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Epidemiological profile of fungal keratitis in urban population of West Bengal, India.

Saha S, Banerjee D, Khetan A, Sengupta J - Oman J Ophthalmol (2009)

Bottom Line: Ocular trauma in 35 cases (47.29%) was identified as a high risk factor and vegetative injuries in 17 cases (22.97%) were identified as a significant cause for fungal keratitis.Although Aspergillus sp. was implicated in most of the patients in our study population, Candida sp. were found in higher numbers than previously reported.Early diagnosis with prompt identification of the pathogenic organism is mandatory to initiate appropriate therapy and thereby reduce morbidity.

View Article: PubMed Central - PubMed

Affiliation: Ocular Microbiology Division, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India.

ABSTRACT

Background: Corneal diseases are one of the major causes of visual loss and blindness, second only to cataract. Amongst corneal diseases, microbial keratitis is a major blinding disease. In some countries, fungal keratitis accounts for almost 50% of patients with culture-proven microbial keratitis.

Aim: This study was conducted to determine the epidemiological characteristics of fungal keratitis in an urban population of West Bengal and identify the specific pathogenic organisms.

Methods: The charts of patients with microbial keratitis who attended the Cornea Services of Priyamvada Birla Aravind Eye Hospital from January to December 2008 were retrospectively reviewed. Records of patients with 10% KOH mount and culture positive fungal keratitis were analyzed for epidemiological features, laboratory findings and treatment outcomes.

Results: Of the 289 patients of microbial keratitis included in the study, 110 patients (38.06%) were diagnosed with fungal keratitis (10% KOH mount positive). Of the 110 patients, 74 (67.27%) fitted the study inclusion criteria (10% KOH mount and culture positive). Forty five of 74 patients (60.81%) in the study group were in the older age group (>50 years). Ocular trauma in 35 cases (47.29%) was identified as a high risk factor and vegetative injuries in 17 cases (22.97%) were identified as a significant cause for fungal keratitis. Maximum organism source was from corneal scrapings in 41 cases (55%). The predominant fungal species isolated was Aspergillus sp (55.40%) followed by Candida albicans 14 cases (18.91%) and Fusarium sp. in 8 cases (10.81%). Agricultural activity related ocular trauma was the principal cause of mycotic keratitis and males were more commonly affected. Thirty of 74 cases (40.55%) of the culture positive patients healed with corneal scar formation with medical treatment whereas 44 cases (59.45%) required therapeutic keratoplasty.

Conclusion: Fungal keratitis is an important cause of microbial keratitis with injury to the cornea being a leading predisposing factor. Although Aspergillus sp. was implicated in most of the patients in our study population, Candida sp. were found in higher numbers than previously reported. Keratitis caused by filamentous fungi responds adequately to medical management. Therapeutic keratoplasty continues to remain an important treatment modality in infections with Candida sp. Early diagnosis with prompt identification of the pathogenic organism is mandatory to initiate appropriate therapy and thereby reduce morbidity.

No MeSH data available.


Related in: MedlinePlus

Age distribution of keratitis patients
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Figure 0002: Age distribution of keratitis patients

Mentions: Of 289 microbial keratitis patients, 110 patients (38.06%) were diagnosed as fungal keratitis based on clinical findings as well as observation of fungal filaments in KOH mount and Grams staining. Of these patients, 74 patients (67.27%) were culture positive fungal keratitis; the remaining 36 (32.73%) patients were only smear positive. There were more male patients (48/74 i.e. 65%; 95% CI 53–74) compared to female patients (26/74 i.e. 35%; 95% CI 26–46) in our study. The male to female ratio was (1 : 1.84) [Figure 1]. The mean patient age was 53 years. Older patients (>50 years) were more frequently affected (34/74 i.e. 46%; 95% CI 35–57) [Figure 2]. There was a history of trauma in 35 patients (48%; 95% CI 36–58) followed by history of steroid usage in 12 patients (16%) and previous ocular surgery in 9 patients (12%). No obvious predisposing factor could be identified in 17 patients (23%) [Figure 3]. Among patients with a history of injury, trauma with vegetative matter was found in 20 patients [Figure 4]. Maximum culture positivity was found from corneal scraping, 41 of 74 patients (55%; 95% CI 44–66), followed by recipient corneal button obtained during therapeutic keratoplasty, 16 of 74 patients (22%; 95% CI 12–30), anterior chamber tap 15 of 74 patients (20%; 95% CI 13–32) and deep corneal biopsy in 2 patients (3%; 95% CI 0–9) [Figure 5]. Of fungal isolates, 62 out of 74 isolates; (83.8%) were molds and 14 isolates (18.91%) were yeasts [Figure 6]. Aspergillus species was identified as the most common etiologic agent (41 of 74 isolates; 55.4%) followed by Candida albicans (14 isolates; 18.91%). Fusarium species, Dematiaceous fungi, Penicillium sp., Rhizopus sp., Scedosporium sp., Bipolaris sp. and many unidentifiable fungal species were isolated from the fungal keratitis patients [Figure 7]. Thirty (40.55%) patients with culture positive fungal keratitis patients showed response to topical medical therapy with the formation of corneal scar. The remaining 44 patients (59.45%) of mycotic keratitis patients needed therapeutic keratoplasty. This included 16 cases of 41 Aspergillus keratitis (39.02%) and 5 cases of 8 (62.5%) of Fusarium keratitis. In our study all patients with Candida sp. infections required a surgical intervention. Ten patients among 74 (7.4%) culture positive fungal keratitis cases need immediate therapeutic keratoplasty at presentation.


Epidemiological profile of fungal keratitis in urban population of West Bengal, India.

Saha S, Banerjee D, Khetan A, Sengupta J - Oman J Ophthalmol (2009)

Age distribution of keratitis patients
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2903915&req=5

Figure 0002: Age distribution of keratitis patients
Mentions: Of 289 microbial keratitis patients, 110 patients (38.06%) were diagnosed as fungal keratitis based on clinical findings as well as observation of fungal filaments in KOH mount and Grams staining. Of these patients, 74 patients (67.27%) were culture positive fungal keratitis; the remaining 36 (32.73%) patients were only smear positive. There were more male patients (48/74 i.e. 65%; 95% CI 53–74) compared to female patients (26/74 i.e. 35%; 95% CI 26–46) in our study. The male to female ratio was (1 : 1.84) [Figure 1]. The mean patient age was 53 years. Older patients (>50 years) were more frequently affected (34/74 i.e. 46%; 95% CI 35–57) [Figure 2]. There was a history of trauma in 35 patients (48%; 95% CI 36–58) followed by history of steroid usage in 12 patients (16%) and previous ocular surgery in 9 patients (12%). No obvious predisposing factor could be identified in 17 patients (23%) [Figure 3]. Among patients with a history of injury, trauma with vegetative matter was found in 20 patients [Figure 4]. Maximum culture positivity was found from corneal scraping, 41 of 74 patients (55%; 95% CI 44–66), followed by recipient corneal button obtained during therapeutic keratoplasty, 16 of 74 patients (22%; 95% CI 12–30), anterior chamber tap 15 of 74 patients (20%; 95% CI 13–32) and deep corneal biopsy in 2 patients (3%; 95% CI 0–9) [Figure 5]. Of fungal isolates, 62 out of 74 isolates; (83.8%) were molds and 14 isolates (18.91%) were yeasts [Figure 6]. Aspergillus species was identified as the most common etiologic agent (41 of 74 isolates; 55.4%) followed by Candida albicans (14 isolates; 18.91%). Fusarium species, Dematiaceous fungi, Penicillium sp., Rhizopus sp., Scedosporium sp., Bipolaris sp. and many unidentifiable fungal species were isolated from the fungal keratitis patients [Figure 7]. Thirty (40.55%) patients with culture positive fungal keratitis patients showed response to topical medical therapy with the formation of corneal scar. The remaining 44 patients (59.45%) of mycotic keratitis patients needed therapeutic keratoplasty. This included 16 cases of 41 Aspergillus keratitis (39.02%) and 5 cases of 8 (62.5%) of Fusarium keratitis. In our study all patients with Candida sp. infections required a surgical intervention. Ten patients among 74 (7.4%) culture positive fungal keratitis cases need immediate therapeutic keratoplasty at presentation.

Bottom Line: Ocular trauma in 35 cases (47.29%) was identified as a high risk factor and vegetative injuries in 17 cases (22.97%) were identified as a significant cause for fungal keratitis.Although Aspergillus sp. was implicated in most of the patients in our study population, Candida sp. were found in higher numbers than previously reported.Early diagnosis with prompt identification of the pathogenic organism is mandatory to initiate appropriate therapy and thereby reduce morbidity.

View Article: PubMed Central - PubMed

Affiliation: Ocular Microbiology Division, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India.

ABSTRACT

Background: Corneal diseases are one of the major causes of visual loss and blindness, second only to cataract. Amongst corneal diseases, microbial keratitis is a major blinding disease. In some countries, fungal keratitis accounts for almost 50% of patients with culture-proven microbial keratitis.

Aim: This study was conducted to determine the epidemiological characteristics of fungal keratitis in an urban population of West Bengal and identify the specific pathogenic organisms.

Methods: The charts of patients with microbial keratitis who attended the Cornea Services of Priyamvada Birla Aravind Eye Hospital from January to December 2008 were retrospectively reviewed. Records of patients with 10% KOH mount and culture positive fungal keratitis were analyzed for epidemiological features, laboratory findings and treatment outcomes.

Results: Of the 289 patients of microbial keratitis included in the study, 110 patients (38.06%) were diagnosed with fungal keratitis (10% KOH mount positive). Of the 110 patients, 74 (67.27%) fitted the study inclusion criteria (10% KOH mount and culture positive). Forty five of 74 patients (60.81%) in the study group were in the older age group (>50 years). Ocular trauma in 35 cases (47.29%) was identified as a high risk factor and vegetative injuries in 17 cases (22.97%) were identified as a significant cause for fungal keratitis. Maximum organism source was from corneal scrapings in 41 cases (55%). The predominant fungal species isolated was Aspergillus sp (55.40%) followed by Candida albicans 14 cases (18.91%) and Fusarium sp. in 8 cases (10.81%). Agricultural activity related ocular trauma was the principal cause of mycotic keratitis and males were more commonly affected. Thirty of 74 cases (40.55%) of the culture positive patients healed with corneal scar formation with medical treatment whereas 44 cases (59.45%) required therapeutic keratoplasty.

Conclusion: Fungal keratitis is an important cause of microbial keratitis with injury to the cornea being a leading predisposing factor. Although Aspergillus sp. was implicated in most of the patients in our study population, Candida sp. were found in higher numbers than previously reported. Keratitis caused by filamentous fungi responds adequately to medical management. Therapeutic keratoplasty continues to remain an important treatment modality in infections with Candida sp. Early diagnosis with prompt identification of the pathogenic organism is mandatory to initiate appropriate therapy and thereby reduce morbidity.

No MeSH data available.


Related in: MedlinePlus