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ARTICLES
Year : 1981  |  Volume : 29  |  Issue : 4  |  Page : 407-409

Study of fungus keratitis


Department of Ophthalmology and Microbiology, Medical College, Gauhati, India

Correspondence Address:
L C Dutta
Department of Ophthalmology and Microbiology, Medical College, Gauhati
India
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Source of Support: None, Conflict of Interest: None


PMID: 7346468

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How to cite this article:
Dutta L C, Dulal D, Mahanty P, Sarma J. Study of fungus keratitis. Indian J Ophthalmol 1981;29:407-9

How to cite this URL:
Dutta L C, Dulal D, Mahanty P, Sarma J. Study of fungus keratitis. Indian J Ophthalmol [serial online] 1981 [cited 2019 Dec 14];29:407-9. Available from: http://www.ijo.in/text.asp?1981/29/4/407/30941

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Table 1

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100 cases of corneal ulcer were studied to find out the fungal aetiology and the result of the study are presented in this paper.


  Materials and methods Top


100 cases of corneal ulcer admitted in the Eye ward of Gauhati Medical College Hospital during the period from August 1976 to Octo­ber, 1977. Even slides in recording the cases special attention were given to the following points

  1. History of trauma and its mode of infliction.
  2. Local use of steriod and antibiotic preparation.
  3. Use of herbal medicine in the eye prior to coming to the hospital.


After detail clinical examination of the eye, scraping from the floor of the ulcer was treated with KOH and examined under microscope for fungus elements. Some portion of the scraped material was inoculated in Sabouraud's glucose agar media in tube slants and incubated at 37°sub C for 3-4 weeks for growth of fungus. Identification of fungus species was done by studying the colony char­acter and the morphology of the fungus under microscopic examination of KOH preparation and stained slides with Grams stain and Lacto­phenol Blue. Biochemical reaction was not studied for identification of fungus species. Conjunctival swab culture for fungus from 10 clinically normal cases was done to see the fungal flora of healthy conjunctival sac.


  Observations Top


In the 10 clinically normal conjunctival sac swab culture no growth of fungus was seen. Out of the 100 cases of corneal ulcer fungal growth was seen in 32 eyes (all the cases had corneal ulcer in one eye only). Identification of various species of the fungus were done by studying the character of the colonies and by microscopical examination of the stained slide of the positive tube slants. Five species of fungus were identified Aspergillus Fumigatus -11 eyes, Aspergillus Niger-eyes, Penicillium -6 eyes, Fusarium-3 eyes, Lasio-diplodia - 1 eye.

The 32 fungus positive cases were analysed to find out the various aetiological factors of keratomycosis and the clinico-pathological appearance of the ulcers. The following points are of interest.

1. Age incidence : Table f shows the age incidence of these 32 cases. Youngest was 5 years of age and the oldest 70 years. Elderly patients are found to be more affected. Highest incidence is in the age group of 40-60 years.

2. Sex :- Males are more affected than females in the ratio of about 3:2.

3. Occupation : [Table - 2] shows the incid­ence of mycotic keratitis in persons of various occupations. Cultivators and house-wives are found to be affected more.

4. Seasonal variation : It is more common during the harvesting season. There were 8 cases in the month of December.

5. History of injury : almost all the cases (in 28 out of 32 cases) there was a history of injury in the eye. Most commonly the injury was inflicted by various materials at work. Straw, paddy leaf and decaying vegetable matter were the common types of agents caus­ing the injury.

6. Steroid-antibiotic and Herbal medica­tion : Out of 100 cases, 16 patients gave the history of having treatment with steroid anti­biotic ointment and 10 of these 16 cases had positive fungus culture. 5 patients gave the history of treating the ulcer by some indigenous methods like herbal juice and 4 of these 5 cases showed positive fungus culture.

Discussion : About 20-25% of normal con­junctival sac harbours non-pathogenic fungus saprophytes, the incidence is claimed by some authors to be more in rural than urban popula­tion. (Nema et al, 1966) Findings of some authors are just the opposite[1]. However our 10 normal conjunctival swab ulcer were found to be sterile. [Table - 3] shows the incidence of fungus aetiology of kerato-mycosis reported by various authors from different countries. Few authors in India(16),(15),(13),(8) could isolate fungus from corneal ulcer in about 7 to 44% cases. In our series the incidence is found to be 32%.

The typical dry looking, greyish-white ulcer with elevated rolled out margin is sugges­tive of keratomycosis. Antibiotic drugs do not have any effect on these types of coneal ulcers. On the other hand the ulcer progresses down hill with formation of extensive hypopyon. Topical application of steroid­antibiotic preparation in the eye changes the normal homeostatic machanism of fungus bacteria relation of the conjunctival sac. This may be a cause of high incidence of positive fungus culture in urban population[1] who frequ­ently use this type of medicine. Use of herbal medicine in ocular diseases is very common practice in rural areas. In our series 4 gave the history of use of herbal medicine prior to attending the hospital. Fungus is present in almost all types of the decaying vegetable or organic matters. When people working in the paddy field or in the forest gets even a trivival injury in the eye with these types of materials the fungus makes entry into the conjunctival sac and produce keratomycosis. During the harvesting season (November to January) along with the ripening of the paddy plants and seeds, the conidia of the fungus are relea­sed and they are in a highly infective stage. Any injury of the cornea with a dry paddy leaf or straw or hay may produce keratomycosis. In the present series out of 32 cases, 28 gave the history of injury with these types of sub­stances.

Aspergillus is the commonest mycotic orga­nism which can invade the cornea, tear-duct and orbit[2]. Aspergillus Fumigatus and Asper­gillus Niger together constitute 68.7% of the fungus flora of these 32 cases of keratomycosis of the present study. Penicillium could be isolated in 6 cases. This organism predomi­nates in temparate climate. Fusarium is a soil seprophyte and when soil particle enters into the eye, the organism may invade the cornea. In the present series out of 3 cases of Fusarium keratitis, the history of entry of soil particle into the eye was available in 2 cases. Lasio­diplodia was isolated from one case. This patient gave the history, of injury to the eye with dry paddy leaf and the use herbal juice as a form of native treatment before coming to the hospital. Puttanna[2] reported 2 cases of Lasio-diplodia keratitis after instillation of herbal juice.


  Summary Top


Out of 100 cases of corneal ulcer fungus could be cultured in 32 cases. Aspergillus was the commonest type of fungus seen in these cases. History of injury with vegetable organic matter, paddy leaves etc. are the com­monest causes of keratomycosis in this area.

 
  References Top

1.
Agarwal, L.P. and Khosla, P.K., 1967, Ind. J. Ophthalmol 17:172.  Back to cited text no. 1
    
2.
Puttanna, S., 1969, Ind. J. Ophthalmol 17:171  Back to cited text no. 2
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]


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