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   Table of Contents      
ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 3  |  Page : 29-32

Bacterial and mycotic kerato-conjunctivitis


1 Department of Pathology, B.J. Medical College, Ahmedabad, India
2 M. and J. Ophthalmic Institute Civil Hospital, Ahmedabad, India

Correspondence Address:
R Panjarathinam
Department of Pathology, B.J. Medical College, Ahmedabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 511287

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How to cite this article:
Panjarathinam R, Kollali V V, Dixit C V, Mathur R N. Bacterial and mycotic kerato-conjunctivitis. Indian J Ophthalmol 1979;27:29-32

How to cite this URL:
Panjarathinam R, Kollali V V, Dixit C V, Mathur R N. Bacterial and mycotic kerato-conjunctivitis. Indian J Ophthalmol [serial online] 1979 [cited 2020 Oct 29];27:29-32. Available from: https://www.ijo.in/text.asp?1979/27/3/29/31221

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From the time, it is well documented that the cortisone and antibiotic therapy had increased the incidence of infections, bacterial and mycotic kerato-conjunctivitis had been studied in different parts of our country with more emphasis on mycotic keratitis[12],[1],[8],[10],[3],[13].

But, the perusal of Indian literature indicated that there are no such findings available in this part; therefore, the present study was undertaken.


  Materials and methods Top


Seventy five ocular swabs were aseptically collected almost throughout the year (April 1978 to January 1979) from M. and J. Ophthalmic Institute, Civil Hospital, Ahmedabad, and processed immediately in the labora­tory; if delay be expected, they are kept in the refrigerator and streaked on the following media:

(a) Nutrient agar, (b) Mac Conkey agar, (c) Blood agar, (d) Potassium tellurite agar and (e) Sabouraud's glucose agar. All inoculated media were incubated at 37°C for 24 hours, except Sabouraud's agar which was incubated at room temperature for more than 14 days. The same swabs were used for the direct smear for Gram's staining, and also for lactophenol cotton blue stain for fungus­.

Bacteria] isolates were identified on the basis of morphology, cultural and biochemical characteristics, and subjected to the antibiotic sensitivity test.

Fungi were identified by studying the colony characteristics and the morphology in preparation stained by lactophenol blue[6],[2],[9],[4].

Results

Examination of the ocular swabs from 75 cases, with a clinical diagnosis of conjunctivitis (24), corneal ulcer (35) and miscellaneous infections (16), showed that 54 (72%) were culturally positive for both bacteria and fungi.

Out of 54 swabs, which were positive for both bacteria and fungi, 39 (52%) showed the agents responsi­ble only for the bacterial infection; 4 (5.3%) only for fungal infection and 15 (20%) for mixed infection.

It is evident from [Table - 1] that out of 58 bacterial isolates, 27 (46.5%) were Staphylococcus aureus most frequently isolated and followed by Pseudomonas aeruginosa (12), Bacillus subtilis (7), Coryne bacterium diphtheriae (2).

Out of 27 Staph. aureus, 18 and 23 were positive for coagulase and mannitol fermentation tests respectively; Staph. albus (4) were negative for both tests. On the basis of its inability to ferment sucrose and colony characteristics, corynebacterium was identified as C. diphtheriae. No toxigenicity test was performed.

Almost all types of bacteria (30) were isolated from corneal ulcer, whereas in case of conjunctivitis 20 were recovered. The incidence of Staph. aureus was highest in case of corneal ulcer (13) and conjunctivitis (9) and was followed by Ps. aeruginosa [Table - 2].

The antibiotic sensitivity test of bacteria to various antibiotics was conducted. It was found that all isolates (Staph. aureus, Ps. aeruginosa, B. subtilis, C. diphthe­riae) were most sensitive to gentamycin and resistant to penicillin. Staph. aureus was most resistant to strepto­mycin, tetracycline; whereas Ps. aeruginosa to ampicil­lin and tetracycline. B. subtilis was sensitive to erythro­mycin and gentamycin, whereas C. diphtheriae to erythromycin, gentamycin and kanamycin.

Out of 75 swabs, 19 (25.3%) were culturally positive for fungi; however, 5 out of 19 lactophenol preparation from eye showed no hyphae under direct microscope.

The species isolated were Aspergillus niger, 6 [Figure - 1]; Trichophyton mentagrophytes 5, [Figure - 2]; T. ton­surans, 3; T. rubrum, 3 [Figure - 3]; Helminthosporium sp. [Figure - 4] and unidentified, 2. Almost all species of fungi were isolated from corneal ulcer and their frequency was highest to that bacteria, [Table - 3]. Trichophyton sp. was less frequent in conjunctivitis. However, in four corneal ulcer cases only fungi (Asp. niger 1, T. rubrum 1 and unidentified 2) were isolated. In 15 mixed infec­tions, fungi occured in association with Staph. aureus or C. dipbtheriae.


  Discussion Top


In the present study, 72% of specimens were culturally positive for bacteria and fungi. The age of patients ranged from 6 months to 75 years, the majority being adults or elderly persons, and the males were more than females. Bacterial cultures were obtained in 52% of the cases, whereas Prabhakar et al[7] and Dasgupta et a1[3] reported 33.3% and 25% respectively in diseased cases.

Although, Dasgupta et a1[3] isolated 4 bacterial species: saprophytic staph., two Staph. pyogenes and Ps. aeruginosa; and Prabhakar et a1[7] recovered Escherichia coli, Diplococcus pneu­moniae, Ps. aeruginosa, Staph. aureus from diseased eyes, Staph. albus was most frequent; in our present series, Staph. aureus was high in corneal ulcer which was followed by Ps. aeruginosa, B. subtilis and C. diphtheriae.

All the isolates were subjected to the antibiotic sensitivity test; the concentrations of antibiotics in discs were suitable only for paren­teral use; and almost all of them were sensitive to gentamycin and resistant to penicillin.

Out of 75 swabs, 25.3% were culturally positive for fungi with much agreement to 23.2%,[10] 23.3%,[7] 28.6%[3] and 33%[13] A. niger was most frequent in the present study, although Aspergillus sp. is the commonest fungus in India[12],[1],[8],[10],[3],[11] Four fungi were isolated from corneal ulcer (A. niger, T. rubrum, and two unidentified fungi) as shown by Srinivasa Rao et al[11].

In 15 mixed infections, fungi occurred in association with Staph. aureus, whereas Das Gupta et all reported Staph. pyogenes from two fungal positive cases only. Helminthosporium sp. was less common fungus from keratitisa[3],[13].

In this part of our country, Trichophyton sp. was isolated from the corneal ulcer or con­junctivitis; however, Mankodi and Kanvinde[5] reported Trichophyton sp. as most frequent in Ahmedabad from Tinea corporis patients.


  Summary Top


Examination of ocular swabs from 75 cases with a clinical diagnosis of conjunctivitis, corneal ulcer and miscellaneous infections, showed that 54 (72%) were culturally positive for bacteria and fungi. Out of 54 swabs, 39 (52%) showed agents responsible for bacterial infections, (5.3%) only for fungal infection and 15 (20%) for mixed infection.

Of 58 bacterial isolates, 27 (46.5%) were Staph. aureus and followed by Ps. aeruginosa (12), B. subtilis (7), C. diphtheriae (2). All types of bacteria were isolated from corneal ulcer with a highest incidence of Staph. aureus, and were less in conjunctivitis. Almost all isolates were sensitive to gentamycin and resistant to penicillin.

Of 75 swabs, 19 (25.3%) were culturally positive for fungi. A. niger, T. mentagrophytes, T. tonsurans and Helminthosporium sp. and two unidentified fungi were isolated from corneal ulcer.


  Acknowledgement Top


Thanks are due to Dr. C.I. Jhala, Dean, B.J. Medical College, Ahmedabad, for his kind encouragement and to Sri Satish R. Doctor, B.Sc., Senior Technician for his technical assistance.

 
  References Top

1.
Balakrishna, E., 1962, XIX concilium Ophthal­-mologicum II, 1242 (cited by Dasgupta et al).  Back to cited text no. 1
    
2.
Conant, N.F., Smith, D.T., Baker, R.D. and Calloway, J.L., 1971, Manual of clinical mycology. 3rd Ed. W.B. Saunders Co., Philadelphia, London, Toranto.  Back to cited text no. 2
    
3.
Dasgupta, L.R., Gupta, A.K., Ghosh Ray, B., Sunderaraj, T., Ramamurthy, S. and Lamba, P.A., 1973, Ind. Jour. Med. Res., 61, 165.  Back to cited text no. 3
    
4.
Emmons, C.W., Binford, C.H., Utz, J.P. and Kwon-chung, K.J., 1977, Medical mycology. 3rd, Ed. Lea and Febiger, Philadelphia.  Back to cited text no. 4
    
5.
Mankodi, R.C. and Kanvinde, M.S., 1969, Ind. Jour. Path. and Bact., 1, 114.  Back to cited text no. 5
    
6.
Moss, E.S. and McQuown, A.L., 1969, Atlas of Medical mycology. 3rd. Ed. The Williams and Wilkins co. Baltimore.  Back to cited text no. 6
    
7.
Prabhakar, H., Chitkara, N.L. and Prabhakar, B.R , 1969, Ind Jour. Path. and Bact., 12, 158.  Back to cited text no. 7
    
8.
Puttana, S.T., 1967, Jour. of All India Ophthal­mol. Soc., 15, 11.  Back to cited text no. 8
    
9.
Rippon, J.W., 1974, Medical mycology, The pathogenic fungi and pathogenic actinomycetales. W.B. Saunders co. Philadelphia, London.  Back to cited text no. 9
    
10.
Sood, N.N., Ratnaraj, A, Balaraman, G. and Madhavan, H.N., 1968, Hypopyon ulcers-I. Orient Arch. Ophihal., 6, 93 (cited by Dasgupta et al).  Back to cited text no. 10
    
11.
Srinivasa Rao, P.N. and Ramakrishnan, T.S., 1968, bid. Jour. Path. and Bact. 11, 53.  Back to cited text no. 11
    
12.
Srivastava, O.P., Koul, R.L. and Gupta, S.P., 1961, Ind. Jour. of Ophthal., 24, 19.  Back to cited text no. 12
    
13.
Talwar, P. and Sehgal, S.C., 1978, Ind. Jour. Med. Res., 67, 929.  Back to cited text no. 13
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
 
 
    Tables

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



 

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