Yusuf Rizvi1, Piyush Mohan Agarwal2, Prem Prakash Mishra3, Ashutosh Dokania4
CONTEXT
Spectrum of fungal keratitis continues to change with geographical location and season. Microbiological and epidemiological data provide guidelines to the treating physician facilitating chances of successful treatment.
PURPOSE
To report microbiologic and epidemiologic profile of 119 culture-positive cases of fungal keratitis treated at a tertiary centre in North India.
SETTINGS AND DESIGN
All cases reporting directly or referred to the OPD of Eye Department of Rohilkhand Medical College and Hospital, Bareilly, India, diagnosed and treated as fungal keratitis during a 3-year period between March 2012 and Feb 2015.
METHODS
Retrospective analysis of clinical and microbiological data of 119 culture-positive cases of fungal keratitis. Demographic features, risk factors, clinical course and laboratory findings were reviewed.
RESULTS
All patients were residents of 11 adjoining districts of Northern India. Of the 119 patients, 76 (63.8%) were males (male: female ratio 1.79:1). 81(68%) patients were in young productive age group of 20-45 years. 87 (73%) were rural based. Ocular trauma with vegetative material, especially sugarcane leaf or dust falling in eyes were the chief precipitating factors; n = 89 (74.7%).
Microbiologically Fusarium was the predominant isolate, 64 cases (53.7%), followed by Aspergillus 34(28.6%) and Candida 11(9.2%). 2 cases of Alternaria and Curvularia and solitary cases of Acremonium and Scedosporium were reported. 4 strains remained unidentified. Mode of injury had a causal relation with fungal aetiology. Majority of Fusarium infections were caused by vegetative injuries 39(61%). Of these, 15(23.4%) were attributed to sugarcane leaves.
Soil/dust fall in eye or Surma application were responsible for bulk of Aspergillus infections; 21(61.7%). Candida infections were sporadic with a higher presenting age (Mean av 51.2 years) and a frequent association with topical steroid usage, (8 of 11 cases). Aspergillus infections were predominant in the hot and humid months of June to September; 25 of 34 cases (73.5%).
Fusarium infectivity remained largely constant over the year with bimodal spurt during harvesting seasons. A wet KOH mount was effective for early diagnosis with a sensitivity of 89%.
