P165 Mycological profile of keratitis from tertiary care center in the state of Chattisgarh, India

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective To assess the burden of fungal etiology of clinically suspected mycotic keratitis amongst the patient presented to the Ophthalmology department in a tertiary care hospital in Chhattisgarh. Methods This is a laboratory-based retrospective study of the corneal scrapings received for mycological processing between January 2020-December 2021. Demographic data were collected from patients and from their medical records. Corneal scrapings were aseptically collected from the margins of the ulcer using a sterile Kimura blade in the Ophthalmology department and the samples were processed by following the standard microbiology protocol. A wet mount examination with 10% KOH was done. Samples were also smeared onto a sterile slide for Gram stain. Samples were inoculated in a C-shaped manner on media on blood agar, chocolate agar, and Sabouraud's dextrose agar supplemented with chloramphenicol. Media were incubated in a 25°C aerobic incubator and observed for growth daily for a week and thereafter on alternate days. Blood agar was incubated at 37°C. Fungi were identified by the conventional method by Lactophenol cotton blue microscopy (LPCB) and slide culture. Antifungal susceptibility testing for Voriconazole with E-test was performed for Aspergillus and Fusarium species. Results A total of 37 patients with suspected mycotic keratitis were included in the duration of the study period. The demographic details hinted more predisposition of keratitis in females than in males; with a mean age of 49 ± 2 years and a range from 21 to 80 years. The predominant predisposing factor was trauma with organic matter in agricultural background. Amongst the total 37.8% (14/37) were positive for both KOH and culture, while 5.4% (2/37) were KOH negative but culture positive. There were 5 isolates that could hint toward low sample load or certain technical logistic issues could not be culture. Amongst culture-positive isolates, Fusarium species (37.5%) was the most common isolate showing predominance of Fusarium oxysporum, followed by Acremonium species and Aspergillus species 19%, with rare isolation of Colletotrichum dematium and Scedosporium species. Conclusion Culture remained the gold standard for the detection of fungal agents which will help to know the epidemiology of the local areas and guide the clinicians to prevent and treat the affected patients effectively. The tropical environment and agricultural occupation in Chhattisgarh present variability in the etiology of mycotic keratitis. With the predominance of Fusarium species, unusual fungal isolates of C. dematium and Scedosporium species from corneal ulcers were observed. Early detection is essential to initiate appropriate antifungal therapy and to minimize preventable ocular complications like blindness.

Uveitis complicated by Scedosporium apiospermum sensu stricto: relevance of early diagnosis and its multidisciplinary management

“…Se añadió al tratamiento voriconazol oral (400 mg/12 horas las primeras 24 horas, luego 200 mg/12 horas). nóstico de confirmación continúa siendo el cultivo [4][5]. El material obtenido generalmente es escaso y debe ser sembrado directamente en la propia cabecera del enfermo, en medios de cultivo para bacterias, hongos, virus o Acanthamoeba (si existe sospecha clínica).…”

“…El examen directo es barato, simple y rápido y aunque es posible observar estructuras fúngicas con KOH, se prefiere usar tinciones como el Gram, Giemsa o blanco de calcoflúor [ 4 ]. El diagnóstico de confirmación continúa siendo el cultivo [ 4 - 5 ]. El material obtenido generalmente es escaso y debe ser sembrado directamente en la propia cabecera del enfermo, en medios de cultivo para bacterias, hongos, virus o Acanthamoeba (si existe sospecha clínica).…”