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| ORIGINAL ARTICLE |
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| Year : 1982 | Volume
: 30
| Issue : 2 | Page : 81-85 |
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Mycotic infections of cornea
Suresh Prasad, HV Nema
Department of Ophthalmology Institute of Medical Sciences, B.H. U. Varanasi, India
Correspondence Address:
H V Nema
3 Medical Enclave Banaras Hindu University Varanasi-221 005
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 7141598 
How to cite this article:
Prasad S, Nema H V. Mycotic infections of cornea. Indian J Ophthalmol 1982;30:81-5 |
Corneal ulcer is one of the major causes of blindness in our country. From the dawn of the present century, it was realized that a significant percentage of suppurative keratitis is caused by fungi. Recently, a number of reports[1],[2],[3],[4] appeared on the mycotic corneal ulcer from various parts of India. However, our knowledge regarding the epidemiological aspect of keratomycosis is still incomplete. At present we have a few antifungal drugs at our disposal and most of them are very toxic. It was, therefore, thought worth-while to take up a study of mycotic corneal ulcer with a view to know its causative agents and to investigate the drug sensitivity of the isolated fungi.
| Materials and methods | |  |
Sixty controlled cases of corneal ulcer were selected for the study. A complete history of each case, with particular reference to nature of the trauma, and use of local drug was recorded. A thorough clinical examination was carried out. A gentle scraping was taken from the floor of the corneal ulcer using a sterilised platinum wire loop and directly inoculated on Sabouraud's medium slants in tubes. Additional 60 normal subjects were selected, scrapings were taken from their lower fornices and seeded on Sabouraud's medium. Inoculated tubes were kept at room temperature and observed daily for fungal growth. If there was no growth at the end of tenth day, culture was regarded as negative. positive cultures, organisms were identified on their cultural and morphological characteristics.
Sensitivity test of isolated fungi was carried out by spore germination inhibition technique. Sodium sulphacetamide, alum, trifala, nystatin, Garamycin and doxycycline were used in different concentrations and inhibition of spore germination was graded as poor (+), mild (++), moderate (+++) and marked (++++).
| Observations | | |
Out of 60 corneal ulcer cases, 12 were found to b: fungus positive, giving a prevalence rate of 20% whereas in control group only 4 (6.7%) were fungus positive.
A large number (92%) of our cases had a history of trauma. 33% of ulcer cases sustained injury by organic matter. Amongst these, 9 (45%) yielded fungus on culture. The mycotic infection was found to be significantly higher in persons sustaining injury by materials of organic origin than that of metallic origin.
Altogether 4 different genera namely Aspergillus, Penicillium, Curvularia and Candida were isolated from corneal ulcer cases. Aspergillus was the commonest mould; five different species of the Aspergillus viz. A. flavus [Figure - 1], A fumigatus [Figure - 2], A. Sydouri and A. terreus were isolated. Penicillium chrysogenum. Curvalaria lunata [Figure - 3] and Candida albicans were other isolated moulds. In the control group, Aspergillus was isolated from two cases (A. terreus and A. fumigatus) while one case each was positive for Phoma hibernica [Figure - 4] and Papullospora.
| Sensitivity test | | |
Sensitivity test of isolated fungi towards various chemotherapeutic agents and antibiotics was conducted by inhibition of spore germination technique. It was found that the sporulation of A. fumigatus was inhibited maximally by sodium sulphacetamide (90%) followed by alum (77%) trifala (64%) and nystatin (61%) whereas garamycin (28%) and doxycycline (23%) were not much effective [Figure - 5][Figure - 6][Figure - 7][Figure - 8]. A. flavus was more sensitive to sulphacetamide, alum and nystatin than A. fumigatus. Marked inhibition (75-100%) of sporulation of Penicillium chrysogenum, Curvalaria lunata and Candida albicans was observed by sodium sulphacetamide, trifala and alum [Table - 1].
| Discussion | | |
The aim of this work was to identify the types of fungi responsible for corneal ulcer and to ascertain their sensitivity against antibiotics, chemotherapeutic agents and two ancient Indian drugs-alum and trifala.
The overall prevalence in this hospital based study of fungal corneal ulcer was found to be 20%. The fungus positivity in corneal ulcer cases (20%) compared to that in control group (6.67%) was found to be statistically significant (x2=7.07, p<0.0). The percentage of fungus Positivity in corneal ulcer cases (20%) in the present series is found to be lower to the various reports[2],[3],[4],[5]and comparable to some other reports[6],[7].
It is evident from our observation that Aspergillus (50%) was by far the commonest mould causing corneal ulcer. The dominant role of Aspergillus in keratomycosis has already been reported. Five different strains of Aspergillus were isolated from corneal ulcer cases. However, A. fumigatus was the most frequent isolate. Candida albicans was cultured from two cases. Similarly Penicillium and Curvalaria each was also isolated from two cases. Corneal infection by these common fungi has already been documented by various workers. Incidentally our control cases yielded Phoma hibernica and Papullospora in addition to Aspergillus. These fungi are not commonly isolated from normal conjunctival cul-de-sac.
Sensitivity tests conducted by inhibition of spore germination technique showed that the sporulation of Aspergillus fumigatus was inhibited maximally by sodium sulphacetamide (90%) and by alum (70%), Trifala (64%) and nystatin (()I%) were moderately effective while garamycin (28%) and doxycycline (23%) proved to be poor inhibitors. However, in case of Aspergillus sydowi even garamycin and doxycycline were markedly effective. Marked inhibition (75-100%) of sporulation of Penicillium chrysogenum, Curvalaria lunata and Candida albicans was observed by sodium sulphacetamide, trifala and alum. Garamycin, doxycycline and nystatin caused a moderate (50-70%) inhibition of this group of fungi.
Thus sodium sulphacetamide, alum, trifala and nystatin seem to possess remarkable fungistatic action against all common isolates. Doxycycline and garamycin also showed some antimycotic activity. A few workers[4],[8] have reported the efficacy of sodium sulphacetamide in the treatment of keratomycosis. However, it has been generally used in the management of keratomycosis. Fungistatic role of alum has not yet been adequately explained. The drug applied locally in 1.0% drop is capable of removing slough and hastening the formation of healthy granulation tissue. Some may be true for trifala. Nystatin is a known antimycotic agent[8],[9],[10] It is reasonably well tolerated on topical application in ointment form 100000 units per gram) or by subconjunctival injection (5000 units suspended in 0.5 ml saline). Doxycycline and garamycin, both broad spectrum antibiotics, were not much effective against the isolated fungi excepting aspergillus sydowi, hence they have limited value as antimycotic agent.
It is suggested that sodium sulphacetamide and alum should be subjected for clinical and experimental in-vivo and in-vitro trial to establish their role in the management of mycotic corneal ulcers.
| Summary | | |
Mycological studies were carried out on 60 controlled cases of corneal ulcer. The prevalence of fungus positivity was found to be 201,0 in corneal ulcer group while in the control group it was 6.67%. Aspergillus Candida, Penicillium, Curvalaria, Phoma and Papullospora were isolated. Sodium sulfacetamide and alum have remarkable fungistatic activity. Sporulation of all the tested fungi was inhibited by these two drugs. Nystatin, trifala, doxycycline and garamycin also have fungistatic effect in descending order.[11]
| References | | |
| 1. | Agarwal, L.P. and Khosla, P,K. 1963, Orient. Arch. Ophthalmol. 1 : 145.  |
| 2. | Arora, A.L. and Tyagi, S.C. 1976, Ind. J. Ophthalmol. 24: 15. |
| 3. | Kulshreshtha, O.P., Bhargava, S. and Dube, S.K. 1973, Ind. J. Ophthalmol. 21 : 51. |
| 4. | Puttanna, S.T., 1969, J. All India Ophthamol. Soc. 17 :171. |
| 5. | Koul R.L. and Pratap, V.B., 1975, Brit. J. Ophthalmol. 59 :47. |
| 6. | Sood, N.N., Ratanraj, A., Shenoy, B.P. and Madhavan. H.N., 1968, Orient. Arch. Ophthalm,ol. 6 100 |
| 7. | Reddy, S.P., Satyendran, O.N. Satpathy, M., Vijay Kumar, H. and Ranga Reddy, O.P. 1972 Ind. J. Ophthalmol. 20 : 101. |
| 8. | Gingrich. W.D., 1963 J. Amer. Med. Ass. 179 602. |
| 9. | Casero, I, 1963, Arch. Soc. Oftal hisp. Amer. 22 : 293. |
| 10. | Roberts, 1957, Amer. J. Ophthalmol. 44 : 108. |
| 11. | Das Gupta, L.R. Gupta A.K. Ghosh Ray B. Sunderaj, T., Rama Murthy and Lamba PA, 1973, Ind. Jour. med. Res. 61, 11, 16. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]
[Table - 1]
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