Abstract
Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents.
 Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture.
 Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively.
 Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.
Highlights
Fungal infections of the eye are recognized as an important cause of morbidity and blindness worldwide
More than 70 genera of filamentous fungi and yeasts have been identified as the etiological agents of mycotic keratitis.[1,2,3,4]
Patients with suspected or confirmed viral keratitis, healing corneal ulcers, neuroparalytic keratitis, interstitial keratitis, ulcers associated with autoimmune conditions, cornea at risk of perforation, small ulcers, and patients who refused to participate were excluded from the study
Summary
Fungal infections of the eye are recognized as an important cause of morbidity and blindness worldwide. The prevalence of individual pathogens largely depends on geographical and climatic factors. Due to a large agrarian population and environmental factors, mycotic keratitis is common in India. The diversity of clinical presentations observed in each case and new emerging cases each year pose a diagnostic and therapeutic challenge to the ophthalmologist. It shows greater morbidity than bacterial keratitis because of delayed diagnosis and available drugs that may not be effective. More than 70 genera of filamentous fungi and yeasts have been identified as the etiological agents of mycotic keratitis.[1,2,3,4]
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