The importance of opportunistic fungal pathogens in causing ocular infections is emphasized. A study was conducted over a period of 4 years (1974--1977) to investigate the role of opportunistic fungi in causing mycotic keratitis and to elucidate certain aspects of epidemiology of this disease in Nigeria. Fifty-nine cases of corneal ulcers of suspected mycotic etiology were investigated. Fungal etiology was confirmed in 42 of these cases. The predominant etiological agent was Fusarium solani in 14 cases (33.33%) followed by Penicillium citrinum in 8 cases (19.04%) and Aspergillus fumigatus in 5 cases (11.90%). The yeasts were responsible for only 3 cases (7.14%) i.e. one each caused by Candida albicans, C. parapsilosis and C. guilliermondii. Among the remaining 12 cases, one was caused by F. moniliforme, 3 by A. flavus, 2 each by A. niger, Penicillium expansum and Penicillium sp., and one each by Cladosporium cladosporioides and Cladosporium sp. The clinical features of the cases are briefly described. The incidence of mycotic keratitis in relation to sex, age, occupation, trauma and other factors has been analysed. Corneal trauma appeared to be an important predisposing factor as 27 (67.28%) of the patients gave a history of injuries to the eye. Notably, a large number of patients were farmers and trauma was most often from palm tree leaf, thorn, kernel or other plant objects. Topical application of corticosteroids or broad spectrum antibiotics did not seem to play an important role in the etiology of keratomycosis. Cases were recorded throughout the year although the number of cases was higher in the months of March--May, and November--December than that during the rest of the year. The isolates of the causative agents were studied in detail for their morphological and cultural characters. The isolates of F. solani grew well at 37 degrees C and survived at 40 degrees C for more than 3 weeks. In vitro drug sensitivity tests indicated good antifungal activity of pimaricin and econazole for F. solani, clotrimazole and econazole for Aspergillus fumigatus. A. flavus and Penicillium citrinum, and 5-fluorocytosine for Candida spp. Investigations on the incidence of fungi in normal healthy eyes of 450 persons comprising 204 adults and 246 children yielded 204 isolates belonging to 21 genera of fungi. Cladosporium was most frequent (12.88%) followed by Penicillium (10.22%) and Aspergillus (6.66%). Another important fungus was Fusarium represented by 10 isolates, viz. 4 of F. solani, 2 of F. moniliforme, 1 of F. exysporum, and 3 of Fusarium sp. The yeasts were represented by two isolates each of Candida tropicalis, C. pseudotropicalis, C. krusei, Trichosporon sp and Cryptococcus albidus, and one of Candida guilliermondii. Successive culturing of fungi from normal eyes in a small group indicated that fungi occur in the outer eye generally as transients. The epidemiology of mycotic keratitis has been discussed in relation to the present findings and in comparison with observations of other investigators.
Mycotic keratitis is being increasingly recognized as an important problem in ophthalmic practice in several parts of the world (Emmons, Binford, and Utz, 1970). Reports on it from various countries have been comprehensively reviewed by DeVoe and Silva-Hutner (1972). Except for one record from Egypt of a corneal ulcer due to Beauveria sp.(Lichaa, I933), information on the incidence and aetiology of mycotic keratitis in the African continent has been lacking. Therefore a report of 21 cases of this condition diagnosed during a period of two years at the University of Nigeria Teaching Hospital, Enugu, is of interest. This series of cases of fungal corneal ulcers, proved by culture, is one of the largest to be reported. Materials and methodsThe study was limited to cases in which the comeal ulcers were strongly suggestive of a fungal infection. Thirty-six such cases were investigated. A thorough clinical examination together with observation by slit lamp of the size, shape, position, and depth of the ulcer and the type of slough was undertaken, and satellite lesions on the cornea were looked for whenever possible. The patient's occupation, history of onset of the disease or injury, and previous treatment with corticosteroids or broad spectrum antibiotics were recorded. Scrapings for mycological investigation were taken from the edge or the base of the ulcers with a platinum loop under sterile conditions, taking as deep a scraping as possible. A portion of the scrapings was examined microscopically in io per cent potassium hydroxide and the remaining material cultured on slopes of freshly prepared Sabouraud's agar supplemented with chloramphenicol (0o05 mgl ml). Cultures were incubated at 280C for 7 days and regularly examined. In cases in which microscopical examination of scrapings in KOH was negative and the culture was positive, or vice versa, more scrapings were collected and processed. Table.
Summary: The occurrence of pathogenic fungi was investigated in intestines, lungs, livers and spleens of 200 lizards (Agama agama), 50 wall geckos (Hemiolactylus sp.), 20 toads (Bufo bufo) and 10 turtles (Chelonia mydas). The most important pathogenic fungus isolated was Basidiobolus haptosporus. It was recovered from intestinal contents of 125 (62.5%) lizards, 5 (10%) geckos, and a toad. Other important fungi isolated included 2 isolates of Allescheria boydii from lungs, 10 of Aspergillus fumigatus from lungs and intestines, and 5 of Geotrichum candidum from intestines of lizards. The yeast‐like fungi were represented by 6 isolates of Candida parapsilosis from intestines of a turtle and 2 toads, lungs of 2 lizards and from the lungs and liver of a toad, 3 of Candida sp. and 2 of Trichosporon sp. from intestines of lizards, and 1 of Pichia burtoni from the lungs of a lizard. The liver of the toad yielding C. parapsilosis showed abscess like pustules on its surface; direct microscopic examination of a pustule in 10% KOH showed budding yeast cells but histology did not reveal any invasion of the tissue by the fungus. None of the other animals yielding fungal cultures revealed any gross or microscopic evidence of fungal infection of the organs. The significance of the findings has been discussed. Zusammenfassung: Bei 200 Eidechsen (Agama agama), 50 Mauergeckos (Hemiolactylus sp.), 20 Kröten (Bufo bufo) und 10 Schildkröten (Chelonia mydas) wurde das Vorkommen von Pilzen im Darm, in der Lunge, in der Leber und in der Milz untersucht. Als wichtigster pathogener Pilz wurde Basidiobolus haptosporus gefunden. Er wurde aus dem Darminhalt von 125 (62,5%) Eidechsen, 5 (10%) Geckos und bei einer Kröte gefunden. Andere wichtige Pilze, die gefunden wurden, waren 2 Isolate von Allescheria boydii aus der Lunge, 10 Stämme von Aspergillus fumigatus aus Lunge und Darm sowie 5 Stämme von Geotrichum candidum aus dem Darm von Eidechsen. Als hefeartige Pilze wurden 6 Isolate von Candida parapsilosis aus dem Darm einer Schildkröte und von 2 Kröten, aus der Lunge von 2 Eidechsen und aus der Lunge und Leber von einer Kröte gefunden. Ferner wurde 3 × Candida spezies und 2 × Trichosporon spezies aus dem Darm von Eidechsen sowie 1 × Pichia burtoni aus der Lunge einer Eidechse isoliert. Die Leber einer Kröte aus der Candida parapsilosis isoliert worden war, zeigte abszessartige Pusteln an der Oberfläche. Die direkte mikroskopische Untersuchung der Pusteln mit 10% KOH ließ Sproßzellen erkennen. In der Histologie fand sich jedoch keinerlei invasives Wachstum des Pilzes im Gewebe. Bei keinem der anderen Tiere, von denen Pilze isoliert worden waren, zeigten sich makroskopische oder mikroskopische Anzeichen einer mykotischen Infektion der Organe. Die Bedeutung der Befunde wird diskutiert.
The present investigation represents the first study of oropharyngeal carriage of Candida and other yeasts in HIV-infected patients in India. One hundred and fifty HIV-positive patients were investigated by culturing their swish samples on plates of CHROMagar Candida. Ninety-eight patients (65.3%) were positive for Candida and four (2.7%) were positive for other yeasts. Among them, the first Indian C. dubliniensis isolate has been recovered. Molecular typing of selected C. albicans isolates by AP-PCR revealed two major genotypes based on the banding patterns. The susceptibilities of 30 Candida isolates to five antifungal agents including the new triazole voriconazole were determined in a micro-dilution test, according to the NCCLS protocol M 27. All the 22 C. albicans isolates were susceptible to five antimycotic agents (flucytosine, amphotericin B, fluconazole, voriconazole and itraconazole) except one isolate (VPCI-122), which was resistant to flucytosine (MIC > or = 64 mg l-1). The azole-resistant isolates reported here endorse the role of antifungal susceptibility testing whenever antifungal treatment with azoles is planned.
An outbreak of candidemia due to Candida tropicalis involving 16 neonates (gestational age 28-36 weeks) is reported. All infants had received hyperalimentation and at least one course of antibiotics. The commonest clinical manifestations included episodes of acute respiratory distress and lack of response to antibacterial antibiotic therapy. Candida tropicalis was recovered from blood in all the 16 infants and urine cultures were positive in 14 infants. Environmental sampling yielded C. tropicalis from one each of the blankets and mattresses used for neonates. Four of five urinary tract isolates and both environmental isolates genotyped by arbitrarily primed-PCR with several random primers were shown to belong to the same genotype.
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