{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:37:21Z","timestamp":1786649841398,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2]]},"abstract":"\n Purpose:<\/jats:title>\n \n To evaluate the knowledge and skills of clinicians in differentiating cases of\n Pythium<\/jats:italic>\n from fungal keratitis based on their clinical appearance.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Thirty slit-lamp photographs from culture-proven cases of\n Pythium<\/jats:italic>\n and fungal keratitis were selected for conducting a prospective online-based photographic survey. The participants were asked to identify the causative organism and enlist the specific clinical features which helped in reaching the diagnosis. Both cornea specialists and clinical fellows\/trainees participated in the survey. Sensitivity, specificity, and predictive values were estimated, and the factors associated with these, including the identification rates of clinical signs, were evaluated using bivariate and multivariate linear regression analyses. The identification rates between the consultants and fellows were compared.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 42 cornea specialists (28 consultants and 14 clinical fellows) participated in the survey. Clinicians were able to differentiate\n Pythium<\/jats:italic>\n from fungal etiology in only 56% of cases. The differentiating ability between the consultants and fellows was statistically insignificant. Average sensitivity, specificity, and positive and negative predictive values for differentiating\n Pythium<\/jats:italic>\n from fungus were 56%, 65%, 56%, and 66%, respectively. The specific clinical features enlisted by the participants to differentiate\n Pythium<\/jats:italic>\n from fungus were the presence of tentacles, peripheral guttering, dot-like infiltrates, and elevated plaques.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n Clinical knowledge regarding the signs and symptoms and the microbiological identification of features for\n Pythium<\/jats:italic>\n are still lacking among clinicians. As the treatment protocols are distinctly different for both, it is imperative to enhance the knowledge and diagnosing ability to tackle this emerging microorganism which causes high morbidity.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_913_22","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T09:22:50Z","timestamp":1675329770000},"page":"510-514","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Clinical differentiation of keratitis due to fungus and Pythium: A photographic survey"],"prefix":"10.4103","volume":"71","author":[{"given":"Rakhi P","family":"D\u2019cruz","sequence":"first","affiliation":[{"name":"Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashik","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujata","family":"Das","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"key":"R1-20251006","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s12281-013-0144-z","article-title":"The mammalian pathogenic oomycetes","volume":"7","author":"Mendoza","year":"2013","journal-title":"Curr Fungal Infect Rep"},{"key":"R2-20251006","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/QCO.0b013e32834ab21e","article-title":"The emerging epidemiology of mould infections in developing countries","volume":"24","author":"Chakrabarti","year":"2011","journal-title":"Curr Opin Infect Dis"},{"key":"R3-20251006","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/ICO.0b013e3182535841","article-title":"Outbreak of Pythium keratitis during rainy season:A case series","volume":"32","author":"Thanathanee","year":"2013","journal-title":"Cornea"},{"key":"R4-20251006","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1097\/ICO.0b013e318199fa41","article-title":"Pythium insidiosum keratitis in contact lens wear:A case report","volume":"28","author":"Lekhanont","year":"2009","journal-title":"Cornea"},{"key":"R5-20251006","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/j.1442-9071.2009.02135.x","article-title":"Pythium insidiosum keratitis in an Australian child","volume":"37","author":"Badenoch","year":"2009","journal-title":"Clin Exp Ophthalmol"},{"key":"R6-20251006","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/ICL.0b013e3182043114","article-title":"Pythium insidiosum keratitis in Israel","volume":"37","author":"Tanhehco","year":"2011","journal-title":"Eye Contact Lens"},{"key":"R7-20251006","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/S0002-9394(03)00908-5","article-title":"Ocular pythiosis:Is it under-diagnosed?","volume":"137","author":"Krajaejun","year":"2004","journal-title":"Am J Ophthalmol"},{"key":"R8-20251006","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/ICO.0000000000000349","article-title":"Pythium insidiosum keratitis:Clinical profile and role of DNA sequencing and zoospore formation in diagnosis","volume":"34","author":"Sharma","year":"2015","journal-title":"Cornea"},{"key":"R9-20251006","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/ijo.IJO_445_18","article-title":"Pythium keratitis in South India:Incidence, clinical profile, management, and treatment recommendation","volume":"67","author":"Hasika","year":"2019","journal-title":"Indian J Ophthalmol"},{"key":"R10-20251006","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/ICO.0b013e3181ca2ba3","article-title":"Randomized clinical study for comparative evaluation of fourth-generation fluoroquinolones with the combination of fortified antibiotics in the treatment of bacterial corneal ulcers","volume":"29","author":"Shah","year":"2010","journal-title":"Cornea"},{"key":"R11-20251006","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/bjophthalmol-2017-310604","article-title":"Clinical profile of pythium keratitis:Perioperative measures to reduce risk of recurrence","volume":"102","author":"Agarwal","year":"2018","journal-title":"Br J Ophthalmol"},{"key":"R12-20251006","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1167\/iovs.11-8478","article-title":"The clinical differentiation of bacterial and fungal keratitis:A photographic survey","volume":"53","author":"Dalmon","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R13-20251006","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.ajo.2007.02.030","article-title":"The clinical diagnosis of microbial keratitis","volume":"143","author":"Dahlgren","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"R14-20251006","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.ajo.2007.02.016","article-title":"Clinical characteristics and outcome of Candida keratitis","volume":"143","author":"Sun","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"R15-20251006","first-page":"2161","article-title":"Automated differentiation of bacterial from fungal keratitis using deep learning","volume":"62","author":"Redd","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R16-20251006","doi-asserted-by":"crossref","first-page":"e8555","DOI":"10.7717\/peerj.8555","article-title":"Recent update in diagnosis and treatment of human pythiosis","volume":"8","author":"Chitasombat","year":"2020","journal-title":"PeerJ"},{"key":"R17-20251006","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.2147\/OPTH.S303721","article-title":"Clinical characteristics, histopathology, and treatment outcomes of Pythium keratitis:A retrospective cohort study","volume":"15","author":"Puangsricharern","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"R18-20251006","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1093\/jac\/dkv008","article-title":"Treatment outcomes of surgery, antifungal therapy and immunotherapy in ocular and vascular human pythiosis:A retrospective study of 18 patients","volume":"70","author":"Permpalung","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"R19-20251006","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1093\/mmy\/myz013","article-title":"Clinical outcomes in ocular pythiosis patients treated with a combination therapy protocol in Thailand:A prospective study","volume":"57","author":"Permpalung","year":"2019","journal-title":"Med Mycol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_913_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:59:03Z","timestamp":1786647543000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_913_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_913_22","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2]]},"assertion":[{"value":"2022-04-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}