Evaluation of impression cytology as rapid non-invasive diagnostic tool in infected corneal ulcer

Saraa Mohamed Abdel Rahman Elsheikh; Kareman Ahmed Ebrahim Eshra; Khaled Ahmed Nagy; Moataz Mohamed Sabry; Adel Abdou Selima

doi:10.53730/ijhs.v7nS1.14187

Authors

Saraa Mohamed Abdel Rahman Elsheikh Ministry of Health (ophthalmology specialist in Tanta Ophthalmic Hospital)
Kareman Ahmed Ebrahim Eshra
drkaremaneshra2004@hotmail.com
Assistant prof of Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
Khaled Ahmed Nagy Ophthalmology, Departments, Faculty of Medicine, Tanta University, Egypt
Moataz Mohamed Sabry Ophthalmology, Departments, Faculty of Medicine, Tanta University, Egypt
Adel Abdou Selima Ophthalmology, Departments, Faculty of Medicine, Tanta University, Egypt

Keywords:

corneal ulcer, microbial keratitis, impression cytology, smear, culture, non-invasive diagnosis

Abstract

Background: Microbial keratitis (MK) is caused by bacteria, fungi, and protozoa. It is very important to differentiate between these three causative microorganisms very early as they differ in their treatment, and some of these microorganisms, like Pseudomonas aeurogenosa, may result in eye perforation within 72 hours .The purpose of this study was to evaluate impression cytology smear to be used as a guide for early accurate treatment of cases. This study was conducted on 80 patients suspected of having MK. A corneal smear was taken with impression cytology paper (a non-invasive technique) and transported to the microbiology laboratory for examination. Results: The IC smear examination results were as follows: 30 (37.5%) were Aspergillus fungus, 14 (17.5%) were Acanthamoeba, 15 (18.75%) were Gram-negative bacilli, 4 (5%) were Staphylococci, 1 (1.25%) was Streptococci, 14 (17.5%) were both Gram-negative bacilli and Aspergillus fungus, and 2 (2.5%) were both Staphylococci and Aspergillus fungus. There was no significant difference between the diagnosis of MK by the culture method and the IC smear method. Conclusion: The impression cytology smear can be used as guide for early treatment of MK.

Downloads

Download data is not yet available.

References

Alkatan HM and Al-Essa RS. Challenges in the diagnosis of microbial keratitis: A detailed review with update and general guidelines. Saudi Journal of Ophthalmology. 2019;33(3):268-76.

Bharathi MJ, Ramakrishnan R, Meenakshi R, Mittal S, Shivakumar C and Srinivasan M. Microbiological diagnosis of infective keratitis: comparative evaluation of direct microscopy and culture results. Br J Ophthalmol. 2006;90(10):1271-6.

Castano G, Elnahry AG and Mada PK. Fungal keratitis. StatPearls [Internet]: StatPearls Publishing; 2021.

Cheesbrough M. Microbiological tests. In: district laboratory practice in tropical countries. Cambridge University press 2006; 2: 62-127.

Fanselow N, Sirajuddin N, Yin XT, Huang AJW and Stuart PM. Acanthamoeba Keratitis, Pathology, Diagnosis and Treatment. Pathogens. 2021;10(3):11-55.

Goh JW, Harrison R, Hau S, Alexander CL, Tole DM and Avadhanam VS. Comparison of in vivo confocal microscopy, PCR and culture of corneal scrapes in the diagnosis of Acanthamoeba keratitis. Cornea. 2018;37(4):480-5.

Hoffman JJ, Dart JK, De SK, Carnt N, Cleary G and Hau S. Comparison of culture, confocal microscopy and PCR in routine hospital use for microbial keratitis diagnosis. Eye. 2021:1-7.

Hoffman JJ, Yadav R, Sanyam SD, Chaudhary P, Roshan A, Singh SK, et al. Microbial Keratitis in Nepal: Predicting the Microbial Aetiology from Clinical Features. J Fungus. 2022;8(2):201-55.

Jain AK, Bansal R, Felcida V and Rajwanshi A. Evaluation of impression smear in the diagnosis of fungal keratitis. Indian J Ophthalmol. 2007;55(1):33-6.

Kaye S, Sueke H, Romano V, Chen JY, Carnt N, Tuft S, et al. Impression membrane for the diagnosis of microbial keratitis. Br J Ophthalmol. 2016;100(5):607-10.

Kim E, Srinivasan M, Lalitha P, Jayashree D, Cevallos V and Whitcher J. Correlation of corneal scraping smear examination and presence of hypopyon to microbial culture results in suspected infectious keratitis. Investig Ophthalmol Vis Sci. 2006;47(13):3584-.

Lin A, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, et al. Bacterial Keratitis Preferred Practice Pattern®. Ophthalmology. 2019;126(1):1-55.

Moe CA, Lalitha P, Prajna NV, Mascarenhas J, Srinivasan M, Das M, et al. Outcomes of amoebic, fungal, and bacterial keratitis: A retrospective cohort study. PLoS One. 2022;17(2):22-50.

Moshirfar M, Hopping GC, Vaidyanathan U, Liu H, Somani AN, Ronquillo YC, et al. Biological Staining and Culturing in Infectious Keratitis: Controversy in Clinical Utility. Med Hypothesis Discov Innov Ophthalmol. 2019;8(3):145-51.

Moshtaghion SM, Abolhosseini M, Rezaei Kanavi M, Hosseini SB and Rezaei Kanavi M. Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study. Eur J Ophthalmol. 2021;31(3):943-50.

Patel SP, Schaefer JL, Jaber R, Paterson J, Liu W and Gonzalez-Fernandez F. The Value of Cytology Smears for Acanthamoeba Keratitis. Case Rep Ophthalmol Med. 2016;2016:4148968.

Rai PG, Chaudhary M, Sharma AK and Gautam V. Direct microscopy in suppurative keratitis: a report from tertiary level hospital in Nepal. Nepalese Journal of Ophthalmology. 2016;8(2):128-38.

Rathi VM, Murthy SI, Mitra S, Yamjala B, Mohamed A and Sharma S. Masked comparison of trypan blue stain and potassium hydroxide with calcofluor white stain in the microscopic examination of corneal scrapings for the diagnosis of microbial keratitis. Indian J Ophthalmol. 2021;69(9):2457-60.

Rezaei Kanavi M, Hosseini B, Javadi F, Rakhshani N and Javadi MA. Impression cytology in eyes with clinical and confocal scan features of acanthamoeba keratitis. J Ophthalmic Vis Res. 2013;8(3):207-12.

Salmon JF and Bowling B. Cornea. In: Kanski JJ, editor. Kanski's clinical ophthalmology: a systematic approach. 9th ed: Elsevier Health Sciences; 2015. p. 210-12.

Shabrawy RME, El Badawy NES and Harb AW. The incidence of fungal keratitis in Zagazig University Hospitals, Egypt and the value of direct microscopy and PCR technique in rapid diagnosis. J Microbiol Infect Dis. 2013;3(04):186-91.

Sharma S, Taneja M, Gupta R, Upponi A, Gopinathan U, Nutheti R, et al. Comparison of clinical and microbiological profiles in smear-positive and smear-negative cases of suspected microbial keratitis. Indian J Ophthalmol. 2007;55(1):21-5.

Shemis DM and Rahman FESA. Evaluation of Polymerase Chain Reaction and Culture for the Diagnosis of Corneal Ulcer. Life Sci. 2012;9(3):746-55.

Somerville TF, Herbert R, Neal T, Horsburgh M and Kaye SB. An Evaluation of a Simplified Impression Membrane Sampling Method for the Diagnosis of Microbial Keratitis. J Clin Med. 2021;10(23).

Tananuvat N, Salakthuantee K, Vanittanakom N, Pongpom M and Ausayakhun S. Prospective comparison between conventional microbial work-up vs PCR in the diagnosis of fungal keratitis. Eye (Lond). 2012;26(10):1337-43.

Thia ZZ and Tong L. Update on the role of impression cytology in ocular surface disease. Taiwan J Ophthalmol. 2019;9(3):141-9.

Ting DSJ, Ho CS, Deshmukh R, Said DG and Dua HS. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye. 2021;35(4):1084-101.

Zemba M, Dumitrescu OM, Dimirache AE, Branisteanu DC, Balta F, Burcea M, et al. Diagnostic methods for the etiological assessment of infectious corneal pathology (Review). Exp Ther Med. 2022;23(2):137.