Mycological Profile And Antifungal Sensitivity Of Infective Keratitis In A Tertiary Care Hospital Of Southern Odisha

Background: Infective keratitis is the second major cause of blindness next to cataract. Mycotic keratitis is an im-portant ophthalmologic problem especially in developing countries including India. Fungal infection involving cornea is a fatal condition which needs early diagnosis and treatment to save the patient’s eye. Though studies on mycotic keratitis have been reported from different part of India, to the best of our knowledge this study showing antifungal susceptibility is the first to be reported from Southern Odisha. Objective: The purpose of this study was to study epi-demiological characteristics, predisposing factors, fungal etiology and antifungal susceptibility of common fungal isolates in infective keratitis cases. Materials and Methods: A prospective study was conducted from November 2015 to October 2017 in the Department of Microbiology and Ophthalmology M.K.C.G Medical College and Hospi-tal .Relevant information was recorded using standard proforma of keratitis cases. Corneal scrapings were collected under strict aseptic conditions and subjected to10% KOH mount, Gram stain and culture. Identification of fungala-gents were done as per standard microbiological procedures. An antifungal sensitivity test was done by microbroth dilutions as per CLSI reference method. Results: Over a period of two years 149 patients of infective keratitis were evaluated. Microbiological diagnosis of mycotic keratitis was established in 39 (26.17%) cases. Filamentous fungi were isolated more often than yeasts. The most frequently encountered filamentous fungi and yeasts were Aspergil-lusspp. 14 (35.89%) and Candida albicans 7 (17.94%) respectively. Males were more commonly affected and were mostly in the age group of 46-60 years. Ocular trauma due to vegetative matter was the most common predisposing factor. Natamycin was the most effective antifungal against filamentous fungi and amphotericin B was most effective for Candida albicans. Conclusion: Because of serious consequences of mycotic keratitis, it is very important to know the exact etiological agents and effective antifungals to save the eye of the patients. So laboratory confirmation should be undertaken and fungal infection should be ruled out before prescribing antimicrobial agents.

Recent advances in diagnosis and management of Mycotic Keratitis.

Mycotic keratitis is a major cause of corneal blindness, especially in tropical and subtropical countries. The prognosis is markedly worse compared to bacterial keratitis. Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. Over the last decade, considerable progress has been made to rapidly diagnose cases with mycotic keratitis and increase the efficacy of treatment. This review article discusses the recent advances in diagnosis and management of mycotic keratitis with a brief discussion on rare and emerging organisms. A MEDLINE search was carried out for articles in English language, with the keywords, mycotic keratitis, fungal keratitis, emerging or atypical fungal pathogens in mycotic keratitis, investigations in mycotic keratitis, polymerase chain reaction in mycotic keratitis, confocal microscopy, treatment of mycotic keratitis, newer therapy for mycotic keratitis. All relevant articles were included in this review. Considering the limited studies available on newer diagnostic and therapeutic modalities in mycotic keratitis, case series as well as case reports were also included if felt important.

Keratomycosis caused by Blastoschizomyces capitatus.

Keratomycosis or fungal infections of cornea are common causes of ocular morbidity particularly in developing countries and in tropical climate. Traumatic inoculation is the predominant predisposing factor for this condition. Most of the cases are caused by filamentous fungi. Blastoschizomyces capitatus is one of the emerging fungal agents causing infection in different organ systems particularly in immunocompromised individuals. Barring one case of keratitis and melting of corneal graft there is no report of keratomycosis by B. capitatus. Here we present a case of keratomycosis caused by B. capitatus, which is the first such case reported from India.

Mycotic keratitis due to Engyodontium album: First case report from India.

Engyodontium album is a rare and an unusual human pathogen. It is a common inhabitant of waste and moist material and frequently isolated from substrates such as paper, jute, linen and painted walls. This fungus grew within 3 days on SDA with chloramphenicol from corneal scrapping of a 70‑year‑old male farmer with a history of trauma by unknown vegetative matter. The fungus can be confused with Tritirachium sp and Beauveria sp.

A retrospective study of fungal corneal ulcer from the western part of Uttar Pradesh.

Background: Infectious keratitis is a major cause of avoidable blindness worldwide. Fungus is an important aetiological agent of infectious keratitis following corneal trauma with vegetative matter. This infection should be promptly treated to limit the morbidity and dangerous sequelae. The purpose of this study was to detect causative agents from corneal scrapings and to identify the predisposing factors of mycotic keratitis. Methods: Corneal scrapings were taken in full aseptic precautions in total 112 suspected patients for fungal etiology and were subjected to direct examination by 10% KOH mount, gram stain and culture. Results: A total 112 cases of suspected corneal ulcers were subjected to KOH mount to detect fungal elements in corneal scraping and culture to isolate aetiological agents. In our study 29 (25.8%) samples were found positive in KOH mount and fungus was isolated from the all KOH positive samples. Males were more commonly affected and were mostly in the age group of 30-50 years. Fusarium species was the most common fungus isolated followed by Aspergillus species. Conclusion: Mycotic keratitis is a serious problem usually following corneal trauma, it requires rapid detection and identification of fugal agents for treatment to prevent disastrous consequences.

Queratitis por Lasiodiplodia theobromae: comunicación de un caso y revisión de la literatura / Keratitis by Lasiodiplodia theobromae: a case report and literature review

We report a case of mycotic keratitis caused by Lasiodiplodia theobromae in a 60-year-old man with a history of ocular trauma with vegetable matter. Ophthalmological assessment with slit-lamp and microbiological evaluation of the corneal ulcer by conventional microbiological techniques were performed. Mycology study of the corneal scraping showed the presence of fungal filaments and the isolate was identified as Lasiodiplodia theobromae. Patient was treated with natamycin 5% and fluconazole 0.2% for 37 days. The infection was controlled but the corneal scars required a cornea transplant. This is the first case of keratitis by Lasiodiplodia theobromae in Paraguay. Difficulties in the management of these cases, which often requires surgical procedures, are discussed.

Se presenta un caso clínico de queratitis causada por Lasiodiplodia theobromae en un agricultor de 60 años de edad, con antecedentes de un trauma ocular con un vegetal. Se realizó un examen oftalmológico con lámpara de hendidura y estudio microbiológico de la úlcera corneal por técnicas microbiológicas convencionales. El examen micológico del raspado corneal reveló la presencia de hifas septadas y el cultivo fue identificado como Lasiodiplodia theobromae. El paciente fue tratado con natamicina al 5% y fluconazol al 0,2% durante 37 días. La infección fue controlada, sin embargo, el paciente quedó con cicatrices corneales y con necesidad de trasplante. Es el primer caso de queratitis por Lasiodiplodia theobromae en Paraguay. Se discute la dificultad de manejo de estos casos que a menudo requieren procedimientos quirúrgicos y trasplante de córnea.

Oculomicosis: una infección subestimada en Venezuela / Ocular mycosis: an underestimated infection in Venezuela

Venezuela, debido a su localización geográfica, clima y situación social, tiene el perfil para que las enfermedades oculares de origen fúngico se presenten. Aunque, en el país, la incidencia y prevalencia de las oculomicosis no ha sido suficientemente documentada, la mayoría de los oftalmólogos han tenido que atenderla en su consulta tanto pública como privada. La queratitis micótica es la forma más frecuente de presentación oftalmológica de las infecciones de origen fúngico que puede tener complicaciones irreversibles, incluso ceguera monocular, especialmente para aquellas personas que viven en comunidades agrícolas de países en vías de desarrollo. La enfermedad es fácilmente desapercibida, y los diagnósticos tardíos son comunes. Este hecho, hace que aumente las probabilidades de secuelas severas y la necesidad de intervenciones quirúrgicas. Los hongos filamentosos son los microorganismos causantes más frecuentemente asociados con traumatismos oculares o al uso de lentes de contacto. El propósito de este estudio, es presentar una revisión clínico-epidemiológica actualizada que incluye estrategias de tratamiento y diagnóstico de un problema subestimado en Venezuela e incentivar futuros estudios epidemiológicos con el objetivo de conocer los factores de riesgo asociados y medidas preventivas necesarias a ser implementadas en la región.

Due to its climate, geographical and social situation, Venezuela has the profile for fungal ocular diseases. Even though the incidence and prevalence of this ocular morbidity is undetermined in our country, most of the ophthalmologist have encountered the disease yearly in public or private practice. Fungal keratitis is the most frequent form of presentation of ocular mycosis, it can lead to irreversible complications and even monocular blindness, especially for people living in the agricultural communities of the developing world. The disease is easily overlooked or missed, and delayed diagnosis is common. This fact increases the likelihood of severe sequelae and surgical interventions. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with ocular trauma or contact lens wear. The purpose of this study is to present a clinical-epidemiological review-update, which includes diagnosis and treatment strategies of this underestimated disease in Venezuela, as well as to encourage future epidemiological studies to recognize risk factors and preventive treatment in our region.

Generalidades de Queratitis Micótica / Overview of Mycotic Queratitis

La queratitis micótica es una importante causa de discapacidad visual en los países desarrollados. En los últimos años ha aumentado su incidencia en países de regiones tropicales, relacionado con el aumento de las conductas de riesgo como el uso indiscriminado de antifúngicos y corticoides oftálmicos en la práctica médica. La confirmación del diagnóstico es necesaria, no sólo en caso de queratitis micótica, sino también en otras enfermedades oculares infecciosas para así iniciar la terapia oportuna y exacta, y evitar el uso innecesario de antimicrobianos. El pronóstico visual de los pacientes dependerá del diagnóstico temprano y el tratamiento médico oportuno.

Fungal keratitis is a major cause of visual disability in developed countries. In recent years its incidence has increased in tropical countries, related with risk behaviors such as indiscriminate use of antifungal and corticosteroid ophthalmic in clinical practice. Diagnostic confirmation is needed, not only in cases of fungal keratitis, but also for other infectious eye diseases, to initiate timely and accurate therapy, and avoid the unnecessary use of antimicrobials. The visual prognosis of patients depends on rapid diagnosis and prompt medical treatment.

Mycotic corneal ulcers in upper Assam.

Purpose: To study the association of various risk factors and epidemiological variables of mycotic keratitis treated at a tertiary referral hospital of upper Assam. Materials and Methods: In this hospital-based prospective study a total of 310 consecutive corneal ulcer cases attending the ophthalmology outpatient department of Assam Medical College were enrolled between April 2007 and March 2009. After clinical and slit-lamp biomicroscopic examination in all suspected cases, smears and culture examination for fungus was done to establish the etiology. Demographic information and associated probable risk factors of individual cases were noted in a predesigned questionnaire. Results: In 188 (60.6%) cases fungal etiology could be established. Out of them 67.6% were males. The most commonly affected age group was 41-50 years (25.5%). The maximum (23.4%) cases were reported during the paddy harvesting season in Assam (January and February). Fungal element could be demonstrated in 65.2% cases in direct potassium hydroxide (KOH) mount. The commonest predisposing factor was corneal injury (74.5%). While diabetes was a significant systemic predisposing factor in mixed bacterial and fungal infections in 11.1% cases, blocked naso-lacrimal duct was the local predisposing factor in 11.1% of cases. Fusarium solani (25%) was the commonest isolate followed by Aspergillus species (19%), Curvularia species (18.5%) and Penicillium species (15.2%). Yeasts were isolated in 2.7% (n=5) cases. Conclusions: Ocular trauma was the commonest cause of fungal corneal ulcer in Assam and Fusarium solani was the commonest species responsible for it. Most of the mycotic ulcer cases come from rural areas including the tea gardens.

Especies de Fusarium como agentes de queratitis micóticas en adultos en Tucumán, Argentina / Fusarium species as agents of mycotic keratitis in adults, in Tucumán, Argentina

Las queratomicosis por hongos filamentosos son una de las causas de daño en la córnea en los países de climas tropicales y subtropicales y se consideran dentro de las micosis de difícil tratamiento. El presente estudio evalúa la etiología de las queratitis sicóticas en Tucumán (R. Argentina) para determinar su incidencia e importancia clínica regional. En un lapso de 5 años se estudiaron 48 muestras (biopsias, raspados cornéales y/o aspirados oculares) recogidas por el oftalmólogo y enviadas al laboratorio para análisis micológico. Mediante examen directo, cultivos y estudios macro y micromorfológicos se confirmó etiología micótica en 13 pacientes (27 por ciento). De ellos, se identificaron 7 cultivos como Fusarium solani complex, 4 F. oxysporum y 2 F. verticillioides. Estos hallazgos permiten profundizar el conocimiento de los agentes etiológicos locales involucrados y los factores de riesgo, dos aspectos importantes en la prevención y la terapéutica de estas micosis.

Keratomycosis caused by filamentous fungi is one of the agents of damage to the cornea in subtropical and tropical climate countries and belongs to those mycoses identified as of difficult treatment. This study evaluates the etiology of mycotic keratitis in Tucumán (R. Argentina) with the purpose of assessing its incidence and regional and clinical significance. In a 5-year period, 48 samples (biopsy, corneal scrapes and/or ocular aspiration) collected by the oculist were examined and sent to the laboratory for a mycological analysis. By means of direct exam, macro and micromorphological cultures and studies of the presence of mycotic etiology in 13 patients (27 por ciento) was confirmed. Among them 7 cultures such as a Fusarium solani complex, 4 F. oxysporum and 2 F. verticillioides were identified. These findings allow to enlarge the knowledge of the local etiological agents involved as well as the risk factors, two elements that are significant in the prevention and therapeutics of these mycoses.

Fungal Keratitis Caused by Chromomycetes

PURPOSE: Chromomycetes is a plant parasite and one of the pigmented filamentous fungi, which rarely causes human infection. The authors report the first case of fungal keratitis caused by chromomycetes in korea. METHODS: A 65-year-old woman developed pain, redness, and an yellowish-brown infiltrate in her right eye. She had a history of corneal scratch by a pumpkin stalk and transferred by a local clinic after management for about 1 months. The clinical features suggested fungal keratitis, and the patient was undertaken surgical debridement with amniotic membrane graft and treated with oral terbinafine with natamycin and amphotericin B eyedrops. Surgically taken biopsy specimen was cultured. Amniotic membrane was removed after 1 week. After slight improvement of symptom, necrotizing ulceration was enlarged in spite of continuous antifungal therapy. Lamellar keratoplasty with amniotic membrane graft was done with antifungal therapy. Systemic agent was changed to fluconazole. Clinical improvement was achieved after about 2 months. The fungus was identified as Fonsecaea pedrosoi. RESULTS: Fungal keratitis was successfully treated with antifungal medication combined with amniotic membrane graft. CONCLUSIONS: This is a rare case of infectious keratitis caused by chromomycetes. But its clinical course was severe, so exact culture and identification following aggressive surgical and medical treatment was needed.

A Clinical and Mycological Study of 14 Cases with Mycotic Keratitis / 대한의진균학회지

BACKGROUND: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. OBJECTIVE: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. METHODS: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. RESULTS AND CONCLUSION: Mycotic keratitis showed high incidence in fifth (42.9%), sixth (35.7%), and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in mycotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%).