title: The clinical differentiation of bacterial and fungal keratitis: a photographic survey.
abstract: OBJECTIVE
  The purpose of this study was to determine whether clinical signs of infectious keratitis can be used to identify the causative organism.
  
  
  METHODS
  Eighty photographs of eyes with culture-proven bacterial keratitis or smear-proven fungal keratitis were randomly selected from 2 clinical trials. Fifteen cornea specialists from the F. I. Proctor Foundation and the Aravind Eye Care System assessed the photographs for prespecified clinical signs of keratitis, and they identified the most likely causative organism.
  
  
  RESULTS
  Clinicians were able to correctly distinguish bacterial from fungal etiology 66% of the time (P < 0.001). The Gram stain, genus, and species were accurately predicted 46%, 25%, and 10% of the time, respectively. The presence of an irregular/feathery border was associated with fungal keratitis, whereas a wreath infiltrate or an epithelial plaque was associated with bacterial keratitis.
  
  
  CONCLUSIONS
  Cornea specialists correctly differentiated bacterial from fungal keratitis more often than chance, but in fewer than 70% of cases. More specific categorization led to less successful clinical distinction. Although certain clinical signs of infectious keratitis may be associated with a bacterial or fungal etiology, this study highlights the importance of obtaining appropriate microbiological testing during the initial clinical encounter.
authors.affiliation: F. I. Proctor Foundation and Department of Ophthalmology, University of California-San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Cyril
authors.initials: C
authors.lastname: Dalmon
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.forename: N Venkatesh
authors.initials: NV
authors.lastname: Prajna
authors.forename: Lalitha
authors.initials: L
authors.lastname: Prajna
authors.forename: Mano Ranjan
authors.initials: MR
authors.lastname: Das
authors.forename: J Arun
authors.initials: JA
authors.lastname: Kumar
authors.forename: Jeena
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Todd P
authors.initials: TP
authors.lastname: Margolis
authors.forename: John P
authors.initials: JP
authors.lastname: Whitcher
authors.forename: Bennie H
authors.initials: BH
authors.lastname: Jeng
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Matilda F
authors.initials: MF
authors.lastname: Chan
authors.forename: Stephen D
authors.initials: SD
authors.lastname: McLeod
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
mesh_terms: D001419:Bacteria / Q000145:classification; D003315:Cornea / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000382:microbiology; D003937:Diagnosis, Differential; D003941:Diagnostic Techniques, Ophthalmological; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000382:microbiology; D005658:Fungi / Q000145:classification; D006801:Humans; D009885:Ophthalmology; D010781:Photography; D013038:Specialization