Clinical and Microiological Profile of Infective Keratitis in a Tertiary Care Hospital in North India
Shubham Mittal1, Harvinder Nagpal1, Balbir Singh2, Rupinder Bakshi3, Anand Aggarwal1*, Pradeep Deewan4, Rishabh Taneja3, Divjot Kaur1, Chiman Lal1 and Indu Khosa1
1Department of Ophthalmology, Government Medical College, Patiala, India
2Director, Guru Teg Bahadur Superspecialty Eye Hospital, Patiala and Honorable Health Minister, Vidhan Sabha Punjab, Chandigarh, India
3Department of Microbiology, GMCH Sector 32, Chandigarh, India
4Chief Administrator and Director, Beas Hospital, Beas, India
*Corresponding Author: Anand Aggarwal, Department of Ophthalmology, Government Medical College, Patiala, India.
March 21, 2023; Published: April 04, 2023
Design: This was a observational, prospective, interventional study.
Setting: Department of Ophthalmology, Government Medical College, Patiala, Punjab.
Introduction: Infective Keratitis refers to the diseases affecting cornea caused by infective agents which leads to necrosis and suppuration resulting in corneal tissue ulcers. It is a potentially blinding condition that must be treated emergently to preserve vision. Fungal corneal ulcers are the most common, accounting for 30-40% of the cases followed by bacterial, viral and amoebic corneal ulcers.
Methods: It was a prospective, open labelled, interventional study including 75 patients of infective keratitis reporting to the Ophthalmology OPD at Rajindra Hospital, Patiala. Cases diagnosed with microbial keratitis were evaluated clinically using slit lamp biomicroscope and microbiologically using smears and cultures. The patients were treated accordingly and followed up to analyze the treatment response and outcomes in these patients.
Results: Out of 75 patients enrolled in the study, 31 were diagnosed to have fungal keratitis (41.3%), 22 had bacterial keratitis (29.3%) and 6 had mixed infection (8%). 9 patients were diagnosed with viral keratitis based on the clinical picture. Aspergillus was the most commonly isolated fungal species followed by Fusarium and Staphylococcus was the most common isolated bacteria. Fungal keratitis took the longest to heal and had maximum complications compared to other etiologies.
Conclusion: Being an agricultural state the incidence of fungal keratitis is much more in Punjab compared to other microbes. Treating a fungal corneal ulcer is very challenging inspite of the available diagnostic and treatment methods.
Keywords: Infective Keratitis; Microbiology; Bacteria; Fungi
- Whitcher JP., et al. “Corneal blindness: a global perspective”. Bulletin of the World Health Organization 3 (2001): 214-221.
- Patel KP., et al. “A retrospective study to analyse epidemiological profile of community acquired infectious keratitis in a tertiary care hospital located in Northern Mumbai”. International Journal of Community Medicine and Public Health7 (2022): 2888-2892.
- Kenia VP., et al. “Diagnosis and management protocol of acute corneal ulcer”. International Journal of Health Sciences and Research 3 (2020): 69-78.
- Bakshi R., et al. “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.
- Khor WB., et al. “The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia”. American Journal of Ophthalmology 195 (2018): 161-170.
- Zhang W., et al. “Use of potassium hydroxide, Giemsa and calcoflour white staining techniques in the microscopic evaluation of corneal scrapings for diagnosis of fungal keratitis”. Journal of International Medical Research 6 (2010): 1961-1967.
- Wang JJ., et al. “Trends in Infectious Keratitis in Taiwan: An Update on Predisposing Factors, Microbiological and Antibiotic Susceptibility Patterns”. Diagnostics (Basel)9 (2022): 2095.
- Kaliamurthy J., et al. “Spectrum of bacterial keratitis at a tertiary eye care centre in India”. BioMed Research International 2013 (2013).
- Rautaraya B., et al. “Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India”. BMC Ophthalmology 11 (2011): 39.
- Bajracharya L., et al. “Demography, risk factors and clinical and microbiological features of microbial keratitis at a tertiary eye hospital in Nepal”. Clinical Ophthalmology 14 (2020): 3219-3226.
- Satpathy G., et al. “Spectrum of mycotic keratitis in north India: Sixteen years study from a tertiary care ophthalmic centre”. Journal of Infection and Public Health 3 (2019): 367-371.
- Lim Wen Siang J., et al. “Profile of Microbial Keratitis”. Cureus12 (2021).
- Tawde Y., et al. “Clinical and mycological profile of fungal keratitis from North and North-East India”. Indian Journal of Ophthalmology6 (2022): 1990-1996.
- Saha S., et al. “Epidemiological profile of fungal keratitis in urban population of West Bengal, India”. Oman Journal of Ophthalmology3 (2009): 114-118.
- Basak SK., et al. “Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India”. Indian Journal of Ophthalmology1 (2005): 17-22.
- Wuletaw T., et al. “Clinical and Microbiological Profile of Bacterial and Fungal Suspected Corneal Ulcer at University of Gondar Tertiary Eye Care and Training Centre, Northwest Ethiopia”. Journal of Ophthalmology 2021 (2021): 1-9.
- Chopra A., et al. “Microbial profile of infectious corneal ulcer in a remote Himalayan teaching hospital in Himachal Pradesh (India)”. Journal of Clinical Ophthalmology Research 3 (2022): 101-104.
- Mohod PN., et al. “Incidence of various causes of infectious keratitis in the part of rural central India and its visual morbidity: prospective hospital-based observational study”. Journal of Ophthalmology and Clinical Research 1 (2019): 31-34.
- Moe CA., et al. “Outcomes of amoebic, fungal, and bacterial keratitis: A retrospective cohort study”. Plos One2 (2022): e0264021.