|Year : 1975 | Volume
| Issue : 2 | Page : 7-10
Shobha Grover1, Pushpa Jagtap2, KD Sharma3
1 Medical College, Nagpur, India
2 Reader in Deptt. Path. & Bact. Govt. Ayurvedic College, Nagpur, India
3 Professor of Pathology, Medical College, Nagpur, India
Deptt. Path. & Bact. Medical College, Nagpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Grover S, Jagtap P, Sharma K D. Mycotic keratitis. Indian J Ophthalmol 1975;23:7-10
Laber  in 1879 reported the first case of keratomycosis. He established clinical diagnosis by mycological studies. There is a wide spread topical use of steroids and antibacterial antibiotics which are responsible for the increased frequency of keratomycosis  . In the last few years fungal infections of cornea have been frequently reported , .
The present study was carried out with the aim to study the selected cases who were clinically diagnosed as mycotic keratitis. Routine bacteriological investigations failed to yield positive cultures. These cases also had a poor response to antibacterial antibiotics.
| Material & Methods|| |
Patients suspected of mycotic keratitis were examined at the outpatient department of Ophthalmology, Government Medical college, Nagpur. Few cases were referred from other hospital. A total of 17 cases were studied. Deep corneal scraping and swabs were collected by the clinician and immediately transported to the laboratory.
The following techniques were employed.
1. Direct examination in 10% KOH.
2. Culture was done in Sabouraud's dextrose medium with antibiotics and Brain Heart infusion agar. Culture tubes were kept at room temperature at 22°C and also incubated at 37°C for 4 weeks. Periodical readings were taken.
3. Positive cultures were repeated at least on two or three occasions to exclude contamination.
| Observations|| |
17 selected cases were studied in the age group of 4-60 years. 9 cases were male and 8 female. In all the cases there was a history of injury.
Out of 17 cases, culture was positive in 14 cases. The species identification was carried out in all 14 cases. Identification was done on the baisis of morphology and cultural characteristic. The species isolated were Aspergillus sp. 7 cases, Penicillium sp. 2 cases, one case each of Candida albicans, Fusarium sp. [Figure - 1], Scopuloriopsis sp. Trichosporon sp. and Curvulavia geniculata [Figure - 2].
Further identification of Aspergillus species was carried out. Aspergillus niger was isolated in 5 cases, Aspergillus glaucus in one case and Aspergillus terrus in one case.
To exclude contamination the culture were considered positive only if the same species was cultured abundantly on at least three occasions.
| Discussion|| |
Mycotic keratitis is a primary infection of a healthy cornea but is produced by opportunist fungi that invade injured or diseased tissue. Wide spread topical use of steroids and antibacterial antibiotics are also responsible for the increased frequency of keratomycosis  .
One of the most unusual characteristic of mycotic keratitis is its highly varied etiology. Fungi of more than ten genera have been detected from eye infection , .
In the present series 17 selected cases were studied. History of injury was forthcoming in all the cases. These patients had also shown a poor response to antibacterial treatment and were referred for mycological culture. 14 cases were positive in culture and the species identification revealed predominance of Aspergillus species as the incriminating fungus in 50% of the cases. The other species were identified as Candida albicans, Fusarium, Scopuloriopsis, Trichosporum, Penicillum and Curvularia [Table - 1]. It appears that the etiological agents are numerous but the commoner species are Aspergillus, Fusarium, Cephalosporium and Penicillium.
The present study in the selected patients revealed 84% positive cultures for fungi. Similar results were obtained by Polack  et al (96% positive cultures) in their selective study.
The importance of diagnosis of mycotic keratitis cannot be over emphasized. Diagnostic failure is due to difficulty of identification by routine methods, slow growth of fungi and absence of pathogenic features to differentiate from more common bacterial and viral infections. Awareness of keratomycosis amongst the ophthalmologist is essential. Diagnosis can be delayed in the absence of proper mycological laboratory technic. This delay would result in treatment of the ulcer with antibiotics, steroids or both in combination favouring the rapid proliferation of the organism resulting in perforation and loss of the eye. In the present series of selective cases 82% were diagnosed as keratomycosis and immediate treatment had prevented further complications.
| Summary|| |
Seventeen selected cases which were diagnosed clinically as mycotic keratitis were studied. Mycotic flora was grown on 14 cases. The species isolated were Aspergillus Sp. 7, Penicillium Sp. 2, and one case each of Candida Sp., Fusarium Sp., Curvularia Sp., Trichosporum Sp. and Scopuloriopsis Sp. History of injury was recorded in all cases.
| Acknowledgement|| |
The authors are thankful to Dr. Ishwarchandra, Prof of Ophthalmology, Medical college, Nagpur and Dr. Sudha Sutaria for referring the cases.
| References|| |
Bakerspigel A., Fungi isolated from keratomycosis in Ontario Canada, Monosporium apiosperumum.
9: 107: (1971) Sahouraudia.
Dube, N.K.; Gupta, O.P. and Sogani, R K., 1968, A study of superficial mycosis in Udaipur. Presented at XVIII Annual meeting of Indian Association of Pathologists.
Emmons, C.W.; Binford, C.H.; & Utz, H.P., 1970, Medical Mycology, Lea & Febiger,
Philadelphia, Second Ed.
Grover, A.D, and Agarwal, K.C. 1961, Mycotic keratitis. Brit. J. Ophthal. 45:
Kulshrestha, O.P.; Bhargava, S. and Dube, M. K. 1973, Keratomycosis. A report of 23 cases. Ind. J. Ophthal. 21:
Laverde, S., Luz H. Moncuda, Augela, Restrepo & Vera, C.L. Mycotic Keratitis, 5 cases caused by unusual fungi. Sabourandia, 11:
Leber T. Keratomycosis aspergillina als ursache von Hypopy on keratitis. Arch. Opthal.
Naumann, G.; Green, W.R. and Zimmerman, L.E. Mycotic keratitis. 1967, Amer. J. Ophthal 64:
Nityanand, K.; Siva; Subramaniam, P. & Agillo, L. 1962, Mycotic keratitis caused by Curvularia Lunata. Case report Sabourandia, 2:
Polack, F.M.; Kaufman, H.E. and Newmark, E. 1971, Keratomycosis, Medical and Surgical Treatment, Arch. Ophthal. 85: 410.
Puttanna 1969, Primary Keretomycosis Experimental and clinical study. J. All Ind. Ophthal.
Soc. 17: 171.
Viers, E. R. and Davis, C.T. 1958 Fungus infection of the eye and Orbit. A.M.A. Arch, Ophthal. 59:
Zimmerman, E.L. 1962, Mycotic keratitis. Lab Investigations. 2:
[Figure - 1], [Figure - 2]
[Table - 1]
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