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A corneal infection is an infection of the cornea, the clear section in front of the eyeball that allows light into the eye (find out more about how the eye works).
Corneal infections usually occur because of exposure to bacterial, viral or microbiological agents that cause the eyes to become red and swollen. Apart from contact lens related infections, infections can also occur due to existing abnormalities or disturbances of the eye surface or cornea or in cases of eye injury.
Corneal infections after eye trauma can also be prevented in work site-related injuries with the appropriate use of safety googles. Surgery for corneal infections may be indicated in very severe infections or when the infection is not responding to medical treatment i.e. Joint Commission International (JCI) accreditation is internationally recognized as a premier credential for hospitals and other medical institutions. The Excellence for Singapore Award was set up by the Singapore Totalisator Board in 1996 to recognise and honour individuals, groups of individuals or organisations that bring credit to Singapore by being among the best in their areas of activity in Asia or in the world. ISO 9001 is the globally implemented standard for providing assurance about the ability to satisfy quality requirements and to enhance customer satisfaction in supplier-customer relationships.
The Excellent Service Award (EXSA) is a national award managed by SPRING Singapore and nine industry lead associations.
Servi-CertTM is a service certification adapted from France and introduced into Singapore by the SGS International Certification Services Singapore Pte Ltd. The Singapore HEALTH (Helping Employees Achieve Life-Time Health) Award is presented by the Health Promotion Board to give national recognition to organisations with commendable Workplace Health Promotion (WHP) programmes.
As Singapore’s largest integrated healthcare provider and leading international medical group, SingHealth’s hospitals and Specialty Centres are recognised as tertiary centres. The Ophthalmology & Visual Sciences ACP (EYE-ACP), launched jointly by SingHealth and Duke-NUS, is a cluster-wide framework for all ophthalmologists to advance in Academic Medicine with resources and funding support. Despite its large surface area and constant exposure to the environment, the skin resists infection well. Cutaneous infections occur when the skin’s protective mechanisms fail, especially when trauma, inflammation, maceration from excessive moisture, or other factors disrupt the stratum corneum.
Anthropophilic dermatophytes are the most common cause of fungal skin infections in humans. Dermatophyte infections occur more frequently in certain ethnic groups and in people with impaired cell-mediated immunity.
The various forms of dermatophytosis, also called ringworm, are named according to the site involved. Tinea capitis occurs primarily in children but may develop in adults—especially the elderly, those who are unkempt, and the impoverished. Figure 1 Classic annular lesion of tinea corporis shows a raised or vesicular margin with central clearing. Figure 2 A typical kerion presenting as a zoophilic Microsporum canis infection of the scalp (tinea capitis).
Tinea corporis typically appears as a single lesion or multiple circular lesions with scaling, well-delineated margins, and a raised, erythematous edge. Figure 3 (a) The scaling of tinea pedis appears between and under the toes and on the plantar surface. Tinea barbae occurs in adult men and involves the skin and coarse hairs of the beard and mustache area.
Tinea faciei occurs as an infection of the face in women and children and infection of the area outside the mustache and beard in men. Tinea cruris, infection of the groin, is much more common in men than women and is often associated with infection of the feet. Clinicians should suspect dermatophyte infection in patients with any scaling, erythematous eruption and in patients whose nails exhibit the characteristics of tinea unguium (see above). The specimen is prepared for microscopic examination by first placing it on a glass slide and treating it with potassium hydroxide (KOH), which digests the keratin of the skin, nails, and hair, and then heating it to hasten the process.
Tinea corporis, tinea cruris, tinea pedis, and tinea faciei respond to topical agents applied once or twice daily to the affected area, usually for 2 to 4 weeks. The azoles include ketoconazole, itraconazole, and flucona-zole; like griseofulvin, they are fungistatic.
The yearly incidence of infections related to contact lens wear varies between 1 in 10,000 hard contact lens users, 4 in 10,000 soft contact lens users to 22 in 10,000 extended wear contact lens wearers. In severe cases, it can cause changes to the corneal shape leading to astigmatism, opacification of the cornea from scarring or a combination of both. Avoiding contact lens wear completely in patients who have predisposing diseases of the cornea or surface of the eye may be necessary. It is an international mark and endorsement for quality patient care and safety, and organisation management.

It is an important way of honouring organisations that strive to help their employees lead healthy and vibrant lives. SingHealth institutions are equipped with highly advanced medical technology and offers pioneering treatments in a wide range of medical procedures, with outcomes comparable with the best institutions worldwide.
Key appointment holders appointed include chair, and vice chairs for education and research. The most important protective factor is an intact stratum corneum, the tough barrier of protein and lipid formed on the cutaneous surface by the underlying epidermis.1 This barricade impedes invasion by environmental pathogens, and its dryness discourages colonization and growth of the many organisms that require moisture to survive, such as gram-negative bacilli.
The organisms causing infection may originate from the victim’s own resident flora, either on the skin or on adjacent mucous membranes, but many come from other people, animals, or the environment. These organisms, which include Trichophyton, Microsporum, and Epidermophyton species, are classified as an-thropophilic, zoophilic, or geophilic, depending on whether their primary source is humans, animals, or the soil, respective-ly.3 Geophilic dermatophyte infections occur sporadically, primarily among gardeners and farm workers. Transmission of these infections occurs from direct contact between people or from exposure to desquamated skin cells present in the environment— arthrospores can survive for months. Involvement of the feet and groin is most common in adolescents and young adults, especially males, but is unusual in children. These infections include tinea capitis (scalp), tinea corporis (body), tinea barbae (beard area of men), tinea faciei (face), tinea cruris (groin), tinea pedis (feet), tinea unguium (nails), and tinea manuum (hands).
Streptococci do not ordinarily survive on normal skin, but the presence of fungal disease apparently permits streptococci of various groups, including A, B, C, and G, to colonize the toe webs.6 From this location, these bacteria may invade the skin damaged by the tinea pedis or migrate to locations higher up the leg and enter the skin through any defects.
The organisms typically invade the nail from the distal or lateral borders, and infection spreads proximally. Most cases have accompanying involvement of the feet; inexplicably, usually only one hand is affected (so-called two-feet, one-hand disease). The basic culture medium for isolating dermatophytes is an agar containing Sabouraud medium, often combined with antibiotics to eliminate bacteria and with cycloheximide to inhibit sapro-phytic fungi. Five oral agents are currently available: griseofulvin, ke-toconazole, itraconazole, fluconazole, and terbinafine. Ketoconazole is usually well tolerated, but hepatotoxicity occurs in about 1 in 10,000 patients, typically after several weeks of use. The most effective agent is terbinafine, administered at a dosage of 250 mg daily for 6 weeks for fingernail infections and for 12 weeks for toenail involvement.9 Because terbinafine persists in the nails for many weeks, it continues to exert anti-fungal effects long after it is discontinued. They may form filamentous projections, which, unlike the hy-phae of molds, do not contain separate cells. The yearly incidence of vision loss from contact lens related infections has been estimated to be approximately 0.6 in 10,000 users in studies carried out in Australia and India. In most cases, patients with severe corneal infections are admitted into hospital and samples from the infection are taken to identify the likely organism before the start of the treatment. Surgery may also be indicated later on if vision is reduced due to corneal scarring from the infection.
The JCI accreditation program initiated in 1999 was designed to evaluate all the functions of acute care hospitals and medical centres.
SNEC has progressed from the Bronze Award in 2002 to Silver then to the Gold Award in 2005, 2006, 2008,2010 and 2012.
To ensure the healthcare outcomes are world-class, the Ophthalmology & Visual Sciences ACP will be focusing on developing a comprehensive framework of existing well-established research capabilities in SERI and the training capabilities in SNEC. Furthermore, the constant shedding of cells of the epidermis impedes most microbes from establishing permanent residence. Direct inoculation of the spores through breaks in the skin can lead to germination and subsequent invasion of the superficial cutaneous layers.
The characteristic skin lesion is an annular scaly patch [see Figure 1], though the clinical appearance varies not only with the site involved but also with the host’s immune status and the type of infecting organism.
Because the swollen hairs may fracture a few millimeters from the epidermis in this endothrix infection, the scalp sometimes appears to be marked by small black dots. Hair shedding late in the infection is common because the hair shaft is not damaged until the infection is well advanced.
The amount of inflammation varies; when the inflammation is intense, pustules, vesicles, and even bullae may occur. The optimal method of obtaining specimens from the skin is by scraping the scaly lesions; specimens from the nails are best obtained by taking fragments of subungual debris.
Griseo-fulvin, a fungistatic agent, is the oldest oral treatment available and is still useful, primarily in infections not involving the nails. Flucona-zole and itraconazole are very expensive, but they provide protracted levels of antibiotic in the nails, allowing short or intermittent courses of therapy for tinea unguium. It achieves high levels of drug in the nails, and the drug persists for many weeks after discontinuance. The terbinafine regimens produce short-term eradication of infection in about 70% to 90% of patients with fingernail infection and in about 50% to 80% of patients with toenail infection.

It normally colonizes the skin of adults, especially of the scalp and upper trunk, where the presence of sebum is highest.
Treatment with intensive eye drops is administered and adjusted until the infection improves. Surgery carried out in these situations aims to remove the diseased cornea (where scarring or severe infections is present) and replace the removed cornea with a corneal graft or transplant.
In general, anthro-pophilic species elicit little inflammation and cause chronic infections. Like all infections with Trichophyton species, these scalp lesions do not fluoresce under a Wood light. The most severe inflammation, usually from a zoophilic species, results in a kerion, a painful, boggy mass in which follicles may discharge pus and in which sinus tracts form [see Figure 2]. Sometimes, involvement of the hair follicles in the middle of a patch of scaling erythema leads to perifollicular nodules, a condition called Majocchi granuloma.
They may crack or crumble, and often, subungual hyperkeratosis lifts the nail plate from the underlying bed (a condition known as onycholysis) [see Figure 4].
Occasionally, vesicles, papules, or follicular nodules form on the dorsal surface of the hands. Der-matophyte test medium culture can be used in the office and is both accurate and inexpensive.7 When both KOH preparations and cultures are negative, a biopsy may be useful in identifying the infecting organism, usually by special tissue stains such as periodic acid-Schiff or Gomori methenamine-silver stains. Tinea pedis often recurs after effective therapy, especially in cases of the moccasin form of the disease.
Both fluconazole and itraconazole can cause gastrointestinal disorders, rashes, and, occasionally, hepatotoxicity and can have serious interactions with several medications, including cyclosporine, digox-in, and quinidine. Candida species are not part of the normal skin flora, but they commonly reside in the orophar-ynx, vagina, and colon.
For unknown reasons, these organisms, which are ordinarily commensals, can become pathogenic and cause tinea versicolor (also known as pityriasis versicolor) or folliculitis. Zoophilic and geophilic species, however, often provoke intense inflammation, which sometimes leads to eradication of the organisms and healing without treatment.
The hairs then become infected, in one of three microscopic patterns: ectothrix, endothrix, or favus. The victims are generally farm workers, and the infection usually causes erythema, scaling, and follicular pustules. Patients often complain of itching and burning, and symptoms may worsen after exposure to sunlight.
The lesions are usually red, scaling, sharply demarcated areas with raised, erythematous borders.
The most common form consists of fissuring, scaling, and maceration in the interdigital spaces, especially between the fourth and fifth toes. When infection reappears, the previous therapy can be resumed without loss of effectiveness.
Ketoconazole, itraconazole, and fluconazole can interact with other medications; pharmacologic sources should be consulted for potential interactions. About 75% of patients who receive one or more courses of terbinafine will have a clinical cure 5 years later. Human infections with zoophilic species have occurred after exposure to dogs, cats, horses, cattle, pigs, rodents, poultry, hedgehogs, and voles. The lesions may be scaly, annular erythematous patches, but often they are indistinct red areas with little or no scaling.
The infection, which affects the medial portion of the upper thighs but consistently spares the scrotum, may extend to the buttocks, abdomen, and lower back. A second type involves scaling, hyperkeratosis, and erythema of the soles, heels, and sides of the feet. This therapy is very expensive, and clinicians must decide in each case whether treatment is warranted. Alternatively, with reduction in the other flora or with impaired host defense mechanisms, these yeasts may proliferate in large numbers to produce lesions on the mucosal surfaces of the mouth and vagina. In this kind of tinea pedis, the lesions occur in a so-called moccasin distribution pattern [see Figure 3a]. All these medications are effective in cases of tinea barbae, Majocchi granuloma, extensive tinea corporis, and tinea manuum that are unresponsive to topical agents.
A third form demonstrates an inflammatory pattern characterized by vesicles, pustules, or even bullae, usually on the soles [see Figure 3b].

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30.11.2015, author: admin

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