Abstract
BackgroundCorneal ulcer, a major cause of monocular blindness in developing countries has consistently been listed as the major cause of blindness and visual disability in many of the developing nations in Asia, Africa and the Middle East, ranking second only to cataract. This study was carried out to determine the microbiological profile of corneal ulcer cases diagnosed among patients visiting Tilganga Institute of Ophthalmology (TIO), Nepal.MethodsA total of 101 corneal scrapping samples were tested for routine culture and antibiotic susceptibility at the pathology department of TIO Nepal from April to October 2014. Microorganisms were identified by using standard microbiological procedures following the manual of American Society for Microbiology (ASM) and their antibiotic susceptibility test, performed by Kirby-Bauer disc diffusion method in conformity with the CLSI guideline.ResultsOut of 101 samples analyzed, 44.6% (45/101) showed positive growth with bacterial isolates i.e., 56% (25/45), more prevalent than fungus i.e., 44% (20/45). Among bacteria Streptococcus pneumoniae (31.1%, N = 14) was isolated in highest number whereas Fusarium (13.4%, N = 6) was the most common fungus species. Pseudomonas aeruginosa was the only Gram negative bacteria isolated from corneal ulcer cases. All bacterial isolates were found to be susceptible to the quinolone group of antibiotics (moxifloxacin followed by ofloxacin and ciprofloxacin).ConclusionsThese findings showcase the current trend in the microbiological etiology of corneal ulcer in Nepal, which have important public health implications for the treatment as well as prevention of corneal ulceration in the developing world.
Highlights
Corneal ulcer, a major cause of monocular blindness in developing countries has consistently been listed as the major cause of blindness and visual disability in many of the developing nations in Asia, Africa and the Middle East, ranking second only to cataract
Herpes Simplex Virus type 1 (HSV-1) is the most common cause of corneal ulcer but other etiological agents frequently associated with corneal ulcer include bacteria (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes, Moraxella species, Pseudomonas aeruginosa, Proteus species, Klebsiella pneumoniae, Yersinia species and Escherichia coli), fungus
Pseudomonas a Gram negative opportunistic bacteria is commonly associated with keratitis arising from contact lens wear, which leads to corneal ulcer [9]
Summary
A major cause of monocular blindness in developing countries has consistently been listed as the major cause of blindness and visual disability in many of the developing nations in Asia, Africa and the Middle East, ranking second only to cataract. An inflammatory or more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma, is one of the major causes of monocular blindness after unoperated cataract in many of the developing nations in Asia, Africa and the Middle East. The annual financial burden borne in United States in direct health care expenditures due to cases related to corneal ulcer and keratitis is estimated to be $175 million [3]. The etiology of corneal ulcer varies disproportionately in different geographical regions with highest proportion of bacterial corneal ulcers reported from North America, Australia, Netherlands, and Singapore and that of fungal corneal ulcer from India and Nepal [10]
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