|Year : 1991 | Volume
| Issue : 2 | Page : 59-61
Conjunctival microbial flora in leprosy
SP Garg, VK Kalra, Lalit Verma
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India
S P Garg
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029
Source of Support: None, Conflict of Interest: None
Conjunctival sacs of seventy one leprosy patients, paramedical and medical personnel working in a leprosy home were cultured. None of these eyes had any pathology in the outer eye. Surprisingly, 46.2% of the eyes which showed a positive culture carried accepted pathogens; Staphylococcus aureus being the commonest. Determining the preoperative bacterial flora and their elimination before undertaking intraocular surgery is recommended.
Keywords: Microbial Flora, Leprosy, Antibiotics
|How to cite this article:|
Garg S P, Kalra V K, Verma L. Conjunctival microbial flora in leprosy. Indian J Ophthalmol 1991;39:59-61
| Introduction|| |
There is no disease which so frequently gives rise to disorders of the eye, as leprosy does. There are an estimated 500,000 to 750,000 patients in the world who are blind due to leprosy . All forms of leprosy may give rise to an acute iritis which, if left untreated, may lead to a profound and permanent loss of vision. Cataract is common in most parts of the world where leprosy is endemic. Many believe that there is no true leprosy cataract and the lens changes observed are part of the changes of senility. Certainly there is a higher incidence of cataract after acute iritis and it may be a major complication in untreated patient . Before lens extraction is planned, it is always desirable to study the microbial flora of the conjunctival sac as it is this indigenous flora which is the most important source of postoperative Infection ,.
In this study we have cultured the conjunctival sacs of leprosy patients with no evidence of clinical infection in the outer eye and also those of healthy people working in the same vicinity to determine the bacterial load they carry. The findings reported here are revealing.
| Material and methods|| |
The patients were examined clinically at Leprosy Home, Seema Puri, Shadara, Delhi, situated at a distance of 25 km. from Dr. Rajendra Prasad Centre. Microbiological specimens were taken to the R.P. Centre. Conjunctival sac specimens were collected with sterile cotton-wool swabs which were inserted in test tubes containing sterile nutrient broth for bacterial cultures. For fungal cultures the swabs were immediately streaked on Sabourand's dextrose agar slants. Both the materials were simultaneously collected around 12 O'clock and were transported to the ocular microbiology laboratory within 3 hours at an ambient temperature of 30°C overnight before subculturing on sheep blood agar medium. Only aerobic cultures were done. Bacteria were identified by standard laboratory procedures. The sensitivity of recognised pathogens to penicillin, streptomycin, tetracycline, chloramphenicol, erythromycin, gentamycin, cloxacillin and olymixin-B was tested by the standard disc diffusion technique and the results were interpreted as recommended by Bauer et a1 .
The slants were incubated at 28° C for 7-10 days before identification of the fungal isolates was done.
Cultures were also taken from the medical and paramedical staff working in the leprosy home. Only clinically clean eyes were chosen.
| Results|| |
A total of 71 eyes of leprosy patients and their attendants from a leprosy home were cultured. Bacterial growth was positive in 97.2% of the eyes and only two eyes were sterile. Out of a total of 78 bacterial isolates, 36 were recognised pathogens [Table - 1]. The correlation of the clinical category with the pathogens is shown in [Table - 2]. Staphylococcus aureus was the commonest pathogen, followed by Acinetobacter cacoaceticus, Pseudomonas aeruginosa and Proteus mirabilis. Enterobacter aerogenes and Streptococcus pneumoniae were isolated once. The non-pathogens included strains of Staphylococcus epidermidis, aerobic spore bearing bacilli, diphtheroids and micrococci. Fungi were cultured from 79.0% of the samples, the commonest being species of Aspergillus, Alternaria and Phialophora.
Sensitivity pattern of 36 pathogenic strains and 3 strains of S. epidermidis to routinely used antibiotics is shown in [Table - 3].
| Discussion|| |
Several studies of the ocular flora of healthy eyes of children and adults all over the world, consistently confirm the preponderance of staphylococci and diphtheroids; streptococci including pneumococci being infrequently present. Others are far less frequently seen  . Of the staphylococci, S. epidermidis is present in almost 50-90% of the eyes and the pathogenic variety. S. aureus can be cultured from the lid margins or conjunctiva in 6-35% of the normal subjects. However, our recently concluded study from Delhi and its surrounding areas revealed S. epidermidis and S. aureus in 37.1 and 6.4% respectively in the normal sacs . One may think that there is nothing more to report on the microbial flora of the healthy sacs. The interesting findings obtained in this small study compelled us to revive this subject again. Over seventy seven per cent of the 71 eyes of leprosy patients and staff working in a leprosy home, carrying staphylococci is alarming. It is noteworthy that none of these eyes showed any pathology of the outer eye. Even if we ignore the non-pathogenic staphylococcus, which has now been established as an opportunistic pathogen, the percentage of eyes carrying coagulase positive S. aureus is considerably high (33.8%). The presence of other pathogens is also notably high (17.0%). From these findings we wish to arouse not only the awareness about the substantially higher number of people in a leprosy home carrying pathogens or potential pathogens but also to emphasise that their elimination from the sac must be ascertained before undertaking intraocular surgery. Interestingly most of the organisms were found sensitive to commonly used antibacterial antibiotics; cloxacillin, gentamycin, framycetin and erythromycin being the drugs of choice.
| References|| |
Editorial Blindness in leprosy. Br. J. Ophthalmol. 65:221-222.1981.
Ffytche T.J.: The eye and leprosy. Lepr. Rev. 52:111-119. 1981.
Allen H.F.. Mangtiaracine A.B. : Bacterial endophthalmitis after cataract extraction. Arch. Ophthal. 72: 454-462. 1964.
Allen H.F.. Mangliaracine A.B. : Bacterial endophthalmdtis after cataract extraction- Arch. Ophthalmol. 91: 3.7. 1974.
Fahmy J. A.. Molter S.. Benzton M.W. : Bacterial flora in relation to cataract extraction III. Postoperative flora. Acta Ophthalmot. 53: 765-780. 1975
Locatcher K.D. Seegal B.C. : Microbiology of the eye. SL Louis: Mosby. 1972.
Mahajan. V.M. : Postoperative ocular infections - an analysis of laboratory data on 750 cases. Ann. Ophthalmol. accepted for publication, 1984.
Bauer. A W.. Kirby. W.M M.. Sherris J.C.. Turck M.: Antibiotic susceptibility testing by a standardised single disc method. Am. J. Clin. Path. 21 : 93-96, 1968.
Mahajan V.M.: Acute bacterial infections of the eye : Their aetiology and treatment. Br. J. Ophthalmol. 67: 191-194. 1983
Perkins R E., Kundsin R.B.. Pratt M.V., Abrahamsen I.. Leibcwitz H.M. Bacteriology of normal and infected conjunctiva. J Clin. Microhiol. I 147-149. 1979.
Seal D.V.. Barett S D.. McGiII J.I.: Etiology and treatment of acute bacterial infection of the external eye Br. J. Ophthalmol 66:3 57-360. 1982
[Table - 1], [Table - 2], [Table - 3]