Staining with methylthioninium chloride for the diagnosis of fungal keratitis

Lan,Lan; Wang,Feng-Yun; Zeng,Guangwei

doi:10.3892/etm.2013.1288

Staining with methylthioninium chloride for the diagnosis of fungal keratitis

Authors:
- Lan Lan
- Feng-Yun Wang
- Guangwei Zeng
View Affiliations

Affiliations: Department of Ophthalmology, Reconstructive and Burns Surgery, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P.R. China, Department of Plastic, Reconstructive and Burns Surgery, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P.R. China
Published online on: September 5, 2013 https://doi.org/10.3892/etm.2013.1288
Pages: 1229-1232

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of this study was to investigate the potential efficacy of staining with methylthioninium chloride (MC) for the diagnosis of fungal keratitis. A total of 70 cases of fungal keratitis were included in the study from January 2009 to December 2010. The corneal scraping specimens of the patients were collected and stained with MC or a 10% potassium hydroxide (KOH)‑based smear prior to microscopic examination. The staining results were confirmed with fungal culture and strain identification, which are recognized as ‘gold standards’ for the diagnosis of fungal keratitis. Among the 70 cases of fungal keratitis, 58 cases were positive and the positive rate was 82.86%. MC staining showed a positive rate of 62.86%, with higher levels of sensitivity (70.69%) and specificity (34.61%) compared with staining with the 10% KOH‑based smear. The KOH‑based smear showed a positive rate of 44.29% (P<0.05), a level of sensitivity of 44.83% (P<0.05) and a specificity of 17.95% (P<0.05). In addition, the MC staining showed false positive and negative rates of 25.00 and 29.31%, respectively, an accuracy index of 5.30% and positive and negative predictive values of 93.18 and 34.61%, respectively. The results indicate that MC staining is a fast and effective method for the early diagnosis of fungal keratitis.

View Figures

View References

1.	Jurkunas U, Behlau I and Colby K: Fungal keratitis: changing pathogens and risk factors. Cornea. 28:638–643. 2009. View Article : Google Scholar : PubMed/NCBI
2.	Sun GH, Li SX, Gao H, Zhang WB, Zhang MA and Shi WY: Clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis. Int J Ophthalmol. 5:88–91. 2012.
3.	Pucket JD, Allbaugh RA and Rankin AJ: Treatment of dematiaceous fungal keratitis in a dog. J Am Vet Med Assoc. 240:1104–1108. 2012. View Article : Google Scholar : PubMed/NCBI
4.	Kymionis GD, Kankariya VP and Kontadakis GA: Combined treatment with flap amputation, phototherapeutic keratectomy, and collagen crosslinking in severe intractable post-LASIK atypical mycobacterial infection with corneal melt. J Cataract Refract Surg. 38:713–715. 2012. View Article : Google Scholar
5.	Liu X, Zhao Y, Yang Y, et al: Mycobacterium massiliense keratitis. Optom Vis Sci. 89:E944–E947. 2012. View Article : Google Scholar : PubMed/NCBI
6.	Das M, Murthy SI, Dikshit S and Rathi V: Natamycin and voriconazole in fungal keratitis. Arch Ophthalmol. 129:8142011.PubMed/NCBI
7.	Das S, Sharma S, Kar S, Sahu SK, Samal B and Mallick A: Is inclusion of Sabouraud dextrose agar essential for the laboratory diagnosis of fungal keratitis? Indian J Ophthalmol. 58:281–286. 2010. View Article : Google Scholar : PubMed/NCBI
8.	Nayak N: Fungal infections of the eye - laboratory diagnosis and treatment. Nepal Med Coll J. 10:48–63. 2008.PubMed/NCBI
9.	Bashir G, Shah A, Thokar MA, Rashid S and Shakeel S: Bacterial and fungal profile of corneal ulcers - a prospective study. Indian J Pathol Microbiol. 48:273–277. 2005.PubMed/NCBI
10.	Galperin G, Berra M, Tau J, Boscaro G, Zarate J and Berra A: Treatment of fungal keratitis from Fusarium infection by corneal cross-linking. Cornea. 31:176–180. 2012. View Article : Google Scholar
11.	Kurbanyan K, Hoesl LM, Schrems WA and Hamrah P: Corneal nerve alterations in acute Acanthamoeba and fungal keratitis: an in vivo confocal microscopy study. Eye (Lond). 26:126–132. 2012.
12.	Mathelin C, Salvador S, Croce S, Andriamisandratsoa N, Huss D and Guyonnet JL: Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera. World J Surg Oncol. 5:1322007. View Article : Google Scholar : PubMed/NCBI
13.	Pradhan L, Sharma S, Nalamada S, Sahu SK, Das S and Garg P: Natamycin in the treatment of keratomycosis: correlation of treatment outcome and in vitro susceptibility of fungal isolates. Indian J Ophthalmol. 59:512–514. 2011. View Article : Google Scholar : PubMed/NCBI
14.	Barequet IS, Bourla N, Pessach YN, et al: Staphylolysin is an effective therapeutic agent for Staphylococcus aureus experimental keratitis. Graefes Arch Clin Exp Ophthalmol. 250:223–229. 2012. View Article : Google Scholar : PubMed/NCBI
15.	Menassa N, Bosshard PP, Kaufmann C, Grimm C, Auffarth GU and Thiel MA: Rapid detection of fungal keratitis with DNA-stabilizing FTA filter paper. Invest Ophthalmol Vis Sci. 51:1905–1910. 2010. View Article : Google Scholar : PubMed/NCBI
16.	Avunduk AM, Beuerman RW, Varnell ED and Kaufman HE: Confocal microscopy of Aspergillus fumigatus keratitis. Br J Ophthalmol. 87:409–410. 2003. View Article : Google Scholar
17.	Xie L, Li S, Shi W and Han D: Clinical diagnosis of fungal keratitis by confocal microscopy. Zhonghua Yan Ke Za Zhi. 35:7–9. 1999.(In Chinese).
18.	Zhang B, Bai Y and Chen G: Clincal significance of sentinel lymph node biopsy in breast Cancer. Zhonghua Zhong Liu Za Zhi. 22:395–397. 2000.(In Chinese).