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   Table of Contents      
ORIGINAL ARTICLE
Year : 1992  |  Volume : 40  |  Issue : 1  |  Page : 31-33

Mycotic keratitis : A study in coastal Karnataka


Department of Microbiology, Kasturba Medical College, Manipal, India

Correspondence Address:
Shivananda P G
Prof. & Head of the Dept. of Microbiology, Kasturba Medical College. Manipal
India
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Source of Support: None, Conflict of Interest: None


PMID: 1464454

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  Abstract 

Fungi were isolated from 67 cases out of the 295 cases of corneal ulcers investigated. Aspergillus species and species of Candida were the major fungal members isolated. Allescheria boydii was isolated from 3 cases, having no previous history of injury to the eye or infection with bacterial or viral agents. A boydii corneal infection is a rare occurrence. Higher incidence of mystic keratitis was seen among females than males. No relationship to seasonal changes could be established. Bacterial infection was associated in 46. 27% of the cases of mycotic keratitis and Staphylococcus was the predominant bacterial pathogen observed.


How to cite this article:
Kotigadde S, Ballal M, Jyothirlatha, Kumar A, Srinivasa RaoP, ShivanandaP. Mycotic keratitis : A study in coastal Karnataka. Indian J Ophthalmol 1992;40:31-3

How to cite this URL:
Kotigadde S, Ballal M, Jyothirlatha, Kumar A, Srinivasa RaoP, ShivanandaP. Mycotic keratitis : A study in coastal Karnataka. Indian J Ophthalmol [serial online] 1992 [cited 2019 Oct 17];40:31-3. Available from: http://www.ijo.in/text.asp?1992/40/1/31/24413



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  Introduction Top


Eye is one of the important organs of sensory perception. Normally it is kept free from microbial infections by the cleansing effect of lacrimal secre­tions. However, certain conditions like trauma to the eye ball and therapy with antibiotics and cor­ticosteroids, render the eye susceptible to infection with various fungal members with or without bacterial associates [1],[2]. Mycotic keratitis since its recognition in 1879 [1] has emerged oat to be a major Ophthalmic problem. Early diagnosis of mycotic keratitis and treatment of the eye are important in preventing further complications like hypopyon formation and endophthalmitis or less of vision. A large number of fungi have been incriminated to be the cause of mycotic keratitis. However, the frequency and spectrum of fungal members involved differs from place to place largely based on climatic, geographical and socio-economic conditions.

The present study was undertaken to study the fungal aetiology of corneal ulcers under the influence of socio-demographic and predisposing factors in a rural, coastal environment of western part of South India.


  Material and methods Top


Between October, 1985 and September, 1988, 295 cases of corneal ulcers attending the Ophthalmology department of Kasturba Medical College Hospital, Manipal were investigated. Corneal scrapings were collected from the edge of the base of the ulcers using fresh sterile Baird-Parker blades after anaes­thetising the eye with 2-3 drops of sterile local anaesthetic solution. A direct smear prepared from a portion of the scrapings was stained by Gram's method and examined microscopically both for fungal elements and bacteria. Scrapings were also examined in 10% KOH wet preparations for fungal elements. The other portions of corneal scrapings were cultured both for fungi and bacteria. Duplicate Sabouraud's dextrose agar slants were inoculated with corneal scrapings to isolate fungi. One of the tubes was incubated at room temperature and the other at 37° C. Both the tubes were examined daily for fungal growth. Positive cultures were identified by colonial morphology like texture, colour and by microscopic morphology in slide cultures. Fungal aetiology of corneal ulcers was considered based on either positively both in smear and culture or repeated appearance in smear or culture or in both. Routine cultures for bacteria too was done: positive cultures identified and their antibiotic sensitivity pattern deter­mined. Social demographic details and a brief clinical history regarding use of antibiotics/corticosteroids, duration of. ailment, history of trauma to the eye, mode of injury, use of herbal medicine and occupation were recorded at the time of taking corneal scrapings.


  Results Top


Sixty seven out of 295 cases of corneal ulcers were positive for fungi. Species of Asperigillus in general and A.fumigatus in particular was the most commonly isolated fungal members. Second highest incriminant was candida species in that order. Various other fungal members were isolated in lesser frequencies [Table - 1].

Age and sex-wise analysis [Table - 2] of the cases of mycotic keratitis showed that females of age groups between 10 to 39 years and above 60 years showed higher incidences than the male population of similar age groups. Contradictory to this males of 0 to 9 years and 40 to 50 years showed higher incidence of fungal eye infection than the peer group females. However in general the fungal isolation from corneal ulcers was higher among females (26.87%) than males (19.25%) which is statistically as follows:

When females above 40 and below 40 were analysed statistically X2 = 7.74 (P .01) which is not significant value. When males and females belonging to the age group of less than or equal to 40 years was analysed statistically X2 = 5.83 (P .02) which is found to be a statistically significant value.

[Table - 3] depicts seasonal incidence of mycotic keratitis. Higher number of positive cases were recorded during October (35.71%) June (29.62%) and January (28.13%) months than the other months of the year. A low rate mycotic infections were recorded during April (16%) August (14.29%), November (16%) and December (11.9%). Attendance of corneal ulcer cases was highest in December (42 cases).

Occupationally, 31 out of 67 cases of mycotic keratitis were house wives, 10 agriculturists, 5 agricultural labourers, 5 students, 5 children, 7 unknown. The remainders were from various walks of life like driver, merchant, factory worker and a fisherman.

While 85 (28.8%) out of 295 cases of corneal ulcers examined were bacteriologically positive, only 31 (46.27%) of the 67 cases of mycotic keratitis revealed bacterial infections too. Staphylococcus aureus was the predominant bacterial isolate (87.1%). This was followed by Pseudomonas aeruginosa (19.35%), Coagulase negative staphylococci (9.68%), Diphtheroids (6.45°0) and various other bacteria [Table - 4].


  Discussion Top


The present study showed fungal involvement of 22.71% of corneal ulcers. Aspergillus was the predominant fungus followed by species of candida. These findings corroborate earlier reports [3].[4]. The frequency of Rhizopus and Allescheria boydii were third on that order. A. Boydii keratitis is a rare occurrence. It is interesting to not that the 3 cases who suffered from A. boydii keratitis had no previous experience of having had injury to the eye or infection with bacterial or viral microbes. The present study also showed a wider spectrum of fungal aetiology of corneal ulcers than the earlier studies [3],[4],[5]. Finding of larger number of mycotic keratitis among females (26.87%) than males (19.25%) is in agreement with the findings of Dutta et al [8]. However Kumar et al [3] reported a higher incidence among male than female population. Our study also showed that females who showed higher incidence of mycotic keratitis were particularly belonging to age groups 10-39 years. During harvesting season it is a common practice that both male and female population in rural areas engage in'the harvesting of crops. This involves the work from cutting crops. through threshing to separate seeds to de husk paddy grains. Hence the house wife has a double role to play with viz to do the agricultural work in addition to household chores. The female folks who extend a helping hand in agricultural work are those who belong to the above age groups . This also explains the high incidence of mycotic keratitis among house wives (33) cases) in this study.

But for a few, all positive cases had a history of injury with paddy grain or husk, hay stick, finger nail, pencil tip, lash with the tail of cow or dust, cement or sand falling into the eye. The commonest mode of injury, specially with houses wives was due to paddy grain or husk or hay.

This study showed that in general hospital attendance for treatment of corneal ulcers was higher from October to April. Though slightly higher incidence of fungal keratitis were observed in the months of October (35.71%), June (29.62%) and January (20.13%) apparently there was no season wise (winter, summer and rainy season), difference it incidence of positive cases. The findings of this study imply that mycotic keratitis has greater causal relationship to occupational than seasonal changes Also as opined by Rao and Ramakrishnan [9] it appears injury with vegetable matter such as hay, paddy grain or husk or stick has a major role to play in fungal infection of the eye than use o corticosteroids, or antibiotics. Only a few of the present study group had a history of prolonged USE of these therapeutic agents.

Although there are reports [3].[8].[10] on the possible causal relationship to mycotic keratitis and herbal medicine use, except for a solitary case, there was no history of use of herbal medicine among cases of mycotic keratitis of the present study group. This single case was a child aged 4 months and had e perforating injury of the eye. Though smears showed fungal hyphae efforts to grow fungus in culture failed

Out of 67 cases of mycotic keratitis, only from 31 (46.27%) cases bacteria were isolated. Staphylococ­cus aureus was the predominant bacterial pathogen followed by Pseudomonas aeruginosa. Similar finding were reported by Mahajan [11],[12]

 
  References Top

1.
Norman. FC., David. T.S. et al. Manual of clinical mycology W.B.Saunders company. Philadelphia. 3rd edition. 1971.  Back to cited text no. 1
    
2.
Kalavathy. M., Thomas. PA. el al. Spectrum of microbial keratitis it Southern India. Jour. MSOA. 1985. 22. 37-48.  Back to cited text no. 2
    
3.
Kumar. PR . Indu. P et al. Proceedings of 3rd All India Congress of Medical Microbiologists T.N. Medical College. Bombay. p 110-112 1979.  Back to cited text no. 3
    
4.
Mohanty. PK.. Ambekar. VA et al. Prevalence of mycotic infections of external eye. Ind. J. Ophthal. 1984. 153-155.  Back to cited text no. 4
    
5.
Gordon, M.A.. Valleton. W.W et al, corneal Allescheriasis. A case of keratomycosis treated successfully with Nyslatin and Amphotericin B. Arch Ophthal. 1959. 62. 758-763  Back to cited text no. 5
    
6.
Ernest. T. Ribbon. J.W et al, Corneal ulcer, due to Alleschena boydii. American J Ophthal 1966, 62. 1202-1204.  Back to cited text no. 6
    
7.
Levitt. JM.. Goldsmith. J et al, keratomycosis due to Allescheria boydii, American J Ophthal 1971. 71. 1190-1191.  Back to cited text no. 7
    
8.
Dutta, L. C.. Dulal. D. et at. Study of fungus keratitis, Indian J Ophthal. 1981. 29. 407-409  Back to cited text no. 8
    
9.
Srinivasa Ran. PN . Ramakrishnan. TS et al, Studies on the fungus diseases affecting man in and around Manipal. III Fungi and diseases of eye. Indian J Pathol and Bacteriol. 1968. 11, 53-60.  Back to cited text no. 9
    
10.
Puttanna, S. J. Primary Keratomycosis. J All India Ophthal Soc. 1969. 171-200,  Back to cited text no. 10
    
11.
Sharma, S I.. Keratomycosis in corneal sepsis, Indian J Ophthal. 1981, 29. 443-445.  Back to cited text no. 11
    
12.
Sood, N.N.. Ratnaraj. A. et al Hypo pyon ulcers. Indian Oriental Arch Ophthal, 1969 , 6, 93-99.  Back to cited text no. 12
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]


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