Microbiological And Epidemiological Profile Of Keratomycosis In A Tertiary Care Hospital – A Prospective Analysis

Introduction: Microbial keratitis is predominantly an opportunistic, serious ocular infectious disease that can lead to significant vision loss and ophthalmic morbidity.1 The fungi are significant pathogens causing ocular infections due to their frequent involvement and difficulty in establishing definitive diagnosis.. Material and Methods: We prospectively analyzed 106 cases of keratomycosis in our tertiary care hospital. Corneal scrapings were collected, processed and fungal pathogens were identified by standard laboratory techniques. Results: Out of 106 suspected cases, culture was positive in 31 cases. Aspergillus species were the most frequent isolates (51.61%). Next to this were Candida spp. (19.35%) followed by Fusarium spp., Alternaria spp., Mucor spp , Penicillium spp, Drechslera spp and Exserohilum spp . Males were more affected than females and trauma was the most common predisposing factor. Conclusions: This study highlights important risk factors and organisms responsible for mycotic keratitis.

Keratomycosis Caused By Pigmented Fungi

Keratomycosis is a major cause of blindness, especially in the developing world. A major proportion of these are caused by fungi, of which pigmented fungi is a good number. Pigmented fungal corneal ulcers may present with surface pigmentation, helping in diagnosis but the presumptive treatment is usually started after evaluation of smears made from scrapping samples. Aggressive treatment with topical anti-fungals help accelerated healing in most of them but few still worsen and need therapeutic keratoplasty. In this study, we evaluated the cases of pigmented Keratomycosis presenting in a tertiary care center for various factors like demographic details, risk factors, clinical characterstics, response to treatment and prognosis

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.

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.

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.

Frecuencia de ulceras corneales de etiología fúngica en el Hospital Universitario de Caracas 2008-2012 / Frequency coneal ulcers fungal etiology University Hospital 2008-2012 Caracas

La queratitis micótica es una infección de curso subagudo que genera inflamación y ulceración de la córnea. La importancia de las queratitis micóticas en la práctica oftalmológica radica en su dificultad diagnóstica y terapéutica, la falla en el reconocimiento temprano del hongo y la instauración tardía del tratamiento adecuado incrementa la infiltración y ulceración del estroma corneal, lo que puede llegar a tener consecuencias graves en la integridad del globo ocular. Se propuso determinar la frecuencia de ulceras corneales de etiología fúngica en el Hospital Universitario de Caracas durante el periodo julio 2008-julio2012. Se diseñó un estudio retrospectivo, descriptivo, basado en la revisión de las 41 historias médicas de todos los pacientes con cultivo y/o examen directo positivo para hongos en muestras de úlceras corneales. El cultivo fue positivo en 97,56%, representando Fusarium spp el 37,5%, F. solani 20%, F. oxysporum 12,5%, Aspergillus spp 7,5%, y A. terreus, A. fumigatus, A. candidus, Penicillium spp, Candida spp, C. parapsilosis, P. boydii, Curvularia sp y Cladosporium sp representaron 2,5% cada uno. Al 58,54% se les realizo tratamiento quirúrgico. De 41 pacientes 73,17%, eran de sexo masculino, el grupo más afectado estuvo comprendido entre 20 y 59 años representando el 75,61%. El 58,54% procedía de zonas urbanas y el 41,56% de zona rural, y el 78,05% de la población atendida pertenecía al interior del país. Un 48,78% tuvo un evento traumático mientras que el 51,22% no y 87,80% pacientes ya habían recibido tratamiento previo. A pesar de los avances en diagnóstico y tratamiento para las queratomicosis siguen constituyendo un problema en los países subdesarrollados donde el diagnóstico tardío es directamente proporcional al grado de mejoría del paciente.

Fungal keratitis is a subacute infection that produces inflammation and ulceration of the cornea. The importance of fungal keratitis in ophthalmology practice lies in its diagnostic and therapeutic difficulties, failure of the fungus early recognition and appropriate treatment of late-onset increases infiltration and ulceration of the corneal stroma, which can have serious consequences in the integrity of the eyeball. Proposed to determine the frequency of fungal etiology corneal ulcers in Caracas University Hospital during the period July 2008- july 2012. We designed a retrospective descriptive study, based on a review of 41 medical records of all patients with culture and / or direct examination positive for fungal corneal ulcers samples. The culture was positive in 97.56%, representing 37.5% Fusarium spp, 20% F. solani, 12.5% F. oxysporum, Aspergillus spp 7.5%, and A. terreus, A. fumigatus, A. candidus, Penicillium spp, Candida spp, C. parapsilosis, P. boydii, Curvularia sp and Cladosporium sp accounted for 2.5% each. At 58.54% received surgical treatment. Of 41 patients 73.17% were males, the group most affected was between 20 and 59 years old representing 75.61%. , 58.54% were from urban areas and 41.56% in rural area, and 78.05% of the population served came from inside the country. A 48.78% had a traumatic event while 51.22% and 87.80% no patients had received previous treatment. Despite advances in diagnosis and treatment for keratomycosis remains a problem in developing countries where late diagnosis is directly proportional to the degree of patient improvement.

Ceratomicose em equinos / Equine keratomycosis

O cavalo, dado o seu meio ambiente, está sujeito a afecções frequentes da córnea e da conjuntiva, tecidos oculares bastante expostos a bactérias e fungos, principalmente Aspergillus spp. e Fusarium spp. As ceratites ulcerativas bacterianas e fúngicas, bem como as ceratites fúngicas não ulcerativas, caracterizadas principalmente pelo abscesso estromal, são frequentes nessa espécie. Ocorrida a lesão inicial, perpetua-se um ciclo vicioso, com liberação de citocinas inflamatórias, que desencadeiam uma rápida e severa infiltração corneal por células polimorfonucleares. A córnea torna-se sujeita à destruição por enzimas proteolíticas liberadas pelos micro-organismos e por células inflamatórias, capazes de desencadear a dissolução estromal e a perfuração do bulbo ocular. O tratamento clínico para a resolução da doença corneal e o controle da uveíte reflexa deve ser agressivo e associado, muitas das vezes, à terapia cirúrgica. Este artigo discorre sobre a fisiopatologia e o tratamento da ceratomicose em equinos.

Environmental and behavioral factors make horses susceptible to corneal and conjunctival lesions, since these structures are constantly exposed to bacteria and fungi specially Aspergillus spp. and Fusarium spp. Bacterial and fungal ulcerative keratitis, as well as non-ulcerative fungal keratitis such as stromal abscess, are frequent in horses. A "cascade" effect follows the initial lesion which triggers the release of inflammatory cytokines followed by an acute and severe infiltrate of polymorphonuclear cells in the cornea. The cornea becomes susceptible to the activity of proteolytic enzymes released by microorganisms and polymorphonuclear cells, resulting in stromal degradation and ocular perforation. The medical treatment targeting the corneal disease and the controlling of reflexive uveitis should be aggressive and surgical therapy should be associated in most of the cases. This paper reviews the pathophysiology of keratomycosis in horses and specific aspects of the treatment in this species.

Keratomycosis caused by Exserohilum rostratum.

We report a case of keratomycosis caused by Exserohilum rostratum. A 46-year-old farmer presented with history of pain, watery discharge and redness of the right eye for the past 2 weeks following trauma with vegetable matter. On ocular examination, a central corneal ulcer of about 8 mm with a greyish-white slough, feathery edges and diffuse corneal edema was seen in the right eye. KOH examination of corneal scrapings revealed thick, brown, branched, septate hyphae. Culture of corneal scrapings on Sabouraud dextrose agar showed velvety greenish-black colony with a black pigment on the reverse. The culture was identified as E. rostratum on the basis of microscopic morphology. The patient responded well to treatment with topical natamycin and oral itraconazole.

Natamycin in the treatment of keratomycosis: Correlation of treatment outcome and in vitro susceptibility of fungal isolates.

In this study, 60 fungal isolates from 60 patients with fungal keratitis were tested in vitro for their susceptibility to natamycin and the mean minimum inhibitory concentrations of natamycin (MICn) were correlated with clinical outcome. The mean MICn for various groups of fungi from patients with either early (<10 days) or late (≥10 days) presentation was correlated with the outcome. Aspergillus flavus showed resistance to natamycin with a high mean MICn (>16 μg/ml). While the clinical response in all patients with early A. flavus keratitis was good it was poor in late cases (5/8 patients, 62.5%). Fusarium species, Acremonium species and dematiaceous fungi were sensitive with low mean MICn (Fusarium: 5.7-7.2 μg/ml, Acremonium: 5.7-6.8 μg/ml, dematiaceous: (1.6-4 μg/ml). However, 46.6% (7/15) patients in Fusarium and 57.1% (4/7) in Acremonium group needed keratoplasty. We conclude that despite susceptibility of most fungal species causing keratitis to natamycin, the treatment outcome is poor in advanced fungal keratitis.

Comparative study on the incidence and outcomes of pigmented versus non pigmented keratomycosis.

Purpose: To determine the incidence, outcomes and establish factors determining visual prognosis of keratomycosis due to pigmented fungi in comparison with nonpigmented fungi. Materials and Methods: All culture-proven cases of fungal keratitis from January 2006 to August 2008 were drawn from a computerized database and cases with adequate documentation were analyzed for predisposing factors, clinical characteristics, microbiology and treatment methods. Outcomes of keratitis due to pigmented and nonpigmented fungi were compared using t-test and χ2 test. Results: Of 373 cases of keratomycosis during the study period, pigmented fungi were etiological agents in 117 eyes (31.3%) and nonpigmented fungi in 256 eyes (68.7%). Eyes with nonpigmented keratitis had significantly larger ulcers (14.96 mm2 ) and poorer vision (1.42 logMAR) at presentation compared to those with keratomycosis due to pigmented fungi (P=0.01). The characteristic macroscopic pigmentation was seen in only 14.5% in the pigmented keratitis group. Both groups responded favorably to medical therapy (78.1% vs. 69.1%) with scar formation (P=0.32) and showed a significant improvement in mean visual acuity compared with that at presentation (P<0.01). Visual improvement in terms of line gainers and losers in the subgroup of eyes that experienced healing was also similar. Location of the ulcer was the only factor that had significant predictive value for visual outcome (P=0.021). Conclusion: Incidence of keratomycosis due to pigmented fungi may be increasing as compared to previous data. These eyes have similar response to medical therapy and similar visual outcome compared to nonpigmented keratitis. Central ulcers have a poor visual outcome.

Localización de Serratia marcescens en perfil bacteriológico y fúngico de la conjuntiva de caballos clínicamente sanos en Monterrey, Nuevo León, México / Localization of Serratia marcescens in bacterial and fungal profile of conjunctiva of clinically healthy horses from Monterrey, Nuevo Leon, Mexico

The conjunctival normal microflora, formed by fungi, yeast and bacteria, of 50 clinically healthy horses from Monterrey, Nuevo Leon, was identified using three to 12 year-old horses of different breeds and gender. Samples were taken from the conjunctival sac of both eyes (n =100 eyes) using a cotton swab under sterile conditions. No eye was negative to the presence of the microorganism. There were differences in colony types in each eye of the same animal. One hundred percent were positive to fungal and bacteria colonies in both eyes, while 60% were positive to yeast. In the present study Serratia marcescens, a pathogenic, opportunist and multidrug-resistant organism, is reported for the first time in the conjunctival sac in horses. Serratia marcescens was isolated from 21 clinically healthy horses (42%) with a number of colony forming units (cfu) that ranged from 9 to 42.

Se identificó la microflora normal, formada por hongos, levaduras y bacterias, de la conjuntiva en 50 caballos clínicamente sanos, de diferente raza y sexo, de tres a 12 años de edad, del área metropolitana de Monterrey, Nuevo León. Las muestras se tomaron del saco conjuntival de ambos ojos (n = 100 ojos) con un hisopo bajo condiciones estériles. Ningún ojo fue negativo a la presencia de microorganismos. Hubo a menudo diferencias en los tipos de colonias entre los ojos del mismo animal, 100% fueron positivos a la presencia de hongos y bacterias en ambos ojos, y 60% positivos a la presencia de levaduras. Este estudio presenta, por vez primera en conjuntiva de caballos, la presencia de Serratia marcescens, considerada microorganismo patógeno oportunista con multirresistencia a fármacos. En esta investigación, Serratia marcescens se logró aislar de 21 caballos clínicamente sanos (42%) con rango de nueve a 42 unidades formadoras de colonias (ufc).

Colletotrichum graminicola keratitis: First case report from India.

Colletotrichum graminicola is a medically important fungus belonging to the order Melanconiales under the class Coelomycetes. The members of the genus Colletotrichum are primarily plant pathogens which cause anthracnoses (fungal infection in plants). In the past few decades, they are progressively being implicated as etiological agents of subcutaneous hyalohyphomycoses and keratomycoses. Of the five medically important members in the genus Colletotrichum, keratitis due to Colletotrichum graminicola is rare. We diagnosed Colletotrichum graminicola keratitis in a 44-year-old man who presented with a non-healing corneal ulcer since three weeks. Positive smears and cultures from the corneal scrapings established the causative organism as C. graminicola. The patient was treated with a combination of oral ketoconazole and topical fluconazole and natamycin. Infection resolved over 10 weeks and antimicrobials were stopped. We describe the clinical presentation and treatment outcome of Colletotrichum graminicola keratitis.

Fungal Profile and Susceptibility Pattern in Cases of Keratomycosis

The present study was undertaken to find out various fungi causing keratomycosis and to determine the antifungal susceptibility profile of these isolates. One hundred corneal scrapings from patients with corneal ulcers were subjected to KOH wet mount preparation. Thirty samples which were positive for fungal elements on direct microscopic examination were cultured on Sabouraud's dextrose agar medium(SDA).The isolates were identified and were subjected to drug susceptibility tests for ketoconazole and fluconazole by tube dilution method. Incidence of fungal corneal ulcers was maximum in the age group of 20-49 years (56.67%). Agriculturists constituted the largest group (53.33%), history of trauma was present in 90% of the patients. Aspergillus species were the commonest isolates (70%) followed by candida (20%), alternaria (6.70%) and penicillium (3.30%). MIC of ketoconazole varied from 0.5mg/ml to 10 mg/ml. MIC of fluconazole varied from 0.5 - 10 mg/ml and 19 isolates of fungi did not show any sensitivity to fluconazole upto concentration of 10 mg/ml which was the upper limit of the test system. As agricultural activity and related ocular trauma were principal causes of mycotic keratitis, KOH wet mount preparation is an essential tool in the diagnosis of these infections. It is a very simple and sensitive method. Susceptibility pattern to antifungal drugs was determined to optimize therapeutic response in eye infections.

A Case Report of Intracameral Amphotericin B Injection in the Management of Deep Keratomycosis

PURPOSE: The management of fungal keratitis can be difficult because fungi are capable of penetrating the intact Descemet's membrane and entering the anterior chamber and because ocular penetration of topical antifungal agents is poor. The authors report the first case of intracameral amphotericin B injection in the management of deep keratomycosis. METHODS: A 73-year-old woman developed pain and decreased vision in her right eye. Corneal ulcer with hypopyon was found, and 10% KOH smear revealed hyphae. There was an initial response after administrating topical amphotericin B along with systemic fluconazole. But deep infiltrates and hypopyon remained. The corneal scraping grew Fusarium on culture. Ten micrograms of amphotericin B in 0.1 mL was injected into the anterior chamber on day 22 after admission. Two months after the intracameral injection, the ulcer and hypopyon cleared completely leaving only a central corneal scar. RESULTS: The results were favorable, with the ulcer and hypopyon clearing completely after the intracameral injection of amphotericin B. CONCLUSIONS: Intracameral amphotericin B may be a useful modality in the treatment of deep keratomycosis not responding to topical antifungal agents.