Epidemiological profile of fungal keratitis in urban population of West Bengal, India

Abstract

BackgroundCorneal diseases are one of the major causes of visual loss and blindness, second only to cataract. Amongst corneal diseases, microbial keratitis is a major blinding disease. In some countries, fungal keratitis accounts for almost 50% of patients with culture-proven microbial keratitis.AimThis study was conducted to determine the epidemiological characteristics of fungal keratitis in an urban population of West Bengal and identify the specific pathogenic organisms.MethodsThe charts of patients with microbial keratitis who attended the Cornea Services of Priyamvada Birla Aravind Eye Hospital from January to December 2008 were retrospectively reviewed. Records of patients with 10% KOH mount and culture positive fungal keratitis were analyzed for epidemiological features, laboratory findings and treatment outcomes.ResultsOf the 289 patients of microbial keratitis included in the study, 110 patients (38.06%) were diagnosed with fungal keratitis (10% KOH mount positive). Of the 110 patients, 74 (67.27%) fitted the study inclusion criteria (10% KOH mount and culture positive). Forty five of 74 patients (60.81%) in the study group were in the older age group (>50 years). Ocular trauma in 35 cases (47.29%) was identified as a high risk factor and vegetative injuries in 17 cases (22.97%) were identified as a significant cause for fungal keratitis. Maximum organism source was from corneal scrapings in 41 cases (55%). The predominant fungal species isolated was Aspergillus sp (55.40%) followed by Candida albicans 14 cases (18.91%) and Fusarium sp. in 8 cases (10.81%). Agricultural activity related ocular trauma was the principal cause of mycotic keratitis and males were more commonly affected. Thirty of 74 cases (40.55%) of the culture positive patients healed with corneal scar formation with medical treatment whereas 44 cases (59.45%) required therapeutic keratoplasty.ConclusionFungal keratitis is an important cause of microbial keratitis with injury to the cornea being a leading predisposing factor. Although Aspergillus sp. was implicated in most of the patients in our study population, Candida sp. were found in higher numbers than previously reported. Keratitis caused by filamentous fungi responds adequately to medical management. Therapeutic keratoplasty continues to remain an important treatment modality in infections with Candida sp. Early diagnosis with prompt identification of the pathogenic organism is mandatory to initiate appropriate therapy and thereby reduce morbidity.

Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern india

“…Certain conditions like trauma to the eyeball and therapy with antibiotics and corticosteroids render the eye susceptible to infection with various fungi especially in tropical parts of the world [1]. A large number of studies from India have reported epidemiological and microbiological profile of fungal keratitis [1-8], however, there are only few that have provided a comprehensive analysis of the clinical and laboratory profile [5,7]. Minor differences in the frequency and spectrum of fungi associated with mycotic keratitis have been reported from southern (36.7%) [2] northern (7.3%) [4] western (36.3%) [6] and north-eastern (25.6%) [7] India.…”

“…A large number of studies from India have reported epidemiological and microbiological profile of fungal keratitis [1-8], however, there are only few that have provided a comprehensive analysis of the clinical and laboratory profile [5,7]. Minor differences in the frequency and spectrum of fungi associated with mycotic keratitis have been reported from southern (36.7%) [2] northern (7.3%) [4] western (36.3%) [6] and north-eastern (25.6%) [7] India. Both the studies from northeastern India have reported high prevalence (38% and 42%) of fungal keratitis in the region [7,8].…”

Clinical efficacy of conjunctival flap surgery in the treatment of refractory fungal keratitis

“…However, some studies (15,17) demonstrated a prevalence in males between 50–60 years of age. Khater et al (12) also observed that mycotic keratitis was most prevalent in the 40–60 years age group (52.4% of cases) (12).…”

Expression of IL-8, IL-6 and IL-1β in Tears as a Main Characteristic of the Immune Response in Human Microbial Keratitis

“…MK is a sight-threatening process, corneal infections progress rapidly, inducing epithelial defects and permanent ocular surface damage; Thus a prompt diagnosis of the causative agent is required to administer opportune treatments [1,2,3,4,5,6,7]. In animal models of MK, the immunological response is central to controlling infectious diseases of the eye and is related to the immunological mechanism of the corneal injury [13,14,15].…”

“…The World Health Organization and Vision 2020 have recognized that corneal diseases are the second leading cause of blindness after cataract and a major cause of preventable blindness in the developing world [1,2]. Many studies have emphasized the importance of determining the epidemiological profile and performing microbial identification with regard to describing the predisposing factors to develop microbial keratitis (MK) [3,4,5,6]. Factors such as trauma, contact lens wear, dry eye, ocular surface disorders and immunosuppression may alter the immune defense mechanisms of the outer eye, and permit microorganisms to invade the cornea [7].…”