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- Title
A Clinicopathological Study and Management of Fungal Corneal Ulcer in a Tertiary Care Hospital.
- Authors
Jajodia, Santosh; Sahoo, Sushree Sagarika; Nanda, Prasanta Kumar
- Abstract
Background: In this study we wanted to assess the prevalence of specific fungal pathogens, analyze the influence of demographic factors on the spectrum of fungal species responsible for fungal corneal ulcers and also determine the effectiveness of treatment. Methods: This was a prospective study carried out over a period of two years involving 53 corneal ulcer patients. Corneal scraping materials collected from the patients were sent for a 10% KOH/NaOH stain and Sabouraud dextrose agar for culture and sensitivity by micro-broth dilution technique. All the patients who were KOH stain positive and/or culture positive in Sabouraud medium were considered for the study. The patients were emperically treated with Topical Natamycin 5percent eye drop. As per culture and sensitivity report, voriconazole (1%), topical amphotericin-B or a systemic anti-fungal drug like Itraconazole (200 mg) was added. All patients were followed up daily for one week, every one week up to one month, and every two weeks up to three months till the epithelium healed, as evidenced by the negative FL stain and disappearance of signs and symptoms. The collected data was tabulated and analyzed using SPSS (Statistical Package for Social Science) version 22.0. For statistical analysis, mean, frequency, percentage and Pearson's chi-square test were performed; a p-value <0.05 was considered to be statistically significant. Results: The maximum number of cases were seen in males in the range of 51-60 years and in females aged 41-50 years, who were mostly involved in outdoor work. Males were more affected (62.26%) than females (37.73%). 52.83% were agricultural workers or farmers, with vegetative matters (39.60%) being the most common traumatic agent. 26.4% of study subjects were diabetics and 13% had a history of using topical steroids. A central location for corneal ulcers was present in 50.9% of cases, and a paracentral location was present in 39.6% of cases. In 77.4% of patients, the ulcer was ≤6 mm. 35 (66%) out of 53 study subjects fell within the range of 34%-67% depth of corneal involvement. 50.94% of study subjects had visual acuity between <6/60 and >1/60. All study subjects had a 10% KOH smear positive. 31 study subjects had a positive SDA culture, the rest had negative and variable reports. Aspergillus was the predominant organism in 45 (84.9%), followed by fusarium in 8 (15.1%). All fungal ulcers were sensitive to natamycin (100%) with a variable sensitivity to voriconazole 17 (32.1%), amphotericin B 7 (13.2%) and itraconazole 15 (28.3%). Conclusion: The present study has brought to light again the fact that fungal keratitis continues to be a major concern for loss of sight, especially in the rural, agricultural population. Goals directed towards proper education, early recognition and appropriate treatment will go a long way towards mitigating the problem of this potentially sight-threatening condition.
- Subjects
CORNEAL ulcer; FUNGAL virulence; TERTIARY care; MARIJUANA; RURAL population; FUNGAL keratitis
- Publication
Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), 2024, Vol 15, Issue 1, p2347
- ISSN
0975-3583
- Publication type
Article