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LETTER TO THE EDITOR
Year : 2020  |  Volume : 68  |  Issue : 10  |  Page : 2323-2324

Clinico-etiological profile of microbial keratitis: A pilot study from the foothills of Himalayas


1 Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Web Publication23-Sep-2020

Correspondence Address:
Dr. Suneeta Meena
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2125_19

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How to cite this article:
Rohilla R, Meena S, Gupta N, Mohanty A, Kaistha N, Gupta P, Mangla A, Rekha U S, Omar BJ. Clinico-etiological profile of microbial keratitis: A pilot study from the foothills of Himalayas. Indian J Ophthalmol 2020;68:2323-4

How to cite this URL:
Rohilla R, Meena S, Gupta N, Mohanty A, Kaistha N, Gupta P, Mangla A, Rekha U S, Omar BJ. Clinico-etiological profile of microbial keratitis: A pilot study from the foothills of Himalayas. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 24];68:2323-4. Available from: https://www.ijo.in/text.asp?2020/68/10/2323/295698



Dear Editor:

Microbial keratitis (MK) is known to be one of the most significant causes of monocular blindness in developing countries.[1] Therefore, the knowledge of etiology in a specific region is crucial for the optimal management of these infections. Hence, this study was undertaken to determine the etiology of MK at a tertiary health care institute and to explore epidemiological risk factors.

The age, sex, occupation, and various predisposing factors for suspected cases of MK were recorded for 120 patients. Corneal scrapings that were collected using a sterile Bard-Parker blade (N15) were inoculated on 5% sheep blood agar, chocolate agar, Sabouraud dextrose agar (SDA) (HiMedia, Mumbai). Smears were prepared for Gram staining and wet mount for 10% potassium hydroxide (KOH) and calcofluor white (CFW) staining (Himedia Laboratories, Mumbai, India).

There was a male preponderance in the study, with a male to female ratio of 2:1. The mean age of patients was 48.9 years and a maximum number of patients, that is, 53% (64/120) belonged to 41–60 years age group. Among the participants, 72% (n = 86/120) belonged to the rural background and 52% (n = 63/120) had an agricultural occupation. [Table 1] shows the demographic parameters of the patients enrolled in the study and associated predisposing factors if present. Corneal trauma was the chief predisposing factor documented in 39% (n = 47/120) of cases. Two cases of chemical exposure were noticed. One because of an occupational exposure to cement and the other one due to a broad fungicidal agent containing copper oxychloride (commercially available as Cutox by Gharda Chemicals Ltd., Mumbai, India).
Table 1: Demographic parameters of the patients (n=120) enrolled in the study and predisposing factors associated

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KOH mount/CFW staining was positive for fungal elements in 40% of cases (n = 48/120). On Gram staining, Gram-positive cocci in 7% (n = 8/120) of cases and Gram-negative bacilli in 2.5% (n = 3/120) of cases were seen. In one patient, on Gram stain, a cluster of ovoid spore-like structures was also seen resembling Microsporidia species. Growth in culture was obtained in 50% of cases (n = 60/120). Fungal growth in 26% (n = 31/120) of cases and bacterial growth in 22% (n = 27/120) of cases was obtained. In 2% (n = 2/120) of cases, scraping yielded significant growth of more than one species of fungi or growth of bacteria along with the fungus. Overall, infective etiology could be established in 51% (n = 61/120) of cases according to the predefined criteria. [Table 2] summarizes identified causative micro-organisms responsible for the infection.
Table 2: Distribution of identified pathogens from microbial keratitis cases in 1 year study period (n=64)

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In the study, 41–60 was the most coon age group which is in concordance with studies from other parts of India.[2],[3] There was a male predominance which can be attributed to outdoor work done by them. Similar findings were reported by many authors.[4],[5] Patients engaged in agricultural work were more affected because of exposure to trauma. Trauma was the most significant risk factor observed. Agricultural practices in rural areas and humid environment in the state of Uttarakhand is favorable for the development of MK from minor trauma.[4]

In our study, fungal pathogens outnumbered bacterial pathogens. Fusarium was the most common fungus isolated which is in contrast to other studies from north India.[6] Compared to other infective corneal ulcers, fungal corneal ulcers are difficult to diagnose as well as treat. Hence, rapid communication between microbiologists and ophthalmologists is of utmost significance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chidambaram JD, Prajna NV, Srikanthi P, Lanjewar S, Shah M, Elakkiya S, et al. Epidemiology, risk factors, and clinical outcomes in severe microbial keratitis in South India. Ophthalmic Epidemiol 2018;2018;25:297-305.  Back to cited text no. 1
    
2.
Bharathi MJ, Ramakrishnan R, Vasu S, Meenakshi R, Palaniappan R. Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol 2003;51:315-21.  Back to cited text no. 2
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3.
Basak SK, Basak S, Mohanta A, Bhowmick A. Epidemiological and microbiological diagnosis of suppurative keratitis in gangetic West Bengal, Eastern India. Indian J Opthalmol 2005;53:17-22.  Back to cited text no. 3
    
4.
Manikandan P, Abdel-hadi A, Babu Singh YR, Revathi R, Anita R, Banawas S, et al. Fungal keratitis: Epidemiology, rapid detection, and antifungal susceptibilities of Fusarium and Aspergillus isolates from corneal scrapings. Biomed Res Int 2019;2019:6395840.  Back to cited text no. 4
    
5.
Deorukhkar S, Katiyar R, Saini S. Epidemiological features and laboratory results of bacterial and fungal keratitis: A five-year study at a rural tertiary -care hospital in Western Maharashtra, India. Singapore Med J 2012;53:264-7.  Back to cited text no. 5
    
6.
Satpathy G, Ahmed NH, Nayak N, Tandon R, Sharma N, Agarwal T, et al. Spectrum of mycotic keratitis in north India: Sixteen years studyfrom a tertiary care ophthalmic centre. J Infect Public Health 2019;12:367-71.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]



 

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