Download Prathiba 1 , Taruni 2 , V. Sudha Rani 3 , Aruna Sunder 4

DOI: 10.14260/jemds/2015/1290
ORIGINAL ARTICLE
MYCOTIC KERATITIS IN AND AROUND HYDERABAD
Prathiba1, Taruni2, V. Sudha Rani3, Aruna Sunder4
HOW TO CITE THIS ARTICLE:
Prathiba, Taruni, V. Sudha Rani, Aruna Sunder. “Mycotic Keratitis in and Around Hyderabad”. Journal of
Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 51, June 25; Page: 8913-8917,
DOI: 10.14260/jemds/2015/1290
ABSTRACT: CONTEXT: Patients attending with corneal ulcers. AIM OF THE STUDY: To evaluate the
specific pathogenic agents and epidemiology of mycotic keratitis at a tertiary care center in
Hyderabad. MATERIAL & METHODS: A total of 863 patients of all age groups suffering from corneal
ulcers, who attended Sarojinidevi eye hospital from ‘Jan. 2014 to Dec. 2014’ were included in the
study. All patients underwent through slit lamp bio-microscopic examination by an ophthalmologist.
The material was obtained from active margins and base of ulcer after the debridement of superficial
mucus using a sterile No. 15. Bard – parker blade under slit lamp bio-microscope. Samples were
inoculated on blood agar, mac-conkey agar sabauraud’s dextrose agar & brain heart infusion broth.
The material obtained in next scraping was thinly spread onto labeled slides for direct examination.
The specific identification of pathogen was based onmicroscopic morphology, staining characteristics
and biochemical properties using standard laboratory protocol. RESULTS: Out of total 863 corneal
scrapings collected from confirmed corneal ulcer patients, 563 were from males and 300 were from
females. Highest number of males were in the age group of 49-60, whereas more number of females
were above 60 years. Highest number of cases were in the month of August. Out of 863 scrapings 363
samples (40.25%) were positive for fungal elements by 10% KOH mount examination and 294
samples (34.25%) were culture positive for fungi. Out of 294 fungal isolates, commonest isolate was
Aspergillus species followed by Fusarium species. CONCLUSIONS: The epidemiological pattern of
corneal ulceration varies significantly from country to country and even from region to region. The
findings of our study show that there is a region wise variation in the predominance of corneal
pathogens. This has an important public health implication for the initiation of therapy.
KEYWORDS: Keratitis, KOH mount, Aspergillus, Fusarium.
INTRODUCTION: Mycotic keratitis (International Nomenclature of Diseases disease number 2100)
is a general term for a mycosis of thecornea, and can be caused by a wide variety of
fungi.1Thiscondition is usually manifested by severe inflammation, theformation of a corneal ulcer,
and hypopyon, with the presence of fungal hyphae within the corneal stroma. Synonyms include
‘keratomycosis’ and ‘oculomycosis’ (In part), but ‘mycotic keratitis’ is recommended in preference to
‘keratomycosis’ so as to have similar names for the diseases caused by fungi, bacteria and viruses.1 If
the fungal species causing the infection is identified, a term such as ‘Fusarium keratitis’ (Or, more
specifically, ‘keratitis due to Fusariumsolani’) is recommended.1Corneal infection is a leading cause
of ocular morbidity and blindness worldwide.2,3,4,5,6,7 Corneal ulceration is a major cause of
monocular blindness in developing countries. Surveys in Africa and Asia have confirmed these
findings.2,3,4,5,6,7 and a recent report on the causes of blindness worldwide consistently lists corneal
scarring second only to cataract as the major aetiology of blindness and visual disability in many of
the developing nations in Asia, Africa and the MiddleEast.8 Any microorganism can invade the corneal
stroma if the normal corneal defense mechanisms such as lids, tear film and corneal epithelium
iscompromised.9 More than 70 species of filamentous fungi are also identified as etiological agents of
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DOI: 10.14260/jemds/2015/1290
ORIGINAL ARTICLE
fungal keratitis.10 The early diagnosis and its treatment is utmost important in preventing
complications and loss of vision. The purpose of this study was to evaluate the specific pathogenic
agents and epidemiology of mycotic keratitis at a tertiary care center in Hyderabad.
MATERIAL AND METHODS: A total of 863 patients of all age groups suffering from corneal ulcers,
who attended Sarojinidevi eye hospital from Jan ‘2014 to Dec’ 2014 were included in the study. All
patients underwent through slit lamp bio-microscopic examination by an ophthalmologist. A break
in continuity of epithelium associated with underlying stormily infiltrate was considered infectious
unless proved otherwise. After a detailed ocular examination, corneal scrapings were taken under
aseptic condition after installation of 4% preservative–free lignocaine (Lidocaine) drops.
The material was obtained from active margins and base of ulcer after the debridement of
superficial mucus using a sterile No. 15. Bard–parker blade under slit lamp bio-microscope. Samples
were inoculated on blood agar, mac-conkey agar sabauraud’s dextrose agar & brain heart infusion
broth. Sabauraud’s dextrose agar (SDA) media were incubated at room temperature and the
remaining were incubated at 370C and evaluated after 24hrs. The material obtained in next scraping
was thinly spread onto labeled slides for direct examination.
Direct examination:
1. 10% KOH mount.
2. Grams stain.
3. Acid fast stain was done only when clinician asks for it.
OBSERVING FOR FUNGAL ETIOLOGY: KOH (Postassiurn hydroxide) mount-material of the scraping
was placed on a glass slide within 10% KOH and a cover slip placed, then observed under the
microscope using low power and high power by direct microscopy. SDA culture media were
examined daily for 21days if no growth seen then media was discarded, standard operating
laboratory protocol was followed for all laboratory methods. Microbial cultures were considered
positive only if at least one of the following criteria were met:
1. The growth of the same organism was demonstrated on twoor more solid media on C streak or
there was semi confluentgrowth at the site of inoculation on the solid medium.
2. The same organism was isolated on repeated scrapping.
3. If it was consistent with clinical sign.
4. Smear results were consistent.
The specific identification of pathogen was based onmicroscopic morphology, staining
characteristics andbiochemical properties using standard laboratory protocol.
RESULTS: Out of total 863 corneal scrapings collected from confirmed corneal ulcer patients, 563
were from males and 300 were from females. Highest number of males were in the age group of 4960, whereas more number of females were above 60 years. Highest number of cases were in the
month of August. (Table1). Out of 863 scrapings 363 samples (40.25%) were positive for fungal
elements by 10% KOH mount examination and 294 samples (34.25%) were culture positive for
fungi. Out of 294 fungal isolates, commonest isolate was Aspergillus species followed by Fusarium
species, 3 isolates were Candida, 20 were unidentified. (Figure 1).
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ORIGINAL ARTICLE
Month
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Total
0-19
20-40
41-59
Above 60
Male Female Male Female Male Female Male Female Total
5
3
26
8
17
5
14
7
85
4
3
9
5
16
14
16
3
70
1
4
9
10
15
11
11
8
69
3
1
13
4
20
2
9
4
56
9
3
13
9
16
6
11
12
79
2
17
13
15
10
16
13
86
6
1
23
8
14
4
18
11
85
5
3
18
6
19
8
20
11
90
4
1
20
7
12
4
10
8
66
5
2
8
8
13
8
7
9
60
2
1
12
5
15
4
10
6
55
2
3
12
8
12
5
9
11
62
48
25
180
91
184
81
151
103
863
Table 1: Showing age and monthwise distribution of total corneal ulcers
Fig. 1: Showing different fungal isolates
DISCUSSION: Our study revealed that fungal keratitis accounted for 34.2% of the total microbial
keratitis patients who presented to our center. This high prevalence of fungal pathogens in South
India was not so different from that found in similar studies done by Sharma Amisha, Agrawal Parul
et al (35.66%).11 The age distribution showed the incidence of fungal keratitis predominantly
between the 4th to 6th decades, reflecting the active working period of life and hence the increased
vulnerability to injury during outdoor activities. The incidence of fungal keratitis was significantly
higher in males, in individuals from rural area and following corneal injury. The male predominance
of fungal keratitis noted in the present study correlates with the studies of Bharathiet al, Srinivasan et
al and Chowdhary et al.12,13
Aspergillusspp was the predominant isolate as compared to Fusariumspp as in the various
studies by Samar K, Basak et al(59.8%), Jagdish.
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ORIGINAL ARTICLE
Chander et al (41.18%), JagdishChander et al (35%), Javadi et al (34.8%), Shokohi et al
(33.3%).14,15,16,17,18 In our case highest number of corneal ulcers occurred in the month of August. In a
study done by Lin, Charles C. MD*,†; Lalitha, Prajna MD‡; Srinivasan, Muthiah MD†; Prajna, N. et al
there was uneven distribution of fungal keratitis throughout the year with peaks in July and January.
No significant seasonal trend was observed for the combined bacterial keratitis group.19
CONCLUSIONS: The epidemiological pattern of corneal ulceration varies significantly from country to
country and even from region to region. . The findings of our study show that there is a region wise
variation in the predominance of corneal pathogens. This has an important public health implication
for the initiation of therapy.
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ORIGINAL ARTICLE
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AUTHORS:
1. Prathiba
2. Taruni
3. V. Sudha Rani
4. Aruna Sunder
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of
Microbiology, Sarojini Devi Eye Hospital,
Hyderabad, Osmania Medical College.
2. Assistant Professor, Department of
Microbiology, SRRIT&CD, Osmania
Medical College.
3. Associate Professor, Department of
Microbiology, KMC Warangal.
FINANCIAL OR OTHER
COMPETING INTERESTS: None
4.
Professor, Department of Microbiology,
Sarojini Devi Eye Hospital, Osmania Medical
College, Hyderabad.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. V. Sudha Rani,
Associate Professor,
Department of Microbiology,
Kakatiya Medical College, Warangal, Telangana.
E-mail: [email protected]
[email protected]
Date of Submission: 05/06/2015.
Date of Peer Review: 06/06/2015.
Date of Acceptance: 19/06/2015.
Date of Publishing: 24/06/2015.
J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 4/ Issue 51/ June 25, 2015
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