Etiology of Suppurative Corneal Ulcers in Rural Population of Northern India

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. In 21 cases (20%) had no definitive laboratory diagnosis. The principal causative microorganisms noted in rural population were filamentous fungi (Fusarium and Aspergillus species) in 49.52 % cases. The most common bacterial pathogen was gram positive streptococci. Conclusion: Infections of the cornea due to filamentous fungi are a frequent cause of corneal ulcer in rural population of north India and are very difficult treat. Corneal scrapping is very useful to assess etiology empirically and start anti-fungal drugs earliest. Knowledge of regional etiology will helpful in management of suppurative keratitis for private practitioner when microscopy cannot be performed.