Epidemiological Characteristics and Laboratory Diagnosis of Fungal Keratitis in Patients with Corneal Ulcer in Riyadh, Saudi Arabia
Clinical Medicine Research
Volume 4, Issue 6, November 2015, Pages: 214-220
Received: Nov. 20, 2015; Accepted: Dec. 6, 2015; Published: Dec. 25, 2015
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Noha Fathy Ahmed Osman El-Tahtawi, Department of Biology, College of Science and Humanities, Shaqra University, Al-Dawadmi, Saudi Arabia
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Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as etiologic agents in patients with corneal ulcer attending the ophthalmic departments of 3 hospitals in Riyadh. Corneal scrapings from 100 patients of corneal ulcer with suspected fungal etiology were subjected to direct examination by 10% KOH and lacto-phenol cotton blue mount. Also swabs of diseased eyes were taken with sterilized swabs. The specimens were also inoculated directly on to Sabouraud’s dextrose agar in C-shaped streaks. From 100 patients of corneal ulcer investigated, only 52% of patients were positive. Males were more commonly affected than females (69.23% and 30.76%), respectively. The age of patients was ranged from 28-55 years. 18 (34.61%) patients with fungal keratitis were laborers, 15 (28.84%) teachers, 7 (13.46%) housewives, 6 (11.53%) shepherds and 6 (11.53%) were civil engineers. Corneal trauma with stone chips and metal splinters appeared to be the most common predisposing factors of fungal keratitis (30.76%) followed by ocular surgery and corneal disease (26.92%). Of 52 positive patients with corneal ulcer surveyed the most important causative agents of fungal keratitis were Aspergillus spp. (44.23%), followed by Candida spp. (17.30%) and Fusarium spp. (17.30%). Because of serious consequences of infectious keratitis, it is important to know the exact etiology of fungal keratitis to institute appropriate therapy in time. Laboratory confirmation should be before pre scribing corticosteroids and antifungal.
Fungal Keratitis, Corneal Ulcer, Aspergillus spp., Fusarium spp. , Candida spp. , Predisposing Factors
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Noha Fathy Ahmed Osman El-Tahtawi, Epidemiological Characteristics and Laboratory Diagnosis of Fungal Keratitis in Patients with Corneal Ulcer in Riyadh, Saudi Arabia, Clinical Medicine Research. Vol. 4, No. 6, 2015, pp. 214-220. doi: 10.11648/j.cmr.20150406.18
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Alqurashi, M. A. (2009): Survey of opportunistic fungi in ocular infection in the Eastern Province of Saudi Arabia. Journal of Food, Agriculture & Environment Vol. 7(2): 247-251. 2009.
Bhartiya, P., Daniell, M., Constantinou, M., Islam, F. M., and Taylor, H. R. (2007): Fungal keratitis in Melbourne. Clin Experiment Ophthalmol; 35(2): 124-130.
Centers for Disease Control and Prevention. 2013: Atlanta, USA: Fungal keratitis [updated 2013 may 6]. Available from: http://www.cdc.gov/fungal/ fungal-keratitis/definition.html.
Chander, J., Singla, N., Agnihotri, N., Arya, S. K., and Deep, A. (2008): Keratomycosis in and around Chandigarh: a five-year study from a north Indian tertiarycare hospital. Indian J Pathol Microbiol; 51(2): 304-306.
Chowdhary, A., and Singh, K. (2005). Spectrum of fungal keratitis in North India. Cornea; 24(1): 8-15.
Dunlop AA, Wright ED, Howlader SA, Nazrul I, Husain. R, McClellan K, et al. Suppurative corneal ulceration in Bangladesh. A study of 142 cases examining the microbiological diagnosis, clinical diagnosis, and epidemiological features of bacterial and fungal keratitis. Aust N Z J Ophthalmol. 1994; 22: 105–110.
El-Sayed, O. A.; Othman, T. A.; El-Morsy, F. E.: Hassan, A. M. and Mohamed, S. T. (2010): Mycotic Eye Infections in Ophthalmic Center, Mansoura University. Egyptian Journal of Medical Microbiology, January 2010 Vol. 19, No. 1.
Gopinathan, U., Sharma, S., Garg, P., and Rao, G. N. (2009). Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol; 57(4): 273-279.
Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN (2002): The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in south India. Cornea 21: 555-59.
Haghani, I., Amirinia, F., Nowroozpoor-Dailami, K. and Shokohi T. (2015): Detection of fungi by conventional methods and semi-nested PCR in patients with presumed fungal keratitis. Curr Med Mycol, 2015 Jun, 1 (2): 31-38.
Insans, N. G.; Chaudhart, B. L.; Danu, M. S.; Yadav, A. and Srivastava, V. (2013): Areview of fungal Keratits: etiology and Laboratory diagnosis. Int. J. Curr. Microbiol. App. Sci (2013) 2(6): 307-314
Jones, D. B., 2006. Duane, s Ophthalmology: Diagnosis and Management of Fungal Keratitis. Philadelphia: Lippincott Williams &Wilkins.
Kalshetti, V. T., Wadgaonkar, S. P., Bhate, V. M., Wadile, R. G., Haswani, N. and Bothikar, S. T. (2015): Microbiological evaluation of mycotic keratitis in north Maharashtra, India: A prospective study. Journal of Microbiology and Infectious Diseases; 5 (3): 99-102
Mohd-Tahier, F.; Norhayati, A.; Siti-Raihan, I. and Ibrahim, M. (2012): A 5-Year Retrospective Review of Fungal Keratitis at Hospital Universiti Sains Malaysia. Interdisciplinary Perspectives on Infectious Diseases Volume 2012 (2012), Article ID 851563, 6 pages doi: 10.1155/2012/851563.
Pfaller, MA.; Houston, A. and Coffmann S. Application of CHRO Magar Candida for rapid screening of clinical specimens for Candida. albicans, Candida tropicalis, Candida krusei, and (Torulopsis) glabrata. JClinMicrobiol; 1996; 34: 58-61.
Rondeau, N., Bourcier, T., Chaumeil, C., Borderie, V., Touzeau, O., Scat, Y., Thomas, F., Baudouin, C., Nordmann, J. P., and Laroche, L. (2002). Fungal keratitis at the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts: retrospective study of 19 cases. J FrOphtalmol; 25(9): 890-896.
Rosa RH Jr, Miller D, Alfonso EC. The changing spectrum of fungal keratitis in South Florida. Ophthalmology. 1994; 101: 1005–1013.
Saha, S., D. Banerjee and Sengupta J. 2009: Epidemiological profile offungal keratitis in urban population of West Bengal, India. Oman. J. Ophthalmol. 2(3): 114-118.
Saha, R., and Das, S. (2006): Mycological profile of infectious Keratitis from Delhi.Indian J Med Res; 123(2): 159-164.
Sharma S, Srinivasan M, George C: Thecurrent status of Fusarium species in mycotic keratitis in South India. J Med Microbiol 1993, 11: 140–147.
Shokohi T. Mycotic Keratitis (case report).J Med Facul GuilanUniv Med Sci. 1999; 13: 61–66.
Shokokkohi, T.; Dailami, K. N. and Haghighi, T. M. (2006): FUNGAL KERATITIS IN PATIENTS WITH CORNEALULCER IN SARI, NORTHERN IRAN. Arch Iranian Med 2006; 9 (3): 222–227.
Singh, D.. 2011: Medscape Drugs, Disease and Procedure. New York: Fungalkeratitis (Updated 2011 Oct 27).Available from: http://emedicine.medscape.com/article/1194167-overview.
Sun, R. L., Jones, D. B., and Wilhelmus, K. R. (2007: Clinical characteristics and outcome of Candida keratitis. Am J Ophthalmol; 143(6): 1043-1045.
Thomas PA (2003): Fungal infection of the cornea. Eye 17: 852-862.
Tanure, M. A., Cohen, E. J., Grewal, S., Rapuano, C. J., and Laibson, P. R. (2000): Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea; 19: 307-312.
Tilak, R.; Singh, A.; Maurya, O. P. S.; Ghandraa, A.; Tilak, V. and Gulati, K. A. (2009): Mycotic keratitis in India: a five-year retrospective study. J Infect Dev Ctries 2010; 4(3): 171-174.
Upadhay MP. Karmacharya PCD, KoiralaS, TuladharNR. Bryan LL Smolin D et al. Epidemiologic characteristics, predisposing factors and etiological diagnosis of corneal ulceration in Nepal. Am J Ophthalmo/1988; 106: 92-99.
Upadhyay MP, Karmacharya PC, Koirala S, Tuladhar NR, Bryan LE, Smolin G, et al. Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal. Am J Ophthalmol. 1991; 111: 92 – 99.
Xie, L., Zhong, W., Shi, W., and Sun, S. (2006): Spectrum of fungal keratitis in north China. Ophthalmology; 113(11): 1943-1948.
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