MICROBIOLOGICAL PATTERN AND EPIDEMIOLOGIC TRENDS OF FUNGAL KERATITIS IN NORTH INDIA
Journal of Evidence Based Medicine and Healthcare
CONTEXT Spectrum of fungal keratitis continues to change with geographical location and season. Microbiological and epidemiological data provide guidelines to the treating physician facilitating chances of successful treatment. PURPOSE To report microbiologic and epidemiologic profile of 119 culture-positive cases of fungal keratitis treated at a tertiary centre in North India. SETTINGS AND DESIGN All cases reporting directly or referred to the OPD METHODS Retrospective analysis of clinical and
... sis of clinical and microbiological data of 119 culture-positive cases of fungal keratitis. Demographic features, risk factors, clinical course and laboratory findings were reviewed. RESULTS All patients were residents of 11 adjoining districts of Northern India. Of the 119 patients, 76 (63.8%) were males (male: female ratio 1.79:1). 81(68%) patients were in young productive age group of 20-45 years. 87 (73%) were rural based. Ocular trauma with vegetative material, especially sugarcane leaf or dust falling in eyes were the chief precipitating factors; n = 89 (74.7%). Microbiologically Fusarium was the predominant isolate, 64 cases (53.7%), followed by Aspergillus 34(28.6%) and Candida 11(9.2%). 2 cases of Alternaria and Curvularia and solitary cases of Acremonium and Scedosporium were reported. 4 strains remained unidentified. Mode of injury had a causal relation with fungal aetiology. Majority of Fusarium infections were caused by vegetative injuries 39(61%). Of these, 15(23.4%) were attributed to sugarcane leaves. Soil/dust fall in eye or Surma application were responsible for bulk of Aspergillus infections; 21(61.7%). Candida infections were sporadic with a higher presenting age (Mean av 51.2 years) and a frequent association with topical steroid usage, (8 of 11 cases). Aspergillus infections were predominant in the hot and humid months of June to September; 25 of 34 cases (73.5%). Fusarium infectivity remained largely constant over the year with bimodal spurt during harvesting seasons. A wet KOH mount was effective for early diagnosis with a sensitivity of 89%. CONCLUSION Microbiological data of reviewed cases reveal a high preponderance of filamentous fungi as the aetiological agent, with Fusarium and Aspergillus species alone accounting for 82% of infective pathology in this rural belt of North India.