Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern indiaReport as inadecuate




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BMC Ophthalmology

, 11:39

First Online: 22 December 2011Received: 28 April 2011Accepted: 22 December 2011

Abstract

BackgroundMycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India.

MethodsA retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis.

ResultsBetween July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% 253-997 corneal samples, 23.4% 233-997 were bacterial, 26.4% 264-997 were fungal 45 cases mixed with bacteria, 1.4% 14-997 were Acanthamoeba with or without bacteria and 23.4% 233-997 were microsporidial with or without bacteria. Two hundred fifteen of 264 81.4%, 215-264 samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 70.5% cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%238-251 cases. Aspergillus species 27.9%, 60-215 and Fusarium species 23.2%, 50-215 were the major fungal isolates. Concomitant bacterial infection was seen in 45 17.1%, 45-264 cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 35.6%, 94-264 cases. Fifty two patients 19.7%, 52-264 required therapeutic PK, 9 3.4%, 9-264 went for evisceration, 18.9% 50-264 received glue application with bandage contact lens BCL for impending perforation, 6.1% 16-264 were unchanged and 16.3% 43-264 were lost to follow up. Poor prognosis like PK 40-52, 75.9%, p < 0.001 and BCL 30-50, 60%, p < 0.001 was seen in significantly larger number of patients with late presentation > 10 days.

ConclusionsThe relative prevalence of mycotic keratitis in eastern India is lower than southern, western and north-eastern India but higher than northern India, however, Aspergillus and Fusarium are the predominant genera associated with fungal keratitis across India. The response to medical treatment is poor in patients with late presentation.

KeywordsMycotic fungal keratitis microscopy culture treatment outcome Electronic supplementary materialThe online version of this article doi:10.1186-1471-2415-11-39 contains supplementary material, which is available to authorized users.

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Author: Bibhudutta Rautaraya - Savitri Sharma - Sarita Kar - Sujata Das - Srikant K Sahu

Source: https://link.springer.com/







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