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   Table of Contents      
ARTICLES
Year : 1975  |  Volume : 23  |  Issue : 2  |  Page : 7-10

Mycotic keratitis


1 Medical College, Nagpur, India
2 Reader in Deptt. Path. & Bact. Govt. Ayurvedic College, Nagpur, India
3 Professor of Pathology, Medical College, Nagpur, India

Correspondence Address:
Shobha Grover
Deptt. Path. & Bact. Medical College, Nagpur
India
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Source of Support: None, Conflict of Interest: None


PMID: 1236454

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How to cite this article:
Grover S, Jagtap P, Sharma K D. Mycotic keratitis. Indian J Ophthalmol 1975;23:7-10

How to cite this URL:
Grover S, Jagtap P, Sharma K D. Mycotic keratitis. Indian J Ophthalmol [serial online] 1975 [cited 2019 Oct 16];23:7-10. Available from: http://www.ijo.in/text.asp?1975/23/2/7/31318

Table 1

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Table 1

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Laber [7] 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 [3] . In the last few years fungal infections of cornea have been frequently reported [1],[5] .

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 Top


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 Top


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 Top


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 [3] .

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 [9],[10] .

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 [10] 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 Top


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.[13]


  Acknowledgement Top


The authors are thankful to Dr. Ishwarchandra, Prof of Ophthalmology, Medical college, Nagpur and Dr. Sudha Sutaria for referring the cases.

 
  References Top

1.
Bakerspigel A., Fungi isolated from keratomy­cosis in Ontario Canada, Monosporium apiospe­rumum. 9: 107: (1971) Sahouraudia.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Emmons, C.W.; Binford, C.H.; & Utz, H.P., 1970, Medical Mycology, Lea & Febiger, Phila­delphia, Second Ed.  Back to cited text no. 3
    
4.
Grover, A.D, and Agarwal, K.C. 1961, Mycotic keratitis. Brit. J. Ophthal. 45: 824:  Back to cited text no. 4
    
5.
Kulshrestha, O.P.; Bhargava, S. and Dube, M. K. 1973, Keratomycosis. A report of 23 cases. Ind. J. Ophthal. 21: 51:  Back to cited text no. 5
    
6.
Laverde, S., Luz H. Moncuda, Augela, Restrepo & Vera, C.L. Mycotic Keratitis, 5 cases caused by unusual fungi. Sabourandia, 11: 119: 1973  Back to cited text no. 6
    
7.
Leber T. Keratomycosis aspergillina als ursa­che von Hypopy on keratitis. Arch. Opthal. Berlin 25: 285: (1879)  Back to cited text no. 7
    
8.
Naumann, G.; Green, W.R. and Zimmerman, L.E. Mycotic keratitis. 1967, Amer. J. Ophthal 64: 668.  Back to cited text no. 8
    
9.
Nityanand, K.; Siva; Subramaniam, P. & Agillo, L. 1962, Mycotic keratitis caused by Curvularia Lunata. Case report Sabourandia, 2: 35.  Back to cited text no. 9
    
10.
Polack, F.M.; Kaufman, H.E. and Newmark, E. 1971, Keratomycosis, Medical and Surgical Treatment, Arch. Ophthal. 85: 410.  Back to cited text no. 10
    
11.
Puttanna 1969, Primary Keretomycosis Experi­mental and clinical study. J. All Ind. Ophthal. Soc. 17: 171.  Back to cited text no. 11
    
12.
Viers, E. R. and Davis, C.T. 1958 Fungus infection of the eye and Orbit. A.M.A. Arch, Ophthal. 59: 171.  Back to cited text no. 12
    
13.
Zimmerman, E.L. 1962, Mycotic keratitis. Lab Investigations. 2: 1151  Back to cited text no. 13
    


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

  [Table - 1]


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