Abstract
Background: A corneal ulcer or keratitis is an open sore on the cornea. The cornea covers the iris and the round pupil much like a watch crystal covers the face of a watch. A corneal ulcer usually results from an eye infection, but severe dry eye or other eye disorders can cause it. Corneal ulcer is a major cause of ocular blindness and visual disability in different developing countries in Middle East, Africa and Asia, ranking only second to cataract. This is an endeavour to study about the microbiological figure and prevalence of infectious keratitis in a tertiary eye care hospital of Eastern India, and to test for the in vitro antimicrobial resistance of the bacterial isolates.
Methods: A total of 348 patients who visited a tertiary eye care hospital in Eastern India, with infected corneal ulcer were enlisted in this study. Their risk factors and socio‑demographic data were documented. Corneal scrapings were assembled from the margin of the ulcer and sent for routine microbiological examination which included Gram stain and KOH mount. Culture was obtained from MacConkey agar, blood agar, chocolate agar and Sabouraud’s dextrose (SDA) agar in multiple C shaped streaks. After overnight incubation, bacterial culture was proceeded by standard biochemical tests and antimicrobial sensitivity as stated in the clinical and laboratory standards institute (CLSI) guidelines. Inoculated SDA was observed everyday for up to 10 days and the growth was identified by its colony morphology, pigment production and lacto‑phenol cotton blue mount examination.
Results: Of 348 patients, a microbial etiology was entrenched in 132 cases (37.5%). Of these, 84 (63.63%) were male. The 41‑60 years age range was the most afflicted group. Of 132 positive cases, 58 (43.93%) were bacterial, 67 (50.75%) were fungal and 7 (5.30%) patients showed mixed variety. The most common isolated fungus was Fusarium which was detected in 44 (33.33%) cases, succeeded by Aspergillus spp in 13 (9.84%) patients. Staphylococcus aureus was the most prevailing isolated bacteria. All Gram positive cocci were susceptible to Vancomycin followed by Gatifloxacin, while all Gram negative bacilli were susceptible to Gatifloxacin.
Conclusion: These findings demonstrated the current trend in the microbiological etiology of patients with corneal ulcer in Eastern India, which has a significant public health involvement for the treatment in conjunction with prevention of corneal ulceration in developing world.
Keywords: Corneal Ulcer; Microbiological figure; Antibiotic Susceptibility.
References
- Assudani HJ, Pandya JM, Sarvan R, Sapre AM, Gupta AR, Mehta SJ. Etiological diagnosis of microbial keratitis in a tertiary care hospital in Gujarat. Natl J Med Res 2013;3:60.
- Insan NG, Mane V, Chaudhary BL, Danu MS, Yadav A, Srivastava V. A review of fungal keratitis: Etiology and laboratory diagnosis. Int J Curr Microbiol App Sci 2013;2:307‑314.
- Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211‑1215.
- Das S, Konar J. Bacteriological profile of corneal ulcer with references to Antibiotic susceptibility in a tertiary care hospital in West Bengal. IOSR J Dent Med Sci 2013;11:72‑75.
- Bakshi R, Rajagopal R, Sitalakshmi G, Sudhi R, Madhavan H, Bagayalakshmi R. Clinical and Microbiological Profile of Fungal Keratitis: A 7 Year Study at a Tertiary Hospital in South India. Cornea Session III; AIOC 2008 Proceedings: 207‑209.
- Titiyal JS, Negi S, Anand A, TandonR, Sharma N, Vajpayee B. Risk factors for perforation in microbial corneal ulcers in north India. Br J Ophthalmol 2006;90: 686‑689.
- Cameron NL, Pham JN, Paul BR, Sydney B, Glenn H, Diane RL, et al. Bacteria commonly isolated from Keratitis specimen retain antibiotic susceptibility to Fluoroquinolones and Gentamicin plus Cephalothin. Clin Exp Ophthalmol 2006;34:44‑50.
- Cao J, Yang Y, Yang W, Wu R, Xio X, Yuan J, et al. Prevalence of infectious keratitis in Central China. BMC Ophthalmol 2014;14:43.
- Sethi S, Sethi MJ, Iqba R. Causes of microbial keratitis in patients attending an eye clinic at Peshawar. Gomal J Med Sci 2010;8:20‑22.
- Yusuf N. Microbial Keratitis in Kingdom of Bahrain: Clinical and Microbiology Study. Mid East Afr J Ophthalmol 2009;16:3‑7.
- Krishna S, Shafiyabi S, Sebastian L, Ramesha R, Pavitra D. Microbial keratitis in Bellary district, Karnataka, India: Influence of geographic, climatic, agricultural and occupational risk factors. Int J Pharm Biomed Res 2013;4:189‑193.
- Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 1997;81:965‑971.
- Katara RS, Patel ND, Sinha M. A Clinical Microbiological Study of Corneal Ulcer Patients at Western Gujarat, India. Acta Med Iran 2013;51:399‑403.
- Alkatan H, Athmanathan S. Incidence and microbiological profile of mycotic keratitis in a tertiary care eye hospital. Saudi J Ophthalmol 2012;26:217‑221.
- Idiculla T, Zachariah G, Keshav B, Basu S. A retrospective study of fungal corneal ulcers in the south Sharqiyah region in Oman. Sultan Qaboos Univ Med J 2009;9:59‑62.
- Amrutha KB, Venkatesha D. Microbiological profile of Ulcerative Keratitis in a tertiary care hospital. Int J Res Health Sci 2014;2:599‑603.
- Thomas PA. Fungal infections of the cornea. Eye 2003;17:852-862.
- Forbes BA, Sahm DF, Weissfeld AS. Infections of the eyes, ears and sinuses. In: Forbes BA, Sahm DF, Weissfeld AS, editors. Bailey and Scott’s Diagnostic Microbiology. 12th ed. St. Louis: Mosby; 2007. p. 832‑837.
- Gopinathan U, Sharma S, Garg P, Rao GN. Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade. Indian J Ophthalmol 2009;57:273‑279.
- Narsani AK, Jatoi SM, Lohana MK, Dabir SA, Gul S, Khanzada MA. Hospital‑based epidemiology, risk factors and microbiological diagnosis of bacterial corneal ulcer. Int J Ophthalmol 2009;2: 362‑366.
- Bharati MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivakumar C, Srinivasan M. Microbial Keratitis in South India: Influence of Risk Factors, Climate, and Geographical Variation. Ophthalmic Epidemiol 2007;14:61‑69.
- Perry LD, Briner JH, Colander H. Anaerobic corneal ulcers. Ophthalmology 1982;89: 636‑642.
Corresponding Author
Raktima Baksi (Mandal)
RMO-CT (Tutor), Dept. of Ophthalmology, Rampurhat Government Medical College, Birbhum
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.73
