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   Table of Contents      
Year : 1981  |  Volume : 29  |  Issue : 4  |  Page : 443-445

Keratomycosis in corneal sepsis

Department of Ophthalmology, Medical College, Patiala, India

Correspondence Address:
S L Sharma
Department of Ophthalmology, Medical College, Patiala
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Source of Support: None, Conflict of Interest: None

PMID: 7346474

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How to cite this article:
Sharma S L. Keratomycosis in corneal sepsis. Indian J Ophthalmol 1981;29:443-5

How to cite this URL:
Sharma S L. Keratomycosis in corneal sepsis. Indian J Ophthalmol [serial online] 1981 [cited 2020 Dec 4];29:443-5. Available from: https://www.ijo.in/text.asp?1981/29/4/443/30950

Table 2

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Table 2

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Table 1

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Table 1

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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.[1],[3],[4],6],[8],[9],[10] 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 Top

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 Top

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]

2. Age

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.

3. Occupation

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]

4. Climate

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 Top

Role of prolonged use of antibiotics and corticosteroids has been greatly emphasized. Mitsu and Hanabusa[5] 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[10] 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[6] 47%, Siva Reddy[3] 50% ; Kulshreshtha et a1[3] 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 Top

Incidence and type of mycotic infection of the cornea has been studied in 100 cases of long standing corneal ulcers.

  References Top

Aggarwal, L.P. Malik, S.R.K. Mohan, M. and Khosla, P.K., 1963, Brit. J. Ophthalmol 47: 109.1   Back to cited text no. 1
Aggarwal, L.P. and Khosla, P.K., 1967, Ind. J. Ophthalmol J. of All India Ophth. Soc. 15:1.  Back to cited text no. 2
Gugnaw, H.C. Talwar, R.S. Jokuobi A.N.U.N. Kodillyne, H.C., 1976, Brit. J. Ophthalmol 60; 607.  Back to cited text no. 3
Kulshrestha, O.P. et. al., 1973, Ind. J. Ophthal­mol 21: 51.  Back to cited text no. 4
Malik, S.R.K. and Gurbax Singh, 1972, Paper read at All India Ophth. Soc. at Cuttack.   Back to cited text no. 5
Mitsui and Hanabuse, 1955, Brit. J. Ophthalmol 39:244.  Back to cited text no. 6
Puttana, S.T., 1967, Ind. J. Ophthalmol 15:11.   Back to cited text no. 7
Puttana, S.T., 1969, Ind. J. Ophthalmol 17:171.   Back to cited text no. 8
Reddy, P. Siva and Satyendra, O.M., 1972, Ind. J. Ophthalmol 20; 101.  Back to cited text no. 9
Sood Ratana Raj Shenoy and Madhavan, 1968, Orient. Arch. Ophthalmol 6:93.  Back to cited text no. 10


  [Table - 1], [Table - 2]


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