Transcript 287: Fusarium Keratitis at a Tertiary Eyecare Center in India

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Fusarium keratitis in a tertiary
eye care centre in India
Sujata Das, MS, FRCS
L V Prasad Eye Institute
Bhubaneswar, India, 751024
[email protected]
Savitri Sharma, MD
Samir Mahapatra, MS
Srikant K Sahu, MS
Authors do not have any financial or conflicting interests to disclose
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Introduction
 Fungal keratitis continues to be a cause of concern to
ophthalmologists.
 It accounts for 30 to 50% of all cases of microbial
keratitis in developing countries.#
 Increased awareness coupled with improved laboratory
and in vivo diagnostic techniques have led to an increase
in the frequency of correct diagnosis and consequent
increase in prevalence of the disease.@
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Srinivasan M, et al. Br J Ophthalmol 1997; 81: 965-971.
Gopinathan U, et al. Cornea 2002; 21: 555-559.
Dunlop AA, et al. Aust N Z J Ophthalmol 1994; 22: 105-110.
Hagan M, et al. Br J Ophthalmol 1995; 79: 1024-1028.
O’Brien TP, Rhee P. In Textbook of Ocular Pharmacology. Hagerstown: Lipincott-Raven, 1997: 587-607.
O’Day D. In Ocular Infection and Immunity. St Louis: Mosbey, 1996: 1048-1061.
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Introduction
 The epidemiological features of fungal keratitis vary
across geographic regions and climatic conditions.
 Fungal keratitis occurs more frequently in warm, and dry
climate than in temperate zones.
 Fusarium and Aspergillus species are the most common
fungi isolated from patients in tropical regions.
 The purpose of the study was to report clinical and
microbiological profile of Fusarium keratitis.
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Material and Methods
 A retrospective analysis of medical records was done to
study the clinical and microbiological profile of 42
consecutive culture-proven Fusarium keratitis patients
presented at the corneal unit of L V Prasad Eye Institute,
Bhubaneswar, between November 2006 & July 2009.
 The following data were collected from each record: age,
sex, predisposing risk factor, clinical presentation,
microbiological result, mode of management, and final
outcome.
 All patients had undergone detailed clinical evaluation and
slit-lamp examination.
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Material and Methods
As a part of standard protocol, corneal scrapings were
obtained from all microbial keratitis and subjected to the
following :
Placing on glass slide
Smearing on glass slides
Gram
BA (O2+)
BA (O2-)
CA (CO2)
BHI
Thio
SDA
PDA
NNA
( E. coli )
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Clinical Picture
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Results
 Mean age of patients was 47±17 (range: 4-95, median: 45)
years.
 Eleven eyes (26.2%) had history of injury.
 Mean duration of symptom was 17±14 (range: 3-60, median:
10) days.
 Hypopyon was present in
15 (35.7%) cases.
 Satellite lesion was not
present in any eye.
57.14%
42.86%
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Results
 Thirty six (85.7%) cases were smear-positive for fungus.
 In 3 cases microconidia was observed in direct smear
examination.
 Fusarium solani was the most common (45.2%) fungi.
 Five patients had associated bacterial infection.
 All 3 cases where
microconidia was present
in direct smear
examination were identified
as Fusarium solani in
culture.
 The mean time to positive
culture was 1.8±1 days.
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Microbiological Examination
Giemsa 1000
BA
CA
SDA
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Adventitious Sporulation
CFW 200
LCPB 400
Gram 1000
Gram 1000
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Results
 Twenty one (50%) patients underwent adjunctive surgical
procedure
•
Tissue adhesive application : n = 9;
•
Therapeutic penetrating keratoplasty : n = 13;
•
Anterior chamber wash + Intracameral antifungal : n = 4;
•
Evisceration : n = 3.
 16.7% and 41.5% patients had visual acuity of <20/200 during
presentation and final follow-up respectively.
 Eighteen patients had improvement in visual acuity.
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Conclusion
 Fusarium keratitis may present after trauma without any
satellite lesion and needs surgical intervention in 50% cases.
 Smears of corneal scrapings often disclosed hyphae, and
culture media showed growth within 3 days.
 Microconidia in smear examination may be suggestive of
Fusarium solani.