Gangotri Barui1, Soumyadeep Majumdar2, Udit Raj Sharma3, Shyama Prasad Saha4
BACKGROUND
Corneal ulcer is one of the leading causes of ocular morbidity in developing country. Early diagnosis and targeted therapy is indispensable. Sociodemographic variables along with predisposing factors plays a major role in its development and clinicopathological correlation in diagnosis is very much helpful in diagnosis and subsequent management. The aim of the study is to identify the epidemiological factors and causative organism of the suppurative corneal ulcer.
MATERIALS AND METHODS
In this observational cross-sectional study, after taking proper history, patients with suppurative corneal ulcer are examined for clinical diagnosis. Applying sterile method of swab collection from the ulcer for standard microbiological examination (staining, culture) swabs are taken for predetermined laboratory investigations. Sociodemographic variables (age, gender, occupation) relevant injury history, microbiological data are tabulated for statistical calculations.
RESULTS
After application of inclusion and exclusion criteria wiling 81 patients, M:F=55:26 were assessed. Major number of patients (n=61, 75.30%) are middle aged between 33-62 years of age. Occupation played a major role as evidenced by 44.44% (n=36) contribution from agricultural workers (tea garden worker, pineapple farmer, other agricultural worker) followed by household worker (n=13, 16.05%). Positive history of prior corneal injury is common in fungal corneal ulcer (n=22, 51.16%) as well as in bacterial (n=8, 66.66%). Among the prior corneal injury associated fungal ulcer vegetative matter injury in 15 patients (32.60%), while in bacterial variety, it is 5 (10.86%) in number. In laboratory investigations, pure fungal growths are found in 37 patients (45.68%), while pure bacterial are 12 in number (14.81%). A good number (n=8, 9.81%) shows mixed infection. Culture negative ulcers are good in number (n=24, 29.63%) among which 6 (7.47%) are microscopically positive. The sensitivity and specificity of clinical diagnosis of fungal corneal ulcer are 84.61% and 72.41% respectively with a high correlation between clinical and microbiological diagnosis of fungal corneal ulcer (either smear positive or culture positive and a quiet high positive predictive value for clinical diagnosis (84.61%). But, in case of bacterial corneal ulcer, the positive predictive value is 41.37%, while negative predictive value is 84.61% in our study.
CONCLUSION
Middle-aged agricultural workers are more prone to develop corneal ulcer and fungal corneal ulcers are more prevalent in this region of India than bacterial. History of prior corneal injury is a major risk factor. Fungal corneal ulcers have high correlation between clinical and microbiological diagnosis than bacterial.
