Mycotic Keratitis from Mumbai

Purpose : To find out fungal isolation rate in clinically suspected cases of mycotic keratitis and to identify aetiological agents and risk factors. Methods : 260 suspected cases of mycotic keratitis seen over two and half years from January 2005 to June 2006 were included in the study. Corneal scrapings were subjected to microscopy and fungal culture. Data of patients and various predisposing factors were studied. Results : Fungi were isolated in 13.07 % cases. Correlation between microscopy and culture was present in 58 % cases. Male: Female ratio observed was 3:1. Filamentous fungi were isolated in 79.41% cases and yeasts were isolated in 20.58% cases. Predominant fungal isolates were Aspergillus species 17.64% (16/34), Fusarium species 14.7% (5/34). Curvularia species, Penic i l lium species and Candida albicans were isolated in 3 cases each (8.82% each); Cladosporium species, Dreschleria species, Acremonium species, Aureobasidium species were isolated in 2 cases each (5.88% each), while Alternaria species and Bipolaris species in 1 each. Conclusion : Wide range of fungi were isolated from cases of mycotic keratitis. High index of suspicion by ophthalmologists and laboratory confirmation could save the eye from blindness caused by mycotic keratitis. I n t r o d u c t i o n Mycotic keratitis is an important ophthalmic problem. Scarring of cornea as a result of keratitis is one of the preventable causes of blindness and carries usually unfavourable prognosis due to its protracted course and requirement of specific therapy.1,2 Various reports consistently list corneal ulceration second only to cataract as major aetiology of blindness and visual disability.1-4 Normally eye is kept free from microbial infection by cleansing effect of lacrimal secretion. Untreated keratitis may lead to opacification and ultimately to perforation of cornea. 2 Keratomycosis occurs mainly in warm *Lecturer, Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400 022. (India) climates and coincides with seasonal increase in temperature and humidity.1,4 Trauma particularly with vegetative or soil matter seems to be the most important predisposing factor for keratomycosis.1-9 Apart from that, injudicious use of topical corticosteroids, antibacterial agents for external ocular disease and use of contact lenses further enhances risk. 1-6 Also previous surgery as cataract operation and systemic illness predispose individual to keratitis.1,8 The diversity of clinical presentation observed in each case and also new emerging cases each year pose a diagnostic and therapeutic challenge to ophthalmologists.1,8 The associated morbidity as a result of several factors directly affects the management, because of lack of diagnostic facilities and appropriate treatment.1,2 Specific treatment requires correct identification of causative pathogen.1-3