Study of keratomycosis at a tertiary care teaching hospital

Corneal infections are one of the leading causes of ocular morbidity and blindness world-wide. If normal defence mechanisms of the eye are compromised, almost any microorganism can invade the cornea. It is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time, least serious consequences may follow. To isolate and identify the fungi from corneal scrapings of suspected keratitis patients. A prospective study of Fungal keratitis was conducted at Al-Azhar Medical College & Super Speciality Hospital in Thodupuzha, Kerala a tertiary care hospital with a capacity of 650 beds. The duration of the study was two years from January 2018 to January 2020. Patients with suspected fungal corneal ulcers presenting in the Out-Patient Department (OPD) of Ophthalmology were investigated for fungal etiology in the Department of Microbiology were included in this study. Each patient was examined with slit lamp. Data collected from history given by patient and patient examination. Using standard techniques. The specimens collected were then smeared on two slides, which were stained with Gram stain (for bacterial keratitis) and 10% potassium hydroxide preparation (for fungal keratitis) studied under light microscope. Of the 866 patients with corneal ulcer investigated, 83 cases with fungal and 36 with bacterial aetiology was identified. Males were more commonly affected and were mostly in the age group of 31-40 year. It was seen that trauma was the most common predisposing factor especially in the agriculturists and the farmers. Among the identified fungi, most were hyaline. Of the 83 positive specimens, the most frequent agent isolated was Fusarium species in 31 (37.3%) cases. 23 (27.7%) was the second most common followed by , ., . Candida albicans were 5 (6%) followed by 1 (1.2%). Fungal Keratitis is a serious problem usually following corneal trauma, it requires rapid detection and identification of fugal agents for treatment to prevent disastrous consequences.

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A Study on Microbial Profile of Corneal Ulcer Cases in a Tertiary Health Care Centre of Southern Assam

International Journal of Research and Review ◽

10.52403/ijrr.20210732 ◽

2021 ◽

Vol 8 (7) ◽

pp. 228-235

Author(s):

Barnamoy Bhattacharjee ◽

Atanu Chakravarty

Keyword(s):

Corneal Ulcer ◽

Fusarium Species ◽

Tertiary Care ◽

Agricultural Practice ◽

Care Hospital ◽

Corneal Ulceration ◽

Penicillium Species ◽

Direct Microscopy ◽

Corneal Ulcers ◽

Microbial Profile

Background-Visual impairment due to corneal ulceration has for long been acknowledged as leading cause of blindness both worldwide and in India only next to Cataract. The aetiology for infective corneal ulcer varies considerably with occupation of patients in different regions of India. Thus, continuing with empirical management without lab diagnosis leads to protracted clinical course. So, understanding the microbial profile of corneal ulcers in agriculture dependent population of Southern Assam helps in improved management of this morbidity. Aims- To 1) Find the prevalence of infected corneal ulcers in untreated patients attending Ophthalmology department of a tertiary care hospital of Southern Assam. 2) Study the pattern of microbial aetiology in the infected corneal ulcer cases. 3) Find the association of infected corneal ulcers with various attributing factors. Method-Corneal scrapings from 86 routine untreated cases of corneal ulceration from Ophthalmology Department were studied prospectively from Dec2017 to Jan2019 and subjected to Gram staining and direct examination with 10%KOH. Culture on SDA and Blood Agar were incubated at 25°C and 37°C respectively and followed up for 3 weeks before declaring sterile. Antimicrobial sensitivity was performed for bacterial isolate and yeast-like species. Slide culture and LPCB tease mount were done for identification of moulds. Result- Out of the 86 cases, 58 were positive in direct microscopy, of which 44 were culture positive. Of the 28 samples negative in direct microscopy, 2 were positive by Culture. Bacterial isolates were found in 5 cases and fungal aetiology in 41 cases. Conclusion- The prevalence of infected corneal ulcer as per standard of Culture positivity is 53.5% (46/86). Mycotic involvement was found in 90% cases. Important fungal isolates identified were Aspergillus species, Penicillium species, Curvularia species, Fusarium species, Sarocladium species. Higher prevalence was significantly associated with harvesting season, agricultural practice and history of trauma while diabetes and steroid intake were not significantly associated with mycotic ulcers. Keywords: Corneal ulcer, Assam, Fungal, Fusarium, Sarocladium, Pseudomonas.

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Clinical and Etiological Profile of Mycotic Keratitis from a Tertiary Care Centre in South India

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/410 ◽

2021 ◽

Vol 10 (27) ◽

pp. 2001-2006

Author(s):

John Britto Augustin ◽

Sureshbaboo Variamkandi

Keyword(s):

Risk Factors ◽

Corneal Ulcer ◽

Fusarium Species ◽

Tertiary Care ◽

Government Medical College ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Medical College ◽

Corneal Ulcers ◽

Prompt Treatment

BACKGROUND Corneal ulcer is the leading cause of ocular morbidity and monocular blindness worldwide. To effectively prevent blindness in patients with corneal ulcer, a proper understanding of the risk factors predisposing to ulceration, its clinical and microbiological characteristics are essential. Timely identification of aetiological agents causing corneal ulcers and their prompt treatment helps to save the vision. We wanted to detect aetiological agents of corneal ulcer with special references to fungal causes and characterize the fungal aetiological agents to species level. METHODS This is a cross sectional study, conducted in Government Medical college, Kozhikode, between January 2016 and June 2017. All patients who were clinically diagnosed as cases of infectious corneal ulcer in the Ophthalmology department, Government Medical College, Kozhikode were included in the study. Corneal scrapings collected from the infected eye were subjected to microbiological examination and culture. A total of 120 cases were analysed. Each patient was examined with the slit lamp bio microscope after staining with fluorescein. Scrapings from cornea at the site of corneal ulcer were collected by ophthalmologist after a detailed clinical history and examination of the affected eye. The laboratory procedures used in the diagnosis of infectious keratitis were based on direct visualization of organisms by subjecting corneal scrapings to Gram stain and KOH wet mount and inoculation of material on to blood agar and Sabouraud dextrose agar. RESULTS Among the 120 cases, a total of 49 cases were culture positive. Twenty-one [17.5 %] were bacterial, twenty-two [18.34 %] were fungal and six [5.0 %] were poly microbial [bacteria and fungus]. Among the fungal aetiology, fusarium species was most common [32.14 %], followed by aspergillus species - 25.0 %. Trauma was the major risk factor. Diabetes mellitus, exposure keratitis were the other comorbidities / risk factors. CONCLUSIONS This study shows majority of infected corneal ulcers are associated with risk factors and the aetiology are mainly fungi. Microscopy, culture, and clinical correlation helped in adequate management. Thus, prognosis and outcome of corneal ulcers rely on timely identification of their aetiology and prompt treatment. KEY WORDS Corneal ulcer, Fungal Keratitis

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Profile of fungal keratitis in a Sub-Himalayan territory of north India

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i4.592 ◽

2021 ◽

Vol 17 (4) ◽

pp. 356-364

Author(s):

Anil Kumar Verma ◽

Anuradha Sood ◽

Anil Chauhan ◽

Rajeev Tuli ◽

Subhash Chand Jaryal

Keyword(s):

Corneal Ulcer ◽

Diagnostic Value ◽

Fungal Species ◽

Fungal Keratitis ◽

North India ◽

Mycotic Keratitis ◽

Predisposing Factor ◽

Direct Microscopy ◽

Corneal Ulcers ◽

Wet Mount

Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents. Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture. Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively. Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.

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Epidemiology and laboratory diagnosis of fungal corneal ulcer in the Sundarban Region of West Bengal, eastern India

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v4i1.5847 ◽

1970 ◽

Vol 4 (1) ◽

pp. 29-36 ◽

Cited By ~ 9

Author(s):

S Bandyopadhyay ◽

D Das ◽

KK Mondal ◽

AK Ghanta ◽

SK Purkait ◽

...

Keyword(s):

West Bengal ◽

Corneal Ulcer ◽

Tertiary Care ◽

Laboratory Diagnosis ◽

Microbial Culture ◽

Care Hospital ◽

Eastern India ◽

Corneal Ulcers ◽

Epidemiological Characteristics ◽

Culture Positive

Introduction: Corneal ulcers are the second most-common cause of preventable blindness after cataract in tropical developing countries. Fungal corneal ulcers constitute 30 to 62 % of the total microbial culture-positive corneal ulcers. Objective: To study the epidemiological characteristics, risk factors and laboratory diagnosis of fungal corneal ulcer in the Sundarban Region, West Bengal, eastern India. Materials and methods: A retrospective review of 399 culture-positive, fungal corneal ulcers out of a total 928 corneal ulcer patients attending a tertiary care hospital in Kolkata, eastern India, over a period of four years from February 2007 to January 2011. Results: Males (246; 61.65 %) were more commonly affected than females (P < .0001). The affected people were mostly (342; 85.71 %) residing in the rural areas (P < .0001). 196 patients (49.12 %) were involved in agricultural activities (P < .0001). The younger people of, 21 - 50 years of age, were particularly prone to this disease (269; 67.41 %). Corneal trauma (354; 88.72 %) was the commonest risk factor (P < .0001) and 261 patients (61.41 %) had a history of trauma with vegetative matter (P< .0001). The use of topical corticosteroids was implicated in 65 (16.29 %) cases. The incidence of the disease was highest in the monsoon season, between June to September (192; 48.12 %). The aspergillus spp was the most common fungal growth (151; 37.84 %), followed by an Fusarium spp (81; 20.3 %). Conclusion: The fungal corneal ulcers are an important cause of ocular morbidity in people residing in the Sundarban Region. The identification of the etiology and the predisposing factors of corneal ulcers in this region are important for the prevention and early treatment of the disease. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5847 NEPJOPH 2012; 4(1): 29-36

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Etiological factors & microbiological characteristics of infectious keratitis in western Maharashtra

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.080 ◽

2021 ◽

Vol 7 (2) ◽

pp. 402-409

Author(s):

Madhuvanthi Mohan ◽

Renu Magdum ◽

Sucheta Kaul ◽

Chaitali Desai ◽

Namratha Judith Cardoza ◽

...

Keyword(s):

Fusarium Species ◽

Tertiary Care ◽

Central India ◽

Fungal Keratitis ◽

Etiological Factor ◽

Care Hospital ◽

Infectious Keratitis ◽

Etiological Factors ◽

Microbiological Characteristics ◽

Department Of Ophthalmology

To identify the etiological factors and study the microbiological characteristics of infectious keratitis in Western Maharashtra. This was a prospective observational hospital‐based study conducted at the Department of Ophthalmology, at a tertiary care hospital, in a part of central India. Data related to socioeconomic status and etiological factors was collected. Results were analyzed on the basis of history, slit lamp examination, microbiological scraping and culture results. During the period of September 2018 to August 2020, a total of 60 patients with infectious keratitis were examined in the Ophthalmology OPD. Majority of patients of infectious keratitis were between 61 and 70 (18.33%) age group. Incidence in male was higher (68%) than female. Ocular trauma was the most common etiological factor (52%). Prevalence of Fungal keratitis (52%) was higher than bacterial (46%) in this part of India. 57% subjects showed organism on Gram staining. 53% subjects showed KOH positivity. 68.3% showed growth over microbiological culture with the most common species isolated as Fusarium species (26.6%) followed by Pseudomonas aeruginosa. Incidence of fungal keratitis is higher in this part of Western Maharashtra. Most common etiological factor was determined to be trauma with vegetative matter among farmers which tells us that they are most prone for infectious keratitis. Prompt diagnosis, microbiological scraping, culture growth identification and starting on appropriate treatment can help reduce the morbidity of corneal ulcers.

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A Prospective Study of Corneal Ulcers and Their Microbiological Profile among Patients in a Government Hospital in Ajmer, Rajasthan

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/155 ◽

2021 ◽

Vol 8 (13) ◽

pp. 790-795

Author(s):

Prateek Jain ◽

Sushma Kumari Singhal ◽

Pankaj Sharma ◽

Kalika Gupta

Keyword(s):

Prospective Study ◽

Corneal Ulcer ◽

Bacterial Species ◽

Specific Treatment ◽

Corneal Ulceration ◽

Predisposing Factor ◽

Ocular Surgery ◽

Corneal Ulcers ◽

A Prospective Study

BACKGROUND Significant causes of corneal blindness worldwide are ocular trauma and corneal ulceration that are often under reported. They may be responsible for 1.5 - 2.0 million new cases of monocular blindness every year. Corneal ulceration in developing countries has only recently been recognised as a silent epidemic. Infectious keratitis is one of the leading causes of blindness but in most cases these infections represent preventable or treatable ophthalmic diseases. Important predisposing factors related to corneal ulcers are trauma, chronic ocular surface disease, contact lens usage, ocular surgery, corneal anaesthetics abuse, diabetes mellitus, vitamin deficiency and immuno-deficiencies. This work is proposed to study the prevalence, clinical and lab diagnosis and management of suppurative corneal ulcer. We wanted to study the socio-demographic profile, microbiological investigation and treatment outcome of patients with corneal ulcer. METHODS This is a prospective study conducted among patients presenting with corneal ulcer at a tertiary level Government Medical College, Ajmer, Rajasthan. RESULTS Trauma comes out as a major predisposing factor for the development of corneal ulcer. 18.1 % of the study subjects had bacterial corneal ulcer and 37.7 % had fungal ulcer. More than half of the patients showed good prognosis on follow up. There was good response in most of patients, 51.2 % improved in first week which increased to 57.4 % at the time of second follow up. The most common bacterial species responsible for corneal ulcer was found to be staphylococcus followed by pseudomonas. CONCLUSIONS Bacteria and fungi are a frequent cause of ulcerative keratitis. Microbiological work up is an essential tool in the diagnosis of these infections which should not be under-rated. Timely administration of species-specific treatment certainly results in early resolution of keratitis followed by satisfactory visual outcome. Late or inappropriate treatment worsens the condition resulting in corneal perforation and increased morbidity. KEYWORDS Prospective, Corneal Ulcer, Bacterial, Fungal, Infectious

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Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1410 ◽

2022 ◽

Vol 71 (12) ◽

pp. 2735-2739

Author(s):

Amna Rizwan ◽

Asfandyar Asghar ◽

Syed Ali Hasan Naqvi ◽

Ume Sughra ◽

Hassan Raza

Keyword(s):

Risk Factors ◽

Corneal Ulcer ◽

Tertiary Care ◽

Care Hospital ◽

Ocular Surgery ◽

Duration Of Symptoms ◽

Corneal Ulcers ◽

Department Of Ophthalmology ◽

Culture Sensitivity ◽

Local Risk

Objective: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. Methods: The is a prospective cohort study carried out from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital (FFH) Rawalpindi. A total of 65 eyes of 65 patients of corneal ulcer meeting the inclusion criteria were evaluated and corneal scrapes were sent for microbiological assessment. Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity (BCVA), treatment and complications. Results: Out of 65 eyes of 65 patients, 40 (61.5%) were females and 25 (38.4%) were males. Most common local risk factor was ocular surgery (29.2%) followed by ocular trauma (23.1%). Diabetes was present in 44.6% of the cases. Culture results after corneal scrapings were positive for 39 (60%) of the total samples, while 26 (40%) had no growth. Bacterial growth was present in 51.3% of eyes, fungal in 28.2% while 20.5% of the eyes were infected with polymicrobial organisms. Most common pathogens were Pseudomonas (25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up period 40 cases (61.5%) showed improvement. Conclusion: This study concluded that isolated Pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are very much needed in developing countries to avoid blindness due to keratitis. Keywords: Infective keratitis, risk factors, corneal ulcer, culture sensitivity.

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Fronto-ethmoidal mucoceles: a study of 25 cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20164812 ◽

2016 ◽

Vol 3 (1) ◽

pp. 112

Author(s):

Viral Prajapati ◽

Ajeet Kumar Khilnani ◽

Gambhirsang Gami ◽

Neena Bhalodiya ◽

Devang Gupta

Keyword(s):

Prospective Study ◽

Imaging Modality ◽

Tertiary Care ◽

Geographical Area ◽

Sinus Surgery ◽

Care Hospital ◽

Radiological Findings ◽

Predisposing Factor ◽

A Prospective Study ◽

Comprehensive Study

Background: Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. Fronto-ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses.Methods: This is a prospective study of 25 cases of patients presenting with fronto-ethmoidal mucoceles in a tertiary care hospital in Ahmedabad. All patients were managed surgically through endoscopic approach. Results: The study comprised of 25 cases of fronto-ethmoidal mucoceles. The average age of the patients was 47.72 years with a range of 21–75 years. 16 patients (64%) were females. The most common involvement was of frontal sinus (16 cases, 64%). The most common presenting symptom was displacement of eyeball (68% cases). The most common presenting sign was proptosis, present in 68% cases. Endoscopic sinus surgery was the most commonly used modality of treatment of frontal mucocele and fronto-ethmoidal mucoceles (23 cases). In 2 cases combined approach surgery (endoscopic and external) was done.Conclusions: Mucoceles most commonly occur between 4th to 7th decades of life. In most cases no predisposing factor is identified. The diagnosis is based on the history, physical examination and radiological findings. CT is the preferred imaging modality for mucoceles.Endoscopic endonasal surgery is currently the most commonly used surgical approach.

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