BackgroundMycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India.MethodsA retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis.ResultsBetween July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% (253/997) corneal samples, 23.4% (233/997) were bacterial, 26.4% (264/997) were fungal (45 cases mixed with bacteria), 1.4% (14/997) were Acanthamoeba with or without bacteria and 23.4% (233/997) were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264) samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 (70.5%) cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251) cases. Aspergillus species (27.9%, 60/215) and Fusarium species (23.2%, 50/215) were the major fungal isolates. Concomitant bacterial infection was seen in 45 (17.1%, 45/264) cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 (35.6%, 94/264) cases. Fifty two patients (19.7%, 52/264) required therapeutic PK, 9 (3.4%, 9/264) went for evisceration, 18.9% (50/264) received glue application with bandage contact lens (BCL) for impending perforation, 6.1% (16/264) were unchanged and 16.3% (43/264) were lost to follow up. Poor prognosis like PK (40/52, 75.9%, p < 0.001) and BCL (30/50, 60%, p < 0.001) was seen in significantly larger number of patients with late presentation (> 10 days).ConclusionsThe relative prevalence of mycotic keratitis in eastern India is lower than southern, western and north-eastern India but higher than northern India, however, Aspergillus and Fusarium are the predominant genera associated with fungal keratitis across India. The response to medical treatment is poor in patients with late presentation.
In humans, infection with Hymenolepis diminuta is usually uncommon but has been reported from various areas of the world. Parasitization rates ranging between 0.001% and 5.5% have been reported according to different surveys. We report a rare case of H. diminuta infection in a 10-year-old female from the rural area of Kendrapada district of Odisha. The patient came to our pediatrics outpatient department with the chief complain of intermittent abdominal pain, anal pruritus and nocturnal restlessness. She responded well to praziquantel therapy.
Strongyloides stercoralis is an intestinal nematode causing endemic infection, mostly in immunocompromised individuals, in tropical and subtropical regions. Herewith, we are reporting a rare case of this kind in immunocompetent patient. A 31-year-old male patient presented with chief complaints of chronic diarrhea and loss of weight since last 4 months. He reported passing watery and foul smelling stool. He also had loss of appetite since last 2 months and was diagnosed as diabetic since last 4 months but he was not given any treatment for this and his fasting blood sugar was 110 mg/dl. His HIV status was negative. Stool examination done on three occasions showed plenty of S. stercoralis larvae. Patient responded well to albendazole therapy. Strongyloidiasis is not always associated with compromise in immune status. It should be suspected in immunocompetent individuals with history of long-term diarrhea and weight loss.
Human ocular infestation by a live filarial adult worm is a rare occurrence. We report a case of ocular infestation of a female adult Brugia malayi. A 35-year-old female presented with chief complaint of severe headache, blurring of vision, redness, and lacrimation since one year. On examination, there was conjunctival chemosis, congestion, and white-colored worm with wriggling movement in the anterior chamber of eye. The worm removed by paracentesis of anterior chamber. Identification basing on typical morphology showed to be adult female B. malayi, and was confirmed by immunochromatographic test. The patient responded completely to diethylcarbamazine treatment. Live adult worm in the anterior chamber of eye is uncommon in India; nevertheless, ophthalmologists should be aware of this clinical manifestation and go for a proper identification of the worm.
Live intraocular nematode is a rare occurrence that is mostly reported in South East Asian countries. Herewith we report such a case from Nayagarh district of Odisha. A 28 year old female presented with swelling, redness, lacrimation, pain & diminished vision of left eye since 2 1/2 years. Slit lamp examination revealed a worm piercing iris muscle. The worm was removed by paracentesis of anterior chamber and sent to the Department of Microbiology. It was identified to be Gnathostoma spinigerum basing on the typical morphology of its cephalic end. The patient responded completely to oral albendazole therapy.
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