Infectious Keratitis in Western Nepal: An Experience from a Tertiary Care Hospital

Corneal blindness is a major public health problem worldwide and infectious keratitis remains a leading cause. The aim was to analyze the microbial etiology of corneal ulcers and to determine the antibiotic susceptibility pattern of bacterial isolates. Among 84 clinically diagnosed cases, 33 (39.3%) were farmers by occupation. All cases were reviewed for predisposing conditions and clinical severity. Ulcers were categorized as mild in 49 cases moderate in 12 and severe in 23 cases. Predisposing conditions were detected in 65.5% (55/84) of patients. Forty-two cases showed culture positivity. Among these 42; 25 (29.7%) yielded fungi, 13(30.1%) yielded bacteria and the rest 4 (4.7%) showed mixed growth, accounting for a total of 29 cases showing fungal growth, and 17 demonstrating bacterial growth. Aspergillus spp. (10/29; 34.5%) were the commonest fungi and Staphylococcus aureus, (8/17; 47%) was the most common among bacteria. Majority i.e 66.7% (26 of 39) of those having trauma as the predisposing factor developed moderate to severe degree of corneal ulceration as compared to only 20% (9 of 45) of those without any history of trauma and this difference was found to be statistically significant (p<0.001). Interestingly, 20(68.9%) of 29 cases that yielded fungal growth on culture had previous history of ocular trauma in contrast to only 19 (34.5%) of 55 who had non-fungal keratitis (p=0.003). It was also observed that significantly higher number of fungal keratits cases exhibited pronounced degree of clinical severity, as compared to cases without any fungal aetiology (p<0.001) Topical administration of fourth generation fluoroquinolone eye drops remained the most effective drug of choice as far as the clinical outcome of bacterial keratitis was concerned. Trauma with vegetative matter predisposed to most cases of fungal keratitis. Severe form of ulceration was noticed in patients with fungal infection.

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Infectious Keratitis in Western Nepal: An Experience from a Tertiary Care Hospital

10.21203/rs.2.125/v1 ◽

2018 ◽

Author(s):

Rajani Shrestha ◽

Niranjan Nayak ◽

Babita Gurung ◽

Shishir Gokhale

Keyword(s):

Antibiotic Susceptibility ◽

Fungal Growth ◽

Severe Form ◽

Fungal Keratitis ◽

Clinical Severity ◽

Diffusion Method ◽

Eye Drops ◽

Infectious Keratitis ◽

History Of ◽

Predisposing Conditions

Abstract Background: Corneal blindness is a major public health problem worldwide and infectious keratitis is one of its leading causes. The aim was is to analyze the microbial etiology of corneal ulcers and to determine the antibiotic susceptibility pattern of bacterial isolates in order to find out the existing drug resistance pattern. Methods: Corneal scrapings were collected as per the standard procedure. All the isolates were identifies by conventional microbiological techniques. Antibiotic susceptibility testing was performed using disc diffusion method. Clinical grading of the ulcerative lesion was carried out by the recommended protocol. Results: Among the 84 cases of clinically diagnosed infectious keratitis investigated, 33 (39.3%) were farmers by occupation. All cases were reviewed for predisposing conditions and clinical severity. Ulcers were categorized as mild in 49 cases moderate in 12 and severe in 23 cases. Predisposing conditions were found in 55(65.5%) of the 84 cases. Forty-two cases showed culture positivity. Among these 42; 25 (29.7%) yielded fungal growth, 13(30.1%) yielded bacteria and the rest 4 (4.7%) showed mixed growth. Aspergillus spp. (10/29; 34.5%) were the commonest fungi isolated followed by Fusarium spp. (6/29; 20%). Similarly, Staphylococcus aureus, (8/17; 47%) was the most common among bacteria. Majority i.e 66.7% (26 of 39) of those having trauma, as the predisposing factor developed moderate to severe degree of corneal ulceration as compared to only 20% (9 of 45) of those without any history of trauma. (p<0.001). Interestingly, 20(68.9%) of the 29 cases that had yielded fungal growth on culture had had previous history of ocular trauma in contrast to only 19 (34.5%) of the 55 who had non-fungal origin of keratitis. (p=0.003). Fungal keratitis cases presented with more severe form of ulcerative lesions exhibiting more often with infiltrates and hypopion as compared to bacterial keratitis. Topical administration of fourth generation fluoroquinolone eye drops remained the most effective drug of choice with clinical improvement in all cases without any complications. Conclusions: Trauma with vegetative matter predisposed to most cases of fungal keratitis. Severe form of ulceration was noticed in patients with fungal infection. Surveillance of the antibiotic sensitivity is needed for quality patient management.

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Need to suspect fungal etiology in presumed bacterial keratitis - A case report of keratitis due to Scedosporium prolificans

Asian Journal of Medical Sciences ◽

10.3126/ajms.v2i1.4058 ◽

2011 ◽

Vol 2 (1) ◽

pp. 28-30 ◽

Cited By ~ 1

Author(s):

Lata R Chandel ◽

Anuradha Sood ◽

Smriti Chauhan ◽

Kamlesh Thakur

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Fungal Keratitis ◽

Care Hospital ◽

Bacterial Keratitis ◽

Medical Sciences ◽

Prompt Treatment ◽

Acute Presentation ◽

History Of ◽

Scedosporium Prolificans

We describe a case of keratitis with acute presentation and without any history of trauma caused by Scedosporium prolificans; a rare cause of fungal keratitis, from a tertiary care hospital. To the best of our knowledge this is the first such case reported from the region. Because of early diagnosis and prompt treatment the patient could be managed well. Keywords: Keratitis; Scedosporium prolificans; Prompt treatment DOI: 10.3126/ajms.v2i1.4058 Asian Journal of Medical Sciences 2 (2011) 28-30

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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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Acanthamoeba keratitis: A 4-year review from a tertiary care hospital in North India

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v12i1.24769 ◽

2020 ◽

Vol 12 (1) ◽

pp. 83-90

Author(s):

Kirti Megha ◽

Anchal Thakur ◽

Sumeeta Khurana ◽

Rakesh Sehgal ◽

Amit Gupta

Keyword(s):

Clinical Characteristics ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Acanthamoeba Keratitis ◽

Complete Healing ◽

North India ◽

Eye Drops ◽

Care Hospital ◽

Body Sensation ◽

History Of

Introduction: Acanthamoeba keratitis (AK) is a blinding condition reported from both developed and developing countries. Limited knowledge on the clinical characteristics of AK and scarce laboratory diagnostic facilities in such countries poses difficulties in the accurate diagnosis. Objective: To describe the epidemiological and clinical characteristics as well as management of Acanthamoeba keratitis in a tertiary care hospital in North India. Methods: All clinically suspicious cases of Acanthamoeba keratitis (AK) presenting to our centre were screened for Acanthamoeba. All patients diagnosed as Acanthamoeba on microscopic examination, culture and polymerase chain reaction (PCR) were given Polyhexamethylene biguanide (PHMB) eye drops 0.02% half hourly for 1 week, then hourly for 1 week and then gradually tapered according to the response. Out of 300 consecutive patients evaluated, Acanthamoeba was detected in 11(3.6%) patients. A history of trauma was elicited in majority of the patients, 6 (55%). The most common complaints were eye pain, redness and watering in all of the patients, diminution of vision (8, 72.7%), photophobia (7, 63.6%) and foreign body sensation (2, 18.2%). Complete healing with vascularization and scarring was observed in 7 patients (63.6%) patients whereas progression to perforation of corneal ulcer and corneal melt was seen in 3 (27.3%) cases and these patients underwent therapeutic keratoplasty later. One patient did not come for follow up examination. Conclusion: The most common risk factor for the occurrence of Acanthamoeba Keratitis is trauma followed by contact lens use.

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Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: A Blinded Study to Establish Baseline Acquisition Rates

Infection Control and Hospital Epidemiology ◽

10.1086/502224 ◽

2003 ◽

Vol 24 (6) ◽

pp. 415-421 ◽

Cited By ~ 52

Author(s):

Joel T. Fishbain ◽

Joseph C. Lee ◽

Honghung D. Nguyen ◽

Jeffery A. Mikita ◽

Cecilia P. Mikita ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Transmission Rate ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Nosocomial Transmission ◽

Surveillance Culture ◽

Care Hospital ◽

Average Hospital ◽

Methicillin Resistant ◽

History Of

AbstractObjective:To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.Design:A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA Risk factors associated with the likelihood of MRSA colonization on admission were investigated.Setting:Tertiary-care military medical facility.Participants:All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.Results:Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.Conclusions:Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

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Fungal Keratitis in Northern Thailand: Spectrum of Agents, Risk Factors and Putative Virulence Factors

Journal of Fungi ◽

10.3390/jof7060475 ◽

2021 ◽

Vol 7 (6) ◽

pp. 475

Author(s):

Siriporn Chongkae ◽

Sirida Youngchim ◽

Joshua D. Nosanchuk ◽

Angkana Laliam ◽

Chulaluck Tangmonkongvoragul ◽

...

Keyword(s):

Virulence Factors ◽

Vision Loss ◽

Proteolytic Enzymes ◽

Tertiary Care ◽

Fungal Keratitis ◽

High Rate ◽

Ocular Infection ◽

Fungal Culture ◽

Care Hospital ◽

Northern Thailand

Fungal keratitis (FK) is a serious ocular infection that can result in various degrees of vision loss, including blindness. The aim of the study was to identify and retrospectively review all FK cases diagnosed between August 2012 and December 2020 at a tertiary care hospital in northern Thailand with a specific focus on epidemiologic features, including season, patient sex and age, the spectrum of pathogens, and presence of certain putative virulence factors. Of 1237 patients with corneal ulcers, 294 (23.8%) were confirmed by direct microscopic examination and/or fungal culture. For the positive cases, direct examinations of Calcofluor white (CW) stains and KOH mounts were found in 97.3% (286/294) and 76.5% (225/294), respectively (p < 0.05). Of the cases diagnosed by microscopy and culture, fungi were isolated in 152 (51.7%), with Fusarium spp. being the most frequently identified (n = 69, 45.5%) followed by dematiaceous fungi (n = 45, 29.6%) and Aspergillus spp. (n = 18, 11.8%). The incidence of FK was higher in the rainy season of July to October. The mean age was 54.4 ± 14.4 (SD) years, with a range of 9–88 years. Males (75.8%) were affected significantly more than females (24.2%) (p < 0.05). Of 294 patients, 132 (44.9%) were middle-aged adults (41–60 years) and 107 (36.4%) were older than 60 years. Trauma to the eye by soil or vegetative matter were the most common preceding factors (188/294; 64.0%). We assessed two virulence factors. First, 142 of the 152 culture-positive FK cases were due to molds, indicating that hyphal morphogenesis is extremely important in disease. We also demonstrated that fungal melanization occurs in the molds during the course of FK by applying a melanin-specific monoclonal antibody (MAb) that labeled fungal elements in corneal samples of patients, and melanin particles derived from the hyphae were also recovered after treatment of the samples with proteolytic enzymes, denaturant and hot concentrated acid. In summary, we demonstrate that northern Thailand has a high rate of FK that is influenced by season and males engaged in outside activities are at highest risk for disease. Moulds are significantly more commonly responsible for FK, in part due to their capacity to form hyphae and melanins. Future studies will examine models of fungal corneal interactions and assess additional factors of virulence, such as secreted enzymes, to more deeply decipher the pathogenesis of FK.

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Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00441-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Yan-Jun Zheng ◽

Ting Xie ◽

Lin Wu ◽

Xiao-Ying Liu ◽

Ling Zhu ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antifungal Therapy ◽

Species Distribution ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Clinical Severity ◽

Severe Neutropenia ◽

Care Hospital ◽

The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

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COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

10.36106/ijsr/4605295 ◽

2021 ◽

pp. 70-72

Author(s):

Gaurav Santosh Nemade ◽

Sumit Nitin Dhus ◽

Arushi Ramesh Shetty ◽

Neha Dhananjay Firake

Keyword(s):

Tertiary Care ◽

Care Hospital ◽

Female Ratio ◽

Extra Pulmonary Tuberculosis ◽

Younger Age ◽

Tobacco Addiction ◽

History Of ◽

Early Case ◽

Male To Female ◽

Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

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Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

10.53350/pjmhs211592451 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2451-2453

Author(s):

Shahid Iqbal ◽

Muhammad Fareed Khan ◽

Raja Imtiaz Ahmed ◽

Shahab Saidullah ◽

Nisar Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Folic Acid ◽

Congenital Heart ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Febrile Illness ◽

Care Hospital ◽

Younger Age ◽

History Of ◽

Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

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PREVALENCE OF NAFLD AMONG HEALTHY LIVER DONORS

10.36106/ijsr/8024686 ◽

2021 ◽

pp. 46-48

Author(s):

Muzaffer Rashid Shawl ◽

Fahad ul Islam Mir ◽

Saad Abdul Rahman ◽

Anil C Anand ◽

Manav Wadhawan ◽

...

Keyword(s):

Fatty Liver ◽

Tertiary Care ◽

Cross Sectional Study ◽

Western World ◽

Care Hospital ◽

Cross Sectional ◽

Obstructive Sleep ◽

History Of ◽

Healthy Liver ◽

Liver Donors

NAFLD is hepatic pandemic of the twenty rst century, being leading cause of chronic hepatic disease in western world. We did a cross sectional study to nd out prevalence of NAFLD among prospective healthy liver donors at a tertiary care hospital at New Delhi, India over a period from June 2014 to March 2016. 124 apparently healthy prospective liver donors were selected. Exclusion criteria were set to exclude all those who had signicant history of alcohol intake (dened as greater than 30g/day for men and greater than 20g/day for women over last two years), Hepatitis B or C infection, severe surgical weight loss or emaciation, Obstructive Sleep Apnea, Celiac disease, history of drug intake known to cause hepatic steatosis. Out of 124 prospective liver donors included in this study, 29 (23%) donors were found to have fatty liver on USG abdomen; 38 (31%) donors had fatty liver on unenhanced CTof the abdomen (LAI of ≤ 5 HU); 61 (49%) donors had fatty liver on magnetic resonance.

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