Epidemiology, Clinical Profile and Treatment Outcomes of Bacterial and Fungal Keratitis

Purpose: The purpose of the study is to determine the microbiological aetiology, epidemiological factors, and clinical profile and treatment outcomes of infective keratitis in Ophthalmology department, Minia University. EgyptMethods:Prospective, non-randomized, observational clinical series of cases, including 150 patients with mean age 30 (range 12 to 85 years), 90 patients (60 %) were males and 60 (40%) were females, clinically diagnosed as infective corneal ulcer, attending the Ophthalmology Department – Faculty of Medicine. Minia University, Minia, Egypt. From 2018 to 2020.Detailed history taking and all clinical findings were collected. Corneal scrapings were obtained from patients and subjected to staining and culture for bacterial and fungal pathogens; Bacterial and fungal growth were identified by standard laboratory procedures.Results:Corneal trauma by a vegetative matter was the commesnest risk factor associated with infective keratitis in 92 cases (61.3%). Smear and Culture was positive in 83 cases (58.4%) of 142 corneal scrapings obtained, of which 60 cases were fungal (72.3%), 21 cases were bacterial (25.3%) and 2 cases were mixed bacterial and fungal (2.4%), Aspergillus species was the commonest fungal species isolated in fungal keratitis. 142 cases (94.67 %) healed completely with scar. Only 6 cases (4%) required evisceration due to aggressive presentation from the start and keratoplasty was performed for 2 cases (1.33%).Conclusions:Fungal keratitis was the commonest type in cases attending to our department. Adequate diagnosis, management and follow up helped in achieving high successful curative outcomes. Clinical Trials.gov ID: NCT04894630. Time of registration 1 December 2018

Management of Ocular Surface Squamous Neoplasia in Association with Fungal Keratitis in a HIV Positive Individual

Ocular Surface Squamous Neoplasia (OSSN) co-existent with fungal keratitis in an immunodeficient individual has rarely been talked about in literature. Risk factors for fungal keratitis are trauma with vegetative matter, topical steroid abuse, poor ocular surface, corneal anaesthesia, systemic immunosuppression, etc., and for OSSN a major risk factor is immunodeficiency. In current report, patient had multiple risk factors. This report highlights the management of HIV positive 42-year-old male with OSSN and fungal keratitis. A comprehensive evaluation helps clinician decide on treatment priority and achieve good clinical outcome.

Acanthamoeba Keratitis – A Case Report

Introduction: Acanthamoeba keratitis is a serious infection of the cornea which causes severe inflammation of the eye and loss of vision. Case description: A 45 years female came with a history of trauma of right eye with vegetative matter with severe pain and redness. Patient was treated with antibacterial, antifungal eye drops but the condition deteriorated. Diagnosis was based on presence of motile trophozoites and cyst in the culture of non nutrient agar with a lawn of E coli of the corneal ulcer scraping. Therapeutic penetrating keratoplasty was performed as the patient’s condition deteriorated. Conclusion: Acanthamoeba keratitis is a rare parasitic vision threatening infection with poor prognosis in comparison to other infectious keratitis. Therefore prevention is very important.

Phytobezoar causing intestinal obstruction in a neonate: A case report

Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastroin­testinal tract and are a rare cause of intestinal obstruction in children. Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction. Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.

Acanthamoeba keratitis - Camouflage entity in Nepal

Background Acanthamoeba keratitis is a sight threatening corneal infection and is a growing clinical problem in developing countries as well as developed countries. Acanthamoeba keratitis is a local infection of the eye and does not produce systemic illness. Proper diagnostic techniques and appropriate medical management are necessary for good prognosis. Findings We report a series of six cases of acanthamoeba keratitis diagnosed and managed at Biratnagar Eye Hospital in the year 2019. The patients age ranges from 28-58 years, with four males and two females. The mean duration of presentation to hospital was 19 days. Four patients had trauma with vegetative matter. All patients had redness, photophobia, decreased vision, pain among which only two had pain out of proportion. One patient had visual acquity of 2/60 whereas the rest had hand movement to perception of light at time of presentation. Ring infiltrate was noted in all the cases. Five patients had ulcer in central and paracentral regions, four had ulcer larger than 6mm and three showed presence of hypopyon. KOH stained smears revealed acanthamoeba cyst in all cases while Gram stain was positive in only one case. Non-nutrient agar overladen with Escherichia coli revealed feeding tracks in four cases and polymerase chain reaction revealed T4 genotype acanthamoeba in four cases. Amoebicidal treatment was started with Chlorhexidine 0.02% eye drop half hourly. Other drugs Natamicin 5% eye drop half hourly, Fluconazole 0.3% eye drop half hourly and antibiotic Moxifloxacin 0.5% eye drop half hourly were also used simultaneously. Pain was reduced in all patients. After treatment, only one patient had BCVA of 6/9 while others had visual outcome of hand movement. Conclusions Acanthamoeba keratitis can be severe and vision-threatening. Centrally located ulcer, size of the ulcer > 6mm and visual acuity Hand Movement/Perception of light at the time of presentation were associated with poor outcome. Clinically suspected lesions associated with microbiological assessment help in early diagnosis and prompt treatment.

Pigmented Corneal Ulcer

Purpose: To report the clinical characteristics, laboratory findings, and treatment of a rare case of keratitis caused by pigmented fungi Bipolaris hawaiiensis. Case Report: A 55-year-old man presented with a history of trauma with vegetative matter in his left eye. Slit lamp biomicroscopic examination revealed the presence of a brownish-black pigmented plaque with surrounding infiltrates. Corneal scrapings revealed multiple septate hyphae. Culture revealed growth of the Bipolaris species. The patient was treated with topical natamycin 5%, topical voriconazole 1%, and oral itraconazole followed by intracameral amphotericin B (5 μg/mL). The patient responded well to the treatment. Conclusion: Brown pigmented infiltrates are an important clinical feature of dematiaceous fungi. B. hawaiiensis is a rare cause of corneal phaeohyphomycosis. Our patient responded well to intracameral amphotericin B, which obviated the need for penetrating keratoplasty.

Winter food habits of the Golden Jackal Canis aureus (Mammalia: Carnivora: Canidae) in Patna Bird Sanctuary, Uttar Pradesh, India

Golden Jackal (Canis aurius indicus) survives in a wide range of environment. Its foraging adaptation varies according to quality and abundance of food sources. The food habits also fluctuate according to season and habitat. This study investigated the diet composition of Golden Jackal using scat analysis method collected between November 2012 and April 2013 from Patna Bird Sanctuary (PBS), Uttar Pradesh, India. A total of 83 scats of Golden Jackal were collected and analysed. Sixteen food items were identified in Golden Jackal scats. Birds contributed maximum (ca. 38.92%) in Golden Jackal diet followed by rodents (ca. 12.14%), insects (ca. 8.92%), reptile (ca. 8.57%), vegetative matter (ca. 13.56%), rufous-tailed hare (ca. 6.07%), cattle (ca. 2.5%), squirrel (ca.1.42%), nilgai (ca.1.07%) and common palm civet (ca. 0.71 %). However (ca. 6.07 %) of prey items could not identified in Golden Jackal scats. Out of (ca. 38.92%) in bird’s contribution egret alone contributed about (ca.20.35%) in Golden Jackal diet followed by gargeny (ca. 8.93%), greater caucal (ca. 5.71%), babbler (ca.1.07%) and (ca. 2.85%) remains of birds were could not identified as per species level. This study is conducted to find out food habits of Golden Jackal and its impact on bird community structure.

Clinical profile of pythium keratitis: perioperative measures to reduce risk of recurrence

PurposeTo report the clinical profile and role of perioperative adjunctive measures to reduce the risk of recurrence in Pythium insidiosum keratitis.MethodsRetrospective analysis of 10 eyes of 10 patients with P. insidiosum keratitis. Diagnosis was confirmed by PCR DNA sequencing.Results7out of 10 patients were from urban locales, and none had any obvious history of injury with vegetative matter and were being treated for fungal keratitis. 6 eyes presented with central full thickness infiltrates with subepithelial and superficial stromal infiltrates radiating in a reticular pattern. Corneal scraping in all eyes revealed sparsely septate fungal-like filaments on potassium hydroxide/Calcofluor. All eyes underwent the first therapeutic penetrating keratoplasty (TPK) based on worsening or non-responsiveness of clinical features to the antifungal regimen. Recurrence was noted in 7 out of 10 eyes of which 2 eyes underwent evisceration. Of the six eyes that underwent cryotherapy following confirmation of microbiological diagnosis of Pythium (along with primary TPK-1, with re-TPK-5), only one eye had a recurrence and had to be eviscerated. Of the two eyes that did not undergo cryotherapy during re-TPK, following microbiological diagnosis, one eye had a recurrence and had to be eviscerated. In two eyes with adjoining scleritis, the host bed was swabbed using absolute alcohol of which one eye was salvaged.ConclusionThis series highlights the need to be aware of this entity in the management of refractory fungal keratitis. It also brings to fore the adjunctive measures that could have a beneficial role in the management of pythium keratitis.

Corneal Chromoblastomycosis Caused by Fonsecaea pedrosoi

Purpose: To report 2 unusual cases of fungal keratitis due to Fonsecaea pedrosoi. Methods: Two patients were diagnosed with Fonsecaea pedrosoi keratitis. Their files were reviewed for predisposing factors, clinical characteristics, microbiological study, treatment, and outcome. Results: Two consecutive patients presented with brownish pigmented corneal ulcers in their eyes after sustaining eye trauma from vegetative matter. In both cases, corneal scrapings were collected for microscopic examination and culture. Dematiaceous hyphae were seen on the smears, and dark pigmented colonies grew on the culture media, identified as F. pedrosoi. Both patients were treated and cured with combined topical antifungal agents and oral itraconazole. The first patient required an amniotic membrane patch, while the second received an intracameral amphotericin B injection. Conclusions: Pigmented infiltrates can be an important diagnostic clue, but a microscopic evaluation and culture are required to obtain an accurate diagnosis of Fonsecaea keratitis. The prompt diagnosis and combined antifungal treatment can prevent morbidity associated with this fungal infection.

Micro-histological analysis of faeces of Chukar partridge Alectoris chukar gray in Garhwal Himalaya, Uttarakhand, India

In vivo studies on the feeding of Chukar partridge (Alectoris chukar Gray) in Garhwal Himalaya, Uttarakhand and micro-histological analysis of 104 samples of its faeces were investigated during January 2011 to December 2012, to get information on vegetative and non-vegetative diet and feeding behaviour. Plant matter constituted a major portion of the faecal content (87.73±4.31μg) and represented by 14 families. Non- vegetative matter could be recorded as 9.36±1.46μg of dry weight which represented by 8 orders of the arthropods. Fine organic matter + grits constitute was found to be 2.84%±1.17μg in faecal content. Saxifragaceae, Graminaceae, Rosaceae, Poaceae and Fabaceae were found the best plant families for Chukar diet while arthropod insects order like Diptera, Dissotera, Hymenoptera and Araneae remained favorite feeds. Flowers and fruits of Rhus parviflora, leaves of Rumax, roots/ tuber of Vigna and fruits of Rubus were found important diet of Chukar partridge along with Triticum in Rabi crop and Oryza in Kharif. Flies, grasshoppers, spiders were observed the main insects diet of Chukar partridge.