title: Microbiological evaluation of chronic blepharitis among Iranian veterans exposed to mustard gas: a case-controlled study.
abstract: OBJECTIVE
  To evaluate the microbiological characteristics of eyelid margin flora in chronic blepharitis in mustard gas-exposed individuals and compare the results with those in age- and sex-matched unexposed people.
  
  
  METHODS
  In this comparative case series, 289 patients with ocular manifestations of mustard gas exposure (case) were evaluated for signs of chronic blepharitis. Additionally, microbiological evaluation of eyelid margins was conducted in these patients and compared with results of 100 unexposed patients with chronic blepharitis (control).
  
  
  RESULTS
  One-hundred fifty (52.0%) of 289 mustard gas casualties had signs of chronic blepharitis. Microbiological evaluation revealed higher isolation rates of Staphylococcus epidermidis (78%) and Staphylococcus aureus (57%) in the case in comparison to control group (P < 0.01). Moreover, S. aureus isolated from the cases exhibited greater resistance to common antibiotics compared with control group. Fungi were isolated more frequent in the case compared with controls (30% vs. 4%, P < 0.01), with Cladosporium and Candida species being most common in the case group.
  
  
  CONCLUSIONS
  Exposure to mustard gas seems to alter the microbiological flora of the eyelid margin. Staphylococcus spp., including antibiotic-resistant strains, and fungi were more frequently isolated in these patients. The relationship between microbial culture results and the severity of ocular surface manifestations in mustard gas-injured cases warrant further investigation.
authors.affiliation: Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Department of Ophthalmology, Tehran, Iran. karimianf@yahoo.com
authors.forename: Farid
authors.initials: F
authors.lastname: Karimian
authors.forename: Siamak
authors.initials: S
authors.lastname: Zarei-Ghanavati
authors.forename: Baradaran-Rafii
authors.initials: BR
authors.lastname: A
authors.forename: Khosrow
authors.initials: K
authors.lastname: Jadidi
authors.forename: Alireza
authors.initials: A
authors.lastname: Lotfi-Kian
mesh_terms: D000328:Adult; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001762:Blepharitis / Q000139:chemically induced / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D002908:Chronic Disease; D015818:Eye Infections, Bacterial / Q000139:chemically induced / Q000453:epidemiology / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000139:chemically induced / Q000453:epidemiology / Q000382:microbiology*; D005143:Eyelids / Q000382:microbiology; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009151:Mustard Gas / Q000009:adverse effects*; D015995:Prevalence; D014728:Veterans
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas