Mycotic keratitis, a study on etiologic agents, predisposing factors and the result of treatment among 44 patients

ABSTRACT

Mycotic Keratitis is a suppurative, usually ulcerative, and sight threatening infection of cornea that sometimes leads to loss of vision. The peak of incidence is observed in the tropical and subtropical regions. To investigate the etiological agent, predisposing factors and treatment follow up of mycotic keratitis; this study was undertaken over a period of 2 years in Mashhad. In this prospective, cross sectional study, among 466 individuals suffering from keratitis,65 patients, highly suspected to mycotic keratitis were examined by direct fresh smear [KOH 10%] and culture in Mycology Media. The results were analyzed by SPSS method. Among 65 clinically suspected individuals, the results of direct smear and culture of 44 patients were positive, of patients, 21 were male [47.1%] and 24 were female [52.3%]. The patients were between 8 to 84 years old. More than 40% of them were farmers. Trauma was the most common predisposing factor in more than 47% of cases due to vegetable materials. Molds and Yeasts were isolated from 86.4% and 13.6% of the samples respectively. Fusarium spp. were the most frequent isolates [44.4%].Others included Aspergillus spp. [21.8%], Acremonium spp. [8.3%], Penicillium spp. [5.6%] and Candida albicam [13.9%]. Tearing and redness were the most common symptoms observed [93.2%]. Amphotricin B was used in patients with Aspergillus and Candida Keratitis., but for Fusarium and other molds keratitis, Natamycin was used for 6 to 12 weeks. In one patient with Fusarium Keratitis, medical therapy was failed and therapeutic penetrating keratoplasty was performed. Six months follow up showed that prognosis was good in all of the patients. In relation to the last decade, the incidence of Mycotic Keratitis is increased in Mashhad. Keratitis due to the molds is more prevalent than yeast keratitis. Entrance of foreign body [Plant particles] is the most common predisposing factor. However, it needs long term therapy but the prognosis is good