Microbiological profile of mycotic eye infections at a tertiary care institution in the Caribbean: A retrospective analysis

Abstract

Background: This study identifies the aetiologial agents associated with mycotic eye disease in samples sent for fungal investigation, to the Department of Microbiology, University of the West Indies (UWI). Methods & Materials: A retrospective analysis of mycotic eye disease was conducted using microbiology records of all eye related specimens received in the mycology section from January 1998 to December 2014. The study population was comprised mainly of hospitalized patients, those seen in the ophthalmology clinics at the University Hospital of the West Indies (UHWI), as well as those seen by private physicians. The frequency and distribution of the causative agents of fungal eye infections were ascertained. Results: Microbiology records showed that 312 samples were received from 254 patients during the 17 years being examined, with a clinical diagnosis of fungal eye disease. A total of 52 of these samples were positive and the microbiological diagnosis was established in 39 (15.4%) of these patients (26 males, 13 females). Filamentous fungi such as Aspergillus spp n = 17 (32%) and Fusarium spp n = 16 (31%) were the most frequently isolated. They were followed by Penicillium spp n = 5 (9%), Acremonium spp and Aureobasidium spp n = 3 each (6%), Curvalaria spp and Scopularopsis spp n = 2 each (4%), Cladosporium spp, Papulospira and Mucor spp n = 1 each (2%). No yeasts were identified. The ≥ 50 years age group had the most isolates (10/39). Conclusion: Filamentous fungi such as Aspergillus spp and Fusarium spp are the most common causative agents of fungal eye infections in this setting. Consideration should be given to the reviewing of the first line empiric agents used for treatment of clinically diagnosed fungal eye infections locally. Empiric agents to consider should include agents demonstrating high in-vivo activity against moulds. Topical natamycin should be considered as first line for cases of fungal keratitis while voriconazole should be considered in cases of endophthalmitis. Continued surveillance is necessary to identify the introduction of other agents e.g. yeasts such as Candida spp, commonly found in other locations.