Spectrum of Fungal Keratitis in North India

Abstract

To report the epidemiologic features and laboratory results of 191 consecutive cases of fungal keratitis presenting to a tertiary level superspecialty teaching hospital of North India. A prospective hospital-based study was carried out on 485 consecutive patients presenting with corneal ulcers to the outpatient department of Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, from January 1999 to June 2001. The sociodemographic data, predisposing risk factors, clinical details, prior treatment modalities, laboratory results, and visual outcomes were analyzed. Diagnosis of mycotic keratitis was established in 191 (39%) out of the total study group of 485 cases. Direct microscopic examination of KOH mounts and Gram-stained smears revealed presence of fungal elements in the corneal scrapings in 119 (62.3%) and 114 (60%) of the subsequently fungal culture-positive cases, respectively. Men (68%) were more commonly affected by fungal keratitis than women (32%). Young adults 31-40 years of age were the most common age group to be involved (36%). Predisposing risk factors were noted in 79%, with corneal trauma 42%, contact lens wear 25%, and topical corticosteroids in 21% patients. The spectrum of fungi isolated were Aspergillus species in 78 (41%) followed by Curvularia species in 55 (29%). In contrast to other studies from our subcontinent, we found Aspergillus niger to be the most common fungal isolate, followed by Curvularia species in culture-proven cases of fungal keratitis. Direct microscopic examination of KOH mounts emerged as a rapid, reliable, and inexpensive diagnostic modality, with a sensitivity of 62%, which would facilitate the institution of early antifungal therapy before the culture results became available, thus proving to be sight saving.