Epidemiological and Microbiological Profile of Suppurative Corneal Ulcer in a Tertiary Care Hospital in Eastern India (original) (raw)
Related papers
Epidemiological and microbiological profile of infective keratitis in Ahmedabad
Indian Journal of Ophthalmology, 2012
BACKGROUND Corneal ulcer is an open sore on cornea causing significant morbidity especially in developing countries. It is associated with redness, watering, photophobia, pain and decreased vision of that eye. It is a vision threatening emergency and may lead to corneal scarring and perforation. If left untreated it may progress to endophthalmitis. So, an early diagnosis with recognition of the causative agent is very much essential to preserve vision. We conducted this study to evaluate the risk factors, causative organisms, and patient demographics of microbial keratitis. METHODS All new patients with suspected suppurative keratitis presenting at the ophthalmology OPD of Calcutta National Medical College and Hospital for a period of 1 year were evaluated. Sociodemographic data, visual acuity at presentation, and information pertaining to the risk factors were recorded. After diagnosing infective corneal ulcer clinically, corneal scraping was performed. Microscopy and culture were performed on all corneal specimens obtained. From this data we tried to find out the epidemiological pattern and factors involved in suppurative corneal ulcer. RESULTS One hundred and fifty cases of suppurative keratitis were studied clinically and microbiologically. Study showed a male preponderance (73.33%) with cultivators constituting the major occupational group (29.33%). Trauma was the commonest pre-disposing factor (64%). Among the 114 (76%) culture positive cases, 62 (41.33%) patients had pure fungal infection, 33 (22%) patients had pure bacterial infections and 19 cases (12.67%) had mixed fungal and bacterial infections. Aspergillus spp. were the most common fungal isolate, while among the bacteria positive cases, the main isolates were Staphylococcus aureus, Pseudomonas sp. and Pneumococcus. CONCLUSIONS Suppurative corneal ulcer is an important cause of preventable blindness. Smear and culture is an essential tool in the diagnosis of these infections. Region based information about the causative organisms and risk factors helps in empirical management, and to formulate guidelines for prevention of suppurative keratitis in the population at risk.
Etiology of Suppurative Corneal Ulcers in Rural Population of Northern India
Indian Journal of Clinical and Experimental Ophthalmology, 2015
Background: A prospective, interventional, comparative study carried out in rural population of northern India in western UP. Fungal keratitis studies available in literature were also reviewed. Methods: Patients presenting in eye OPD of UPRIMS & R Saifai, Etawah, UP with suspected microbial keratitis were recruited to the study. Corneal ulceration was defined as loss of corneal epithelium with clinical evidence of infection in form of corneal infiltrate with or without hypopyon. Microscopy and culture were performed on all corneal specimens. Results: A total of 105 patients presenting with suppurative keratitis were enrolled in the study from Jan 2014 to April 2015. Fungi were identified as the dominant causative agent of infection (including mixed infections) in 52 patients (49.52%). Bacteria were isolated from 32 cases (30.47%). Mixed infection was present in 9 cases (8.57%). In each case of mixed infection a single bacterial species was associated with a single fungal species. I...
Clinical and microbiological spectrum of corneal ulcer in eastern region of Uttar Pradesh
IP innovative publication pvt. ltd, 2019
Aim: To find clinical microbiological spectrum and predisposing factors of corneal ulcer in eastern Uttar Pradesh. Materials and Methods: This was a hospital based prospective study conducted in Regional Institute of Ophthalmology, IMS, BHU, Varanasi, over a period of three years from May 2015 to April 2018.Suspected microbial keratitis were stained with fluorescent paper strip and examined under cobalt blue light. Scraping of the edge and bases were directly inoculated on Sabouraud’s Dextrose Agar and Blood Agar. Plates were examined daily in 1st week then every 3rd day for next 3 weeks. Results: Maximum cases were seen in the age group of 25-50 years (63.79%), with male preponderance (60.30%). Trauma to the affected eye was major predisposing factor for microbial keratitis (74.10%). The major etiological agent in our study was fungal corneal ulcers followed by bacterial ulcer. Aspergillus spp. (53.84%) was most common filamentous fungi followed by Fusarium spp. (23.07%). Among bacteria most common species was Staphylococcus aureus 57.89% followed by Streptococcus pneumoniae and Pseudomonas aeruginosa present in 21.05% and 15.78% respectively. Conclusions: The major aetiological agent in our study was fungal corneal ulcers followed by bacteria ulcer. Filamentous fungi were most common cause of fungal corneal ulcer with Hyaline fungi (80.76%) and Phaeoid fungi (11.53%).
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Corneal ulcer is one of the leading causes of ocular morbidity in developing country. Early diagnosis and targeted therapy is indispensable. Sociodemographic variables along with predisposing factors plays a major role in its development and clinicopathological correlation in diagnosis is very much helpful in diagnosis and subsequent management. The aim of the study is to identify the epidemiological factors and causative organism of the suppurative corneal ulcer. MATERIALS AND METHODS In this observational cross-sectional study, after taking proper history, patients with suppurative corneal ulcer are examined for clinical diagnosis. Applying sterile method of swab collection from the ulcer for standard microbiological examination (staining, culture) swabs are taken for predetermined laboratory investigations. Sociodemographic variables (age, gender, occupation) relevant injury history, microbiological data are tabulated for statistical calculations. RESULTS After application of inclusion and exclusion criteria wiling 81 patients, M:F=55:26 were assessed. Major number of patients (n=61, 75.30%) are middle aged between 33-62 years of age. Occupation played a major role as evidenced by 44.44% (n=36) contribution from agricultural workers (tea garden worker, pineapple farmer, other agricultural worker) followed by household worker (n=13, 16.05%). Positive history of prior corneal injury is common in fungal corneal ulcer (n=22, 51.16%) as well as in bacterial (n=8, 66.66%). Among the prior corneal injury associated fungal ulcer vegetative matter injury in 15 patients (32.60%), while in bacterial variety, it is 5 (10.86%) in number. In laboratory investigations, pure fungal growths are found in 37 patients (45.68%), while pure bacterial are 12 in number (14.81%). A good number (n=8, 9.81%) shows mixed infection. Culture negative ulcers are good in number (n=24, 29.63%) among which 6 (7.47%) are microscopically positive. The sensitivity and specificity of clinical diagnosis of fungal corneal ulcer are 84.61% and 72.41% respectively with a high correlation between clinical and microbiological diagnosis of fungal corneal ulcer (either smear positive or culture positive and a quiet high positive predictive value for clinical diagnosis (84.61%). But, in case of bacterial corneal ulcer, the positive predictive value is 41.37%, while negative predictive value is 84.61% in our study. CONCLUSION Middle-aged agricultural workers are more prone to develop corneal ulcer and fungal corneal ulcers are more prevalent in this region of India than bacterial. History of prior corneal injury is a major risk factor. Fungal corneal ulcers have high correlation between clinical and microbiological diagnosis than bacterial.
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.7\_July2021/IJRR-Abstract032.html, 2021
Background-Visual impairment due to corneal ulceration has for long been acknowledged as leading cause of blindness both worldwide and in India only next to Cataract. The aetiology for infective corneal ulcer varies considerably with occupation of patients in different regions of India. Thus, continuing with empirical management without lab diagnosis leads to protracted clinical course. So, understanding the microbial profile of corneal ulcers in agriculture dependent population of Southern Assam helps in improved management of this morbidity. Aims- To 1) Find the prevalence of infected corneal ulcers in untreated patients attending Ophthalmology department of a tertiary care hospital of Southern Assam. 2) Study the pattern of microbial aetiology in the infected corneal ulcer cases. 3) Find the association of infected corneal ulcers with various attributing factors. Method-Corneal scrapings from 86 routine untreated cases of corneal ulceration from Ophthalmology Department were studied prospectively from Dec2017 to Jan2019 and subjected to Gram staining and direct examination with 10%KOH. Culture on SDA and Blood Agar were incubated at 25°C and 37°C respectively and followed up for 3 weeks before declaring sterile. Antimicrobial sensitivity was performed for bacterial isolate and yeast-like species. Slide culture and LPCB tease mount were done for identification of moulds. Result- Out of the 86 cases, 58 were positive in direct microscopy, of which 44 were culture positive. Of the 28 samples negative in direct microscopy, 2 were positive by Culture. Bacterial isolates were found in 5 cases and fungal aetiology in 41 cases. Conclusion- The prevalence of infected corneal ulcer as per standard of Culture positivity is 53.5% (46/86). Mycotic involvement was found in 90% cases. Important fungal isolates identified were Aspergillus species, Penicillium species, Curvularia species, Fusarium species, Sarocladium species. Higher prevalence was significantly associated with harvesting season, agricultural practice and history of trauma while diabetes and steroid intake were not significantly associated with mycotic ulcers.
To Study the Causative Organism of Corneal Ulcer in a Tertiary Care Hospital
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Early microbiological examination and treatment of corneal ulcer will prevent further permanent ocular damage in the form of loss of vision and other abnormalities. Aim is to study the common predisposing factors, isolate and identify the bacteria and fungi responsible for the corneal ulcer, and the drug sensitivity pattern of isolated bacteria to the commonly used antibiotics in a tertiary care hospital. MATERIALS AND METHODS In a cross-sectional study, fifty patients of established corneal ulcer were examined, microbiological study carried out and common predisposing factors studied during the period of November 2013 to October 2015 in a government run tertiary care ophthalmic teaching hospital. RESULTS 66% cases were found culture positive of which 40% were bacteria, 16% were fungal and 10% were mixed infection. Staphylococcus aureus was the predominant bacterial isolate and Aspergillus species was the commonest fungal isolate. Males and females were equally affected. The highest incidence of bacterial keratitis and mycotic keratitis were 68% (17/25) and 38.6% (5/13) respectively in the age group of 41-50 years. Farmers were commonly affected due to trauma during the harvesting season of December to February. Six cases (46%) of fungus positive cases were associated with trauma due to paddy leaf. Most of the organisms were sensitive to moxifloxacin, ofloxacin, amikacin and vancomycin. CONCLUSION Corneal ulcer was commonly found in the adults and more so among the low socioeconomic group and in the rural areas where cultivators were more prone to develop corneal ulcer due to trauma during the harvesting season. Staphylococcus aureus and Aspergillus were the commonest pathogenic organisms. Fluoroquinolone appeared to be the therapy of choice for bacterial keratitis with moxifloxacin as the most sensitive antibiotic.
Journal of Evolution of Medical and Dental Sciences, 2020
BACKGROUND Corneal ulcer is a global burden which is an ocular emergency. The outcome of corneal ulcer depends on its management. Aetiology, microbiological flora and antibiotic sensitivity vary from region to region. We wanted to analyse the epidemiology of corneal ulcer in Barak valley region of Assam. METHODS This is a cross-sectional study conducted from May 2017 to June 2018 at Silchar Medical College, Silchar, Assam, India. Cases of corneal ulcer in the study period were included. Corneal scrapping was done, and the sample was sent for Gram stain, KOH mount stain and culture-sensitivity testing. RESULTS A total of 122 patients were examined and 70 cases had positive microbiological findings. Pure bacterial isolates were found in 37 (52.8%) of the 70 cultures and pure fungal isolates in 23 (32.8%) of the cultures. Staphylococcus aureus was the most commonly isolated bacterial organism (42.5%). Out of fungal isolate, Aspergillus spp. (46.7%), was the commonest. Farmers were the most commonly affected work group. CONCLUSIONS Although the major aetiological agents in our study were bacterial, fungal ulcers were also seen in a significant proportion of patients. Staphylococcus was the major bacterial isolate and Aspergillus was the major fungal isolate.
Clinical study of causative microbial agents of suppurative keratitis cases in rural area
The epidemiological pattern and causative agents for suppurative corneal ulcer vary significantly from region to region so it is important to determine the regional etiology for diagnosis and management. A prospective study was conducted to find out the specific microbial agents responsible for suppurative keratitis. 62 patients of keratitis were included in the study. Male patients (58.06%) above 40 years (69.35%), farmers (61.29%) by occupation were commonly involved. The commonest ulcer was fungal (35.48%) &the causative microorganism found on culture was Aspergillus (48.48%). In bacterial ulcer, Staphylococcus aureus (38.70%) &Pseudomonas (19.35%) were isolated as the responsible microbial agents.
Journal of Ophthalmology, 2021
Background. A corneal ulcer is a major cause of monocular blindness in developing countries, including Ethiopia. Its etiology varies based on its geographical location and climatic conditions. erefore, the main objective of this research was to assess the clinical and microbiological profile of suspected bacterial and fungal corneal ulcers at the Tertiary Eye Care and Training Centre at Gondar University. Methods. A cross-sectional hospital-based study of corneal ulcer cases was performed from February to October 2019. Sociodemographic and clinical data were collected using a standardized questionnaire. Corneal scrapings were used to classify bacterial and fungal pathogens. e specimens were inoculated on BHI media and sub-cultured on culture media for the separate cultivation of bacteria and fungi. Biochemical tests have been carried out to classify bacteria. Following CLSI, the antimicrobial resistance pattern of bacterial isolates was carried out. Wet mounting, Lactophenol cotton blue staining, and colony characteristics on SDA were used to classify fungal species. e data were analyzed with version 20 of the SPSS. Results. A total of 30 suspected bacterial and fungal keratitis patients have been enrolled in this study. e visual acuity presented in 90% of the affected eyes was in the category of blindness (<3/60). In 71% of the cases, clinically presumed risk factors were identified. Trauma was the most common risk factor found in 46% of cases, followed by keratitis exposure (13%). Of the corneal scrape tests, 76.6% were positive for bacteria and fungi. Fungi were identified in 53.3% of corneal ulcers followed by 33.3% of bacterial growth. e commonest fungi and bacteria isolated were Aspergillus species (69%) and S. aureus, respectively. e prevalence of Methicillinresistant S. aureus (MRSA) was 2 (40%). e identified Pseudomonas species were susceptible to Gentamicin and Ciprofloxacin but resistant to Ceftriaxone. Conclusion. e primary microbial agents for corneal ulcers were fungi, and trauma was the most significant risk factor associated with corneal ulcers. To avoid chronic ocular morbidity and blindness, early identification of the etiologic agent and the provision of adequate management are recommended.