Abstract
Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as etiologic agents in patients with corneal ulcer attending the ophthalmic departments of 3 hospitals in Riyadh. Corneal scrapings from 100 patients of corneal ulcer with suspected fungal etiology were subjected to direct examination by 10% KOH and lacto-phenol cotton blue mount. Also swabs of diseased eyes were taken with sterilized swabs. The specimens were also inoculated directly on to Sabouraud’s dextrose agar in C-shaped streaks. From 100 patients of corneal ulcer investigated, only 52% of patients were positive. Males were more commonly affected than females (69.23% and 30.76%), respectively. The age of patients was ranged from 28-55 years. 18 (34.61%) patients with fungal keratitis were laborers, 15 (28.84%) teachers, 7 (13.46%) housewives, 6 (11.53%) shepherds and 6 (11.53%) were civil engineers. Corneal trauma with stone chips and metal splinters appeared to be the most common predisposing factors of fungal keratitis (30.76%) followed by ocular surgery and corneal disease (26.92%). Of 52 positive patients with corneal ulcer surveyed the most important causative agents of fungal keratitis were Aspergillus spp. (44.23%), followed by Candida spp. (17.30%) and Fusarium spp. (17.30%). Because of serious consequences of infectious keratitis, it is important to know the exact etiology of fungal keratitis to institute appropriate therapy in time. Laboratory confirmation should be before pre scribing corticosteroids and antifungal.
Highlights
Keratitis is an inflammation of the cornea and is often caused by bacteria, viruses and fungi
Clinical Medicine Research 2015; 4(6): 214-220 appeared to be the most common predisposing factors in our study as it were observed in 16 (30.76%) patients with fungal keratitis, followed by ocular surgery and corneal disease that were recorded as predisposing factors in 14 cases (26.92%).Eight patients (15.38%) received topical antibiotics and corticosteroid
Kalshetti et al(2015) found that from 40 patients only 24(60%) were males and 16(40%) were females. 64% of patients were in the age group 20 to 50 years (Tilak etal. 2009) whereas the highest prevalence rate of fungal keratitis was identified in the patients with 40 - 90 years age group according to Haghani et al(2015).Chowdhary and Singh (2005) found that men (68%) were more commonly affected by fungal keratitis than women (32%)
Summary
Keratitis is an inflammation of the cornea and is often caused by bacteria, viruses and fungi. Fungal keratitis is caused by fungi and is showing inflammation of the cornea, suppurative, ulcerative, sight-threatening infection of the cornea that sometimes leads to loss of the eye. Fungal keratitis was first described by Leber in 1879 (Centers for Disease Control and Prevention, 2013; Singh, 2011). Fungal keratitis is a major blinding eye disease in Asia and 44% of all central corneal ulcers in South India are caused by fungi (Tuladhar et al.1988 and Sharma et al 1993). Fungi cannot penetrate the intact corneal epithelium and do not enter the cornea from episclerallimbal vessels. The principal routes of inoculation are introduction concurrent with a penetrating or perforating wound, either mechanical injury or surgery, and introduction through an epithelial defect (Jones, 2006)
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