous keratitis |
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Definition
stromal
grey-white
elevated
feathery margins,
dry, rough
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Term
| What sort of AC reaction may be expected to accompany a filamentous keratitis |
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Definition
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Term
| Describe the color of a non-filamentous keratitis |
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Definition
| stromal yellow-grey-white infiltrate |
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Term
| DDx borders of bacterial vs. fungal ulcers |
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Definition
Fungal=feather
Bacterial=smooth |
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Term
Bacterial vs. Fungal keratitis
Satellite lesions
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Definition
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Term
Bacterial vs. Fungal keratitis
ulcer onset from infection |
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Definition
Bacterial-hours to days
fungal-days to weeks |
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Term
Bacterial vs. Fungal keratitis
Vegetative etiology |
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Definition
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Term
| Name 2 common media used to work up fungal keratitis |
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Definition
Sabouraud's agar w/o cyclohexamide
Thioglycolate broth |
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Term
| Name 3 types of stains used to work up fungal keratitis |
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Definition
Gram's
Giemsa
Gomori's methenamine silver stain |
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Term
| Name the instrument that can be used in fungal keratitis workup that scans all layers of the cornea at high resolution |
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Definition
| Confocal specular microscope |
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Term
| Name 2 pharmacological topical treatment options for Filamentous keratitis |
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Definition
Natamycin 5% q1h (commercially available)
Amphotericin B 0.15% as 2nd agent (formulated by pharmacy) |
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Term
| What topical drug is contraindicated in fungal keratitis? |
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Definition
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Term
| Topical tx for Candida keratitis |
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Definition
| Amphotericin B 0.15%q5min for 1 hour, then q1h |
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Term
| Name 2 systemic antifungals |
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Definition
Flucytosine(also available topical) PO 150 mg/kg/day
Ketoconazole PO 200-400 mg/day |
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Term
| 4 'places' where acanthamoeba may be found |
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Definition
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Term
| Why must treatment of acanthamoeba continue over months? |
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Definition
| It lives in both a active trophozoite form and a dormant cystic form. The medication does not kill it when it is in cyst form, thus you have to treat it until it reverts to its active form. |
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Term
| NAme 4 risk factors for contracting an acanthamoeba infection |
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Definition
CL wear
unclean CL solution/contaminated water
Co-infections (like HSV, bacterial etc.)
Foreign Body |
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Term
| What solution is associated with an acanthomoeba outbreak in 2007 |
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Definition
| AMO Complete Moisture Plus Multipurpose CL soln. |
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Term
Severe pain far out of proportion to the clinical findings
-which pathogen? |
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Definition
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Term
| Name some symptoms of acanthamoeba infection |
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Definition
unilateral red eye
photophobia
lacrimation
blurry vision
lid edema
waxing/waning of symptoms
severe pain |
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Term
| What signs may be seen within 1 day -2weeks of acanthamoeba infection? |
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Definition
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Term
| What signs of an acanthamoeba infection may be seen around week 3-8? |
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Definition
STROMAL RING INFILTRATE
Radial keratoneuritis (enlarged corneal nerves)
Anterior Uveitis
Hypopyon |
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Term
| How may acanthamoeba infection develop into corneal perforation? |
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Definition
| Stromal necrosis --> Descemetocoele --> Corneal perforation |
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Term
| Name 3 other possible causes that must be ruled out when dealing with a possible acanthamoeba infection |
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Definition
HSV keratitis
Fungal Keratitis
Bacterial keratitis |
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Term
| Name 3 methods of 'workup' of acanthamoeba |
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Definition
Labs
Corneal biopsy
Confocal microscopy |
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Term
| What lab workups may be called for when dealing with acanthamoeba? |
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Definition
Corneal scraping w E.coli overlay
Calcofluor white stain
Gram, Giemsa stain |
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Term
| What might be seen when performing confocal microscopy on acanthamoeba infected cornea? |
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Definition
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Term
| Which infection is basically treated with strong preservatives /antiseptics? |
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Definition
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Term
chlorhexadine digluconate
polyhexamethylene biguanide
Propamidine isethionate
Treat what? |
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Definition
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Term
| Describe the dosage regimen in treatment of acanthamoeba infection? |
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Definition
QH x48 hours (even during sleep)
QH x 3 days while awake
Q3H
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Term
| Name 4 CL cleaning systems that are known to be ineffective in killing acanthamoeba |
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Definition
thimerosal
Sorbic acid
EDTA
Quaternary ammonium compounds |
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Term
| What is the best approach in preventing acanthamoeba infection? |
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Definition
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