|Year : 1981 | Volume
| Issue : 4 | Page : 443-445
Keratomycosis in corneal sepsis
Department of Ophthalmology, Medical College, Patiala, India
S L Sharma
Department of Ophthalmology, Medical College, Patiala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma S L. Keratomycosis in corneal sepsis. Indian J Ophthalmol 1981;29:443-5
Increasing frequency of mycotic corneal ulcer is of considerable concern in present day ophthalmic practice. The remarkable increase in the incidence of fungal infection has been attributed to the increasingly widespread and indiscriminate use of corticosteroids and broad spectrum antibiotics. There have been many reports of high incidence from various parts of India.,,,6],,, We felt it necessary to ascertain the frequency and type of mycotic infection of the complicating corneal sepsis in our part of the country.
| Material and methods|| |
This study of keratomycosis in corneal sepsis was carried out on indoor patients of .Rajendra Hospital, Patiala. A total of one hundred cases of longstanding corneal ulcers were studied. A detailed history was taken which included history of injury, nature of injury, use of antibiotics and steroids in the eye and the occupation of the patient. Detailed examination of the corneal lesion was done including slit lamp examination, scraping from the margins and base of the ulcer were taken under local surface anaesthesia of 4% xylocaine. Attempt was made to take scraping from the deep tissue as far as possible. A portion of the scraping was put on 10% KOH solution and examined under the microscope. The rest was cultured on Sabouraud's medis supplemented with chloramphenicol (0.05 mg/ ml) and blood agar and MacConkey's media.
One tube of sabouraud's media was kept at room temperature and another was kept at 37° C for growth of candida. The tubes were regularly examined for any growth for 4 weeks.
| Observation|| |
100 cases of corneal ulcer were studied from August 1976 to April, 1977. Out of these 19 cases were proved to be complicated by mycotic infection.
I . Sex
Out of 100 cases of corneal ulcer, 43 were female and 57 were male. Out of 19 cases of mycotic infection 8 were female and 11 were male.[Table - 1]
Out of 100 cases of corneal ulcer, 12 were seen in the age group between 5-12 years while the rest were seen in adults mostly in the 4th and 6th decade. Out of 19 cases of mycotic ulcer almost all were found in adults.
Ten of the mycotic ulcer patients were farmers, two were shop-keepers, one a teacher and six housewives. Out of six housewives, five used to take active part in the field helping their menfolks. So we can say that actually fifteen of our cases were farmers.[Table - 2]
Incidence of mycotic corneal ulcers was highest in the months of February (3 cases), March (6 cases), September (5 cases) and October (5 cases).
5. Mode of Onset
Mode of onset of the mycotic ulcers, seven cases gave history of injury which was mostly some sort of vegetable matter. Five patients clinically started as dendritic corneal ulcer who came to us after 2 to 3 weeks of some sort of treatment. Seven cases were clinically of bacterial in origin.
6. Treatment taken
Most of the patients reported to us within one week to 3 weeks of start of disease. Most of them have been using broadspectrum antibiotics and four out of seven cases of injury were also using cortico-steroids.
7. Result of corneal ulcer scrapings
On wet film study of scraping in 10% KOH, only 12 cases were positive. Another seven cases negative on wet film study, but were strongly positive on culture on Sabouraud's media. In no case bacteria could be grown on blood agar and MacConkeys media. In nineteen out of 100 cases of corneal ulcer following types of fungi could be seen.
1. Aspergillus 10
2. Mucor 4
3. Rhizopus 1
4. Penicillium 3
5. Unidentified 1
Clinically most cases of mycotic corneal ulcer presented a similar appearance. The ulcers were central with a dry slough at the base. The ulcer was well circumscribed and margins were slightly raised. Many also showed a greyish white hypopyon.
| Discussion|| |
Role of prolonged use of antibiotics and corticosteroids has been greatly emphasized. Mitsu and Hanabusa found 67% incidence of fungus in conjunctival flora in patients treated with topical corticosteroids. Aggarwal and Khosla have reported 6% incidence of fungus in normal conjunctival flora and 20% in patients treated with 1 % hydrocortisone.
The incidence of fungus infection in our series of corneal ulcer is 19%. Out of these 4 cases (21 %) were using corticosteroids for sometime. All were also using broadspectrum antibiotics locally for a period of one to two weeks. Almost all the cases were found in adults between the age of 20-60 years and 79% cases occurred in those who were farmers by profession. All these observations support the view that the indiscriminate use of corticosteroids and antibiotics locally increases the incidence of fungus infection. That fungal ulcers commonly occur in elderly persons pursuing agriculture occupation and injury of the eye with some vegetable matter is an important predisposing factor (37%). Gugnaw et al in their study of mycotic keratitis in Africa found that most of patients were having injury by vegetable matter.
There is a great seasonal variation in the incidence of mycotic corneal ulcers. They are common only during the months of Sept., Oct, Feb. and March in this part of the country. Various factors like humidity, temperature and increased rush of work in the fields may account for this.
The most common type of fungus responsible in our series was Aspergillus 52.6%. The next less common were Mucor 21%, Penicillium 15.8%, Rhizopus 5.3% and un-identified one 5.3%. Aspergillus is reported to be quite common by other investigators also. Puttanna 47%, Siva Reddy 50% ; Kulshreshtha et a1 34.8% ; In our series the Mucor variety of fungus was more common than reported by other authors while the candida albicans was conspicuous by its absence though reported more frequently by others. The significance of this is difficult to say. It was not possible to differentiate the various types of fungi from the clinical picture as there were no differentiating clinical features.
| Summary|| |
Incidence and type of mycotic infection of the cornea has been studied in 100 cases of long standing corneal ulcers.
| References|| |
Aggarwal, L.P. Malik, S.R.K. Mohan, M. and Khosla, P.K., 1963, Brit. J. Ophthalmol 47: 109.1
Aggarwal, L.P. and Khosla, P.K., 1967, Ind. J. Ophthalmol J. of All India Ophth. Soc. 15:1.
Gugnaw, H.C. Talwar, R.S. Jokuobi A.N.U.N. Kodillyne, H.C., 1976, Brit. J. Ophthalmol 60; 607.
Kulshrestha, O.P. et. al., 1973, Ind. J. Ophthalmol 21: 51.
Malik, S.R.K. and Gurbax Singh, 1972, Paper read at All India Ophth. Soc. at Cuttack.
Mitsui and Hanabuse, 1955, Brit. J. Ophthalmol 39:244.
Puttana, S.T., 1967, Ind. J. Ophthalmol 15:11.
Puttana, S.T., 1969, Ind. J. Ophthalmol 17:171.
Reddy, P. Siva and Satyendra, O.M., 1972, Ind. J. Ophthalmol 20; 101.
Sood Ratana Raj Shenoy and Madhavan, 1968, Orient. Arch. Ophthalmol 6:93.
[Table - 1], [Table - 2]