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

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.

Download Full-text

Study of keratomycosis at a tertiary care teaching hospital

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.015 ◽

2021 ◽

Vol 7 (2) ◽

pp. 65-70

Author(s):

Veluri Gayathri ◽

Ami Jeswin

Keyword(s):

Corneal Ulcer ◽

Fusarium Species ◽

Tertiary Care ◽

Fungal Keratitis ◽

Care Hospital ◽

Predisposing Factor ◽

Corneal Ulcers ◽

Detection And Identification ◽

Bacterial Aetiology ◽

A Prospective Study

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.

Download Full-text

The prevalence of characteristic corneal ulcer patients in sanglah general hospital, in indonesia

World Journal of Current Medical and Pharmaceutical Research ◽

10.37022/wjcmpr.v3i4.182 ◽

2021 ◽

pp. 81-84

Author(s):

Sinta Wiranata ◽

I Wayan Eka Sutyawan ◽

I Putu Budhiastra

Keyword(s):

General Hospital ◽

Corneal Ulcer ◽

Sampling Technique ◽

Cross Sectional Study ◽

Predisposing Factor ◽

Cross Sectional ◽

Corneal Ulcers ◽

Analytical Research ◽

Epidemiological Trends ◽

The Relationship

Purpose: The purpose of the study was to perceive epidemiology, predisposing and varied risk factors, age, gender, profession, ulcus location, lateralization, visus category, medication. It also determines the relationship between each factor with infection and non-infection in Sanglah General Hospital, Bali. Methods: This is a cross-sectional study with method was used with 44 patients conferred in the Ophthalmology Department. The purposive sampling technique was also used in this study by considering exclusion and inclusion criteria. Then, the data were analyzed and assessed for medication and surgery for treatment between January 2017 and October 2018 using SPSS 25 version. Results: The mean age at diagnosis was 49.16±2.58 years, where samples of corneal ulcer infection made up 56.8%, and most of the cases occurred within the age group 30 - 60 years. Meanwhile, the infection mostly occurred in males, at a proportion of 77.3%, and based on the profession, 43.2% of the corneal ulcer were farmers. The most predisposing factor for infectious corneal ulcers was trauma, at 36.4%, as 39 patients had a central ulcus, where 47.7% were infectious, and 36.4% were non-infectious. However, not all the study variables were statistically significant (p > 0.05) with the patient's corneal. Conclusion: The findings of this study showed that corneal ulcer is common and mostly affects male. Furthermore, the epidemiological trends from developing countries with a predominance of infectious corneal ulcers were additional or less common. Therefore, more analysis with larger and specific sample sizes is required to be developed for resultant analytical research

Download Full-text

EPIDEMIOLOGICAL PROFILE OF FUNGAL KERATITIS IN PATIENTS ATTENDING A TERTIARY CARE CENTRE IN BIHAR

10.36106/ijar/6701192 ◽

2021 ◽

pp. 32-34

Author(s):

Kumar Vikram ◽

Gyan Bhaskar ◽

Shailesh Kumar ◽

Rakesh Kumar ◽

Namrata Kumari

Keyword(s):

Tertiary Care ◽

Public Health Problem ◽

Fungal Species ◽

Fungal Keratitis ◽

Agricultural Activity ◽

Major Public Health Problem ◽

Care Centre ◽

Tertiary Care Centre ◽

Predisposing Factor ◽

Epidemiological Characteristics

Introduction: Corneal blindness is a major public health problem worldwide and fungal keratitis is one of its predominant causes. The etiological and epidemiological pattern of fungal keratitis varies signicantly with patient population, geographical region and prevailing socioeconomic conditions. Objectives:The objective of the study was to identify the specic pathogenic agents and to study epidemiological characteristics of fungal keratitis presenting at a tertiary care centre in Patna, Bihar. Materials And Methods: Corneal scrapings were obtained from clinically suspected patients of keratomycosis during the period of 18 months from May 2015 to October 2016. The scraping material was processed and identied by standard laboratory techniques. Demographic and clinical features of the patients were also collected. Results: Out of total 115 suspected fungal corneal ulcers, 63(54.78%) were positive for fungal etiology. Of these, 53(84.13%) were positive on KOH mount. 40(63.49%) and 35(55.56%) were positive in Gram stain and culture respectively. In culture, aspergillus spp (16;45.71%) were the predominant fungal species, followed by fusarium spp (12;34.29%). Males (35/63;55.56%) were more commonly affected. 22 out of 63 patients (34.92%) were of age group 31-45 years. Majority of patients were farmers (68.25%). Corneal trauma (50.79%) was the most common predisposing factor in which trauma due to vegetative matter (53.13%) was most signicant. Conclusion: Fungal keratitis continues to be a cause of concern to ophthalmologists. Agricultural activity and related ocular trauma are principal causes of mycotic keratitis. A potassium hydroxide (KOH) wet mount preparation is a simple, and sensitive, method for diagnosis.

Download Full-text

Fungal Keratitis: Epidemiology, Rapid Detection, and Antifungal Susceptibilities ofFusariumandAspergillusIsolates from Corneal Scrapings

BioMed Research International ◽

10.1155/2019/6395840 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 17

Author(s):

Palanisamy Manikandan ◽

Ahmed Abdel-hadi ◽

Yendrembam Randhir Babu Singh ◽

Rajaraman Revathi ◽

Raghavan Anita ◽

...

Keyword(s):

Rapid Detection ◽

Corneal Ulcer ◽

Fungal Keratitis ◽

Mycotic Keratitis ◽

Common Cause ◽

Epidemiological Trend ◽

Male Preponderance ◽

The Common ◽

Ocular Morbidity ◽

Culture Positive

Fungal aetiology of keratitis/corneal ulcer is considered to be one of the leading causes of ocular morbidity, particularly in developing countries including India. More importantly,FusariumandAspergillusare reported commonly implicating corneal ulcer and against this background the present work was undertaken so as to understand the current epidemiological trend of the two fungal keratitis. During the project period, a total of 500 corneal scrapings were collected from suspected mycotic keratitis patients, of which 411 (82.2%) were culture positive for bacteria, fungi, and parasites. Among fungal aetiologies,Fusarium(216, 52.5% of 411) andAspergillus(68, 16.5% of 411) were predominantly determined. While the study revealed a male preponderance with both the fungal keratitis , it further brought out that polyene compounds (natamycin and amphotericin B) and azoles were active, respectively, againstFusariumspp. andAspergillusspp. Additionally, 94.1% of culture provenFusariumkeratitis and, respectively, 100% and 63.6% ofA. flavusandA. fumigatuswere confirmed by multiplex PCR. The sensitivity of the PCR employed in the present study was noted to be 10 fg/μl, 1 pg/μl, and 300 pg/μl of DNA, respectively, forFusarium,A. flavus,andA. fumigatus.Alarming fact was thatFusariumandAspergillusregionally remained to be the common cause of mycotic keratitis and theFusariumisolates had a higher antifungal resistance thanAspergillusstrains against most of the test drugs.

Download Full-text

Direct microscopy in suppurative keratitis: a report from tertiary level hospital in Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v8i2.16993 ◽

2017 ◽

Vol 8 (2) ◽

pp. 128-138 ◽

Cited By ~ 1

Author(s):

Pooja Gautam Rai ◽

Meenu Chaudhary ◽

Ananda Kumar Sharma ◽

Vijay Gautam

Keyword(s):

Potassium Hydroxide ◽

Diagnostic Value ◽

Gram Stain ◽

Predictive Values ◽

Direct Microscopy ◽

Wet Mount ◽

Sensitivity Specificity ◽

Level Hospital ◽

Prompt Diagnosis

Introduction: Infective keratitis is an ocular emergency that requires prompt diagnosis for appropriate management. This study was done todetermine the sensitivity, specificity and predictive values of Gram stain and potassium hydroxide (KOH) wet mount in the diagnosis of suppurative keratitis. Materials and methods: A prospective hospital based study of all patients with clinically diagnosed suppurative keratitis presenting between January 2011 and June 2012 was carried out. Corneal scrapes were taken and subjected to direct microscopy and culture.Results: Corneal scrapings were obtained from 108 eyes with suppurative keratitis. Direct microscopy was positive in 39.2% of cases and organisms were grown in 50.9 % of the cases. Bacteria were responsible in 76.4% and fungi in 23.6%. Of the bacterial isolates, 66.7% was Staphylococcus aureus and of the fungal isolates, 30.7% was Aspergillus species. Sensitivity in vitro showed that Cefazolin, Chloramphenicol and Ofloxacin were most effective against bacteria. Sensitivity of Gram stain in detecting bacteria was 50% (95% CI, 34.43 to 65.56) and specificity was 77.3% (95% CI, 65.0 to86.3) and sensitivity of KOH wet mount in detecting fungi was 53.8% (95% CI, 26.12 to79.6) and specificity was 98.9% (95% CI, 93.44 to 99.9). Positivity of direct smear (65.1%) was found to be higher among eyes with larger ulcers (>2mm) than eyes with smaller ulcers (<2mm). Conclusion: Direct microscopy is of great diagnostic value in the management of suppurative keratitis and it is recommended in all ophthalmic clinics without exception for establishing timely, appropriate and effective treatment.

Download Full-text

A COMPARATIVE STUDY IN EVALUATING EFFECT OF NATAMYCIN AND VORICONAZOLE EYE DROPS IN MYCOTIC KERATITIS IN A TERTIARY EYE CENTRE OF EASTERN INDIA

10.36106/ijsr/3214736 ◽

2020 ◽

pp. 8-9

Author(s):

Somnath Choudhury ◽

Jayanta Dutta ◽

Ashis Majumdar

Keyword(s):

Comparative Study ◽

Visual Impairment ◽

Vision Loss ◽

Fungal Keratitis ◽

Eye Drops ◽

Mycotic Keratitis ◽

Eastern India ◽

Corneal Disease ◽

Common Cause ◽

Corneal Ulcers

Corneal disease is second only to cataracts as the most common cause of blindness worldwide, resulting in more than 1.5 million new cases of vision loss annually.1 Ophthalmic mycosis is emerging as a major cause of vision loss and morbidity, and can be sight-threatening.2,3 Fungal keratitis is one of the major causes of ophthalmic mycosis,4 accounting for more than 50% of proven ophthalmic mycoses in some countries.5 In Africa and other tropical countries, about 44% of corneal ulcers are caused by fungi.6 Treatment of fungal keratitis is generally more difficult than that of bacterial ulcers, and resulting visual impairment is, on average, more severe.

Download Full-text

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

Download Full-text

Corneal ulcer: an epidemiological, microbiological and clinical study of cases attending Assam medical college and hospital, Dibrugarh, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200784 ◽

2020 ◽

Vol 8 (3) ◽

pp. 1076

Author(s):

Mamoni Baruah ◽

Rajiv Kumar Das ◽

Vijaya Agarwalla ◽

Pranami Basyach

Keyword(s):

Corneal Ulcer ◽

Geographical Area ◽

Treatment Protocol ◽

Predisposing Factor ◽

Female Ratio ◽

Medical College ◽

Corneal Ulcers ◽

The Common ◽

Etiological Agents ◽

Male To Female

Background: Corneal ulcer is one of the important ophthalmic conditions causing significant morbidity especially in the developing countries. This study was carried out to evaluate the common etiological agents, predisposing factors, age, gender and occupational distribution and to study the clinical features and management of all corneal ulcers.Methods: A total of 50 cases of corneal ulcers who attended the Ophthalmology outpatient department (OPD) of Assam medical college and hospital, Assam, India, over a 6 months period were included in the study. A detailed history was taken and examination done as per the proforma. Microscopy and culture were performed on all corneal specimens obtained.Results: Corneal ulcers were common in 3rd to 5th decades of life with Male to Female ratio of 1.3:1. Majority of patients were farmers or hired agricultural workers. Ocular trauma was the major predisposing factor in majority of cases (32%). Out of 50 cases, 31 (62%) were culture positive. 19 were bacterial isolates and 12 were fungal isolates. All patients were treated according to standard treatment protocol and majority (95.5%) patients responded well to treatment.Conclusions: This study has revealed that suppurative corneal ulcers are caused by both bacterial and fungal agents with bacterial preponderance in this geographical area. Early and accurate diagnosis and intensive treatment is the need of hour for saving the eye and preventing the catastrophe of lifelong blindness.

Download Full-text

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.

Download Full-text

Mycotic keratitis in India: a five-year retrospective study

The Journal of Infection in Developing Countries ◽

10.3855/jidc.309 ◽

2010 ◽

Vol 4 (03) ◽

pp. 171-174 ◽

Cited By ~ 23

Author(s):

Ragini Tilak ◽

Abhisek Singh ◽

Om Prakash Singh Maurya ◽

Abhishek Chandra ◽

Vijai Tilak ◽

...

Keyword(s):

Potassium Hydroxide ◽

Fungal Growth ◽

Eye Drops ◽

Mycotic Keratitis ◽

Predisposing Factor ◽

Presumptive Diagnosis ◽

Corneal Ulcers ◽

Causative Agents ◽

Prior Application ◽

The Tropics

Background: Mycotic keratitis is a fungal infection of the cornea. This infection is difficult to treat and it can lead to severe visual impairment or blindness. It is worldwide in distribution, but is more common in the tropics and subtropical regions. Trauma is the major predisposing factor, followed by ocular and systemic defects, prior application of corticosteroids, and prolonged use of antibiotic eye-drops. The objective of this study was to determine causative agents and to identify the predisposing factors of mycotic keratitis. Methodology: Corneal scrapings from 90 corneal ulcer patients with suspected fungal etiology were subjected to direct examination by 10% KOH mount, Gram stain and culture. Results: This study included 90 subjects with corneal ulcers, based on clinical suspicion, of whom 41 cases were diagnosed with mycotic keratitis in the laboratory. Among these 41 cases, culture showed fungal growth only in 36 cases whereas the remaining five cases were positive only by potassium hydroxide (KOH) preparation. Males were more commonly affected and were mostly in the age group of 31-40 years. Aspergillus flavus was the most common fungus isolated followed by fusarium solani. Conclusion: Rapid diagnosis and early institution of antifungal therapy is necessary to prevent ocular morbidity and blindness. Although culture helps in definite diagnosis and identification, direct microscopic detection of fungal structures in corneal scrapes or biopsies permits a rapid presumptive diagnosis.

Download Full-text