INTRODUCTIONThis study was conducted to determine the epidemiological pattern and risk factors associated with corneal ulcers in rural areas of western Maharashtra, India, and to identify the bacterial and fungal agents responsible for causing keratitis.

METHODSA total of 852 patients with corneal ulceration were included in the study. Sociodemographic data and information pertaining to risk factors were collected. Corneal scrapings obtained from these patients were processed for bacterial and fungal agents using standard techniques.

RESULTSOut of the 852 patients studied, 537 (63.02%) were culture positive. A majority of the culture-positive patients were farmers (52.32%), and ocular trauma was the most common predisposing factor (60.15%). Among these patients, fungal isolates (57.91%) were more frequent than bacterial isolates (42.08%). The most common fungal isolate was Fusarium spp. (35.04%) followed by Aspergillus spp. (18.00%). Streptococcus pneumoniae was the predominant bacterial isolates (32.74%) followed by Staphylococcus spp. (17.25%).

CONCLUSIONCorneal trauma from plant parts or organic matter was found to be the most common risk factor associated with corneal ulceration in the rural areas of western Maharashtra. Epidemiology and aetiology of microbial keratitis vary from region to region, and therefore, careful history taking and proper identification of aetiological agents are necessary for the institution of appropriate therapy.

Adult ; Cornea ; microbiology ; Corneal Ulcer ; epidemiology ; microbiology ; Eye Infections, Bacterial ; epidemiology ; microbiology ; Eye Infections, Fungal ; epidemiology ; microbiology ; Female ; Hospitals, Rural ; Humans ; India ; epidemiology ; Male ; Risk Factors ; Young Adult

INTRODUCTIONCorneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management. This study analyses the prevalence, microbiology, demography, therapeutic and visual outcome of infectious microbial keratitis in the paediatric age group seen at a tertiary eye care hospital in south India.

MATERIALS AND METHODSA retrospective review of all cases presenting with keratitis to the ocular microbiology and cornea service at Aravind Eye Hospital, Coimbatore, from February 1997 to January 2004, was done to screen the patients for microbial keratitis. Their records were further analysed for clinical and microbiological details. Cases with culture-proven non-viral keratitis in children

RESULTSOf the 310 patients who attended the cornea clinic, 97 (31.2%) patients were confirmed to be positive for microbial keratitis. 54.6% of cases were male. The most common predisposing cause of ulceration was trauma (69%) with organic matter. Pure bacterial cultures were obtained from 64 (65.9%) eyes, whereas pure fungal cultures were obtained from 37 (38.1%) eyes. Four (4.1%) eyes showed mixed growth.

CONCLUSIONThe most commonly isolated organism was Pseudomonas aeruginosa. The most common predisposing cause of infectious microbial keratitis was corneal trauma. Early stage of diagnosis and formulation of an uncompromising management protocol can prevent profound visual morbidity.

Adolescent ; Child ; Child, Preschool ; Eye Infections, Bacterial ; diagnosis ; therapy ; transmission ; Eye Infections, Fungal ; diagnosis ; therapy ; transmission ; Female ; Humans ; India ; Infant ; Keratitis ; diagnosis ; etiology ; microbiology ; therapy ; Male

OBJECTIVETo analyze the epidemiological and etiologic characteristics of ocular fungal infection in Haikou.

METHODSThe samples of corneal, conjunctivae, anterior chambers, lacrimal sacs were taken from the outpatients and inpatients in the Department of Ophthalmology for fungal culture. The positivity rates of fungal culture were statistically analyzed to describe the seasonal and genus distribution of the fungal infections.

RESULTSA total of 683 patients were involved in this study, and the total positivity rate of fungal culture was 27.96%. The positivity rate was 33.42% in male patients and 21.52% in female patients (P<0.01). The positivity rates were 31.42%, 11.32%, 10.81%, 21.28% and 29.17% in the cornea, conjunctivae, anterior chambers, lacrimal sacs and other locations (P<0.01), and were 34.88%, 22.58%, 11.76%, 4.11%, 21.43% and 13.33% in farmers, workers, teachers, government officers, students and personnel of other occupations (Chi2=39.550, P=0.001), respectively. In terms of age, the rate was 32.30% in 21-40 years group, 31.72% in 41-60 years group, 17.12% in over 60 years group and 26.61% in below 20 years group, showing significant differences (P<0.01). The rates were higher in August, September, October, December, November, all above 30%, but lower in March. Nine genera were identified, including Candida (49.21%), Aspergillus (19.37%), Fusarium (9.42%), mucor (5.76%), Actinomyces (5.24%), Penicillium (3.66%), Saccharomyces (2.62%), non-spore group (1.57%), Alternaria (1.57%), and other genera (1.57%). Among the 94 strains of Candida, 63 (67.02%) belonged to Candida albicans and 14 to Candida tropicalis (14.89%).

CONCLUSIONOcular fungal infection occurs more often in male patients and in the cornea. The common pathogen of ocular fungal infection is Candida, which is different from the etiological characteristics in other areas possibly in association with the tropical climate.

Adult ; Candida albicans ; isolation & purification ; China ; epidemiology ; Eye Infections, Fungal ; epidemiology ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Young Adult

A healthy 27-year-old woman with a corneal ulcer underwent fibrin gluing with a bandage contact lens twice, due to an impending perforation. The ulcer lesion slowly progressed, unresponsive to topical antibiotics and amphotericin B. We removed the gluing patch and performed a corneal or scraping or biopsy with multiple amniotic membrane grafts to seal the thinned or perforated cornea. Three days after the surgery, the corneal cultures grew Fusarium, as well as Enterococcus faecalis. Three weeks after surgery, the outermost layer of amniotic membranes, serving as a temporary patch, was removed. The anterior chamber was clear without cells. The signs of infection clinically and symptomatically cleared up four weeks later. Two months after surgery, the lesion became enhanced by amniotic membranes. The use of fibrin glue in infectious keratitis should be avoided, because it not only masks the underlying lesion, but it also interferes with drug penetration into the underlying lesion.
Adult ; Corneal Perforation/*drug therapy ; Corneal Ulcer/*drug therapy/*microbiology ; Eye Infections, Fungal/*microbiology ; Female ; Fibrin Tissue Adhesive/*therapeutic use ; Fusariosis/*microbiology ; Fusarium/*isolation & purification ; Humans

A 64-year-old woman was referred to our clinic for the treatment of chronic uveitis in her left eye, which had started two weeks after an uncomplicated cataract extraction. She was treated with topical steroids with an initially good response, yet she subsequently developed severe inflammation and plaque-like material around the intraocular lens, despite continuous steroid therapy. She underwent pars plana vitrectomy, smear and culture of the aqueous and vitreous fluids, and intravitreal antibiotic injection under the impression of Propionibacterium acne (P. acne) endophthalmitis. As a result of the smear and culture of the vitreous fluid identified as an Acremonium species, she was treated with intravenous amphotericin B injections for five days, followed by oral voriconazole administration. During the post-operative 18-month follow-up, she was stable without significant relapse of uveitis. In this case, the best correction of visual acuity was an improvement from 20/40 to 20/20.
Acremonium/*isolation & purification ; Antifungal Agents/therapeutic use ; *Cataract Extraction ; Endophthalmitis/drug therapy/*microbiology ; Eye Infections, Fungal/drug therapy/*microbiology ; Female ; Humans ; Middle Aged

Phialemonium keratitis is a very rare case and we encountered a case of keratitis caused by Phialemonium obovatum (P. obovatum) after penetrating injury to the cornea. This is the first case report in the existing literature. A 54-year-old male was referred to us after a penetration injury, and prompt primary closure was performed. Two weeks after surgery, an epithelial defect and stromal melting were observed near the laceration site. P. obovatum was identified, and then identified again on repeated cultures. Subsequently, Natacin was administered every two hours. Amniotic membrane transplantation was performed due to a persistent epithelial defect and impending corneal perforation. Three weeks after amniotic membrane transplantation, the epithelial defect had completely healed, but the cornea had turned opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained.
Cornea/*injuries/microbiology/pathology ; Diagnosis, Differential ; Eye Infections, Fungal/diagnosis/etiology/*microbiology ; Eye Injuries, Penetrating/*complications/diagnosis ; Follow-Up Studies ; Fungi/isolation & purification ; Humans ; Keratitis/diagnosis/etiology/*microbiology ; Male ; Middle Aged

No abstract available.
Aged ; Conjunctiva/*surgery ; Dacryocystorhinostomy/*adverse effects ; Eye Infections, Fungal/diagnosis/*etiology/microbiology ; Female ; Humans ; Keratitis/diagnosis/*etiology/microbiology ; Lacrimal Duct Obstruction/*diagnosis ; Paecilomyces/*isolation & purification ; Recurrence ; Surgical Wound Infection/diagnosis/*etiology/microbiology

A 63-year-old female with candidemia following necrotizing pancreatitis developed clinical signs of chorioretinitis and underwent the systemic administration of voriconazole, after which anterior chamber inflammation and multiple, white, fluffy, chorioretinal lesions, under 1mm in diameter, were gradually resolved and visual acuity improved. We report the first Korean case of candida chorioretinitis successfully treated with the systemic administration of voriconazole.
Antifungal Agents/*therapeutic use ; Candidiasis/*drug therapy/microbiology ; Chorioretinitis/*drug therapy/microbiology ; Eye Infections, Fungal/*drug therapy/microbiology ; Female ; Fungemia/drug therapy ; Humans ; Middle Aged ; Pyrimidines/*therapeutic use ; Triazoles/*therapeutic use

BACKGROUNDHypopyon is common in eyes with fungal keratitis. The evaluation of the clinical features, culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions.

METHODSThe medical records of 1066 inpatients (1069 eyes) with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings and treatment outcomes. The incidence of hypopyon, the fungal culture positivity for hypopyon, risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined.

RESULTSWe identified 1069 eyes with fungal keratitis. Of the 850 fungal culture-positive eyes, the Fusarium species was the most frequent (73.6%), followed by Alternaria (10.0%) and Aspergillus (9.0%). Upon admission, 562 (52.6%) eyes with hypopyon were identified. The hypopyon of 66 eyes was evaluated via fungal culturing, and 31 eyes (47.0%) were positive. A total of 194 eyes had ocular hypertension, and 172 (88.7%) of these eyes had hypopyon (P < 0.001). Risk factors for incident hypopyon included long duration of symptoms (P < 0.001), large lesion size (P < 0.001) and infection caused by the Fusarium and Aspergillus species (P < 0.001). The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size. Surgical intervention was more common in cases with hypopyon (P < 0.001). Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation (P = 0.002).

CONCLUSIONSHypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension. About half of the hypopyon cases were positive based on fungal culture. Long duration of symptoms, large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon. The presence of hypopyon increases the likelihood of surgical intervention.

Adult ; Anterior Chamber ; pathology ; Aspergillus ; pathogenicity ; Eye Infections, Fungal ; microbiology ; surgery ; Female ; Fusarium ; pathogenicity ; Humans ; Keratitis ; microbiology ; surgery ; Male ; Microscopy, Confocal ; Middle Aged ; Retrospective Studies ; Risk Factors ; Treatment Outcome

BACKGROUNDPediatric infectious endophthalmitis is a serious sight-threatening disease for children. The purpose of this study was to investigate the etiology, microbiological spectrum, and visual outcomes of infectious endophthalmitis in children at a single institution in China.

METHODSIt is a retrospective study of the medical records of all patients under 14 years of age with histories of infectious endophthalmitis, treated at a single institution from January 1, 2009 to January 1, 2015. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. The Kappa test and Chi-square test were used in the statistical evaluation.

RESULTSA total of 271 children were identified, with a mean age of 5.61 ± 2.93 years (range 5 months to 14 years). Ocular trauma (94.8%) and previous ocular surgery (3.0%) were the most common etiologies. Overall, 147 (54.2%) cases had positive cultures, and 176 organisms were isolated from these patients. A single species was isolated in 120 (81.6%) cases, with multiple organisms in 27 (18.4%) cases, and the most commonly identified organisms were coagulase-negative Staphylococcus and Streptococcus species, comprising 29.5% and 26.8% of the isolates, respectively. Moreover, of 176 isolates, 142 (80.8%) were Gram-positive organisms, 23 (13.0%) were Gram-negative organisms, and 11 (6.2%) were fungi. The final visual outcomes were 20/200 or better in 66 (24.4%) eyes, counting fingers to 20/200 in 34 (12.5%), hand motions in 30 (11.1%), light perception in 33 (12.2%), no light perception in 32 (11.8%), and 9 (3.3%) eyes were enucleated or eviscerated. The visual outcomes were not available in 67 (24.7%) patients.

CONCLUSIONSPenetrating ocular trauma is the most frequent cause of pediatric endophthalmitis in China. Streptococcus and Staphylococcus species are the most commonly identified organisms in exogenous pediatric endophthalmitis whereas Fusarium species are commonly seen in endogenous endophthalmitis. In this research, in spite of aggressive management with antibiotics and vitrectomy, the visual prognosis was found to be generally poor.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; China ; Endophthalmitis ; drug therapy ; microbiology ; pathology ; Eye Infections, Fungal ; drug therapy ; microbiology ; pathology ; Eye Injuries, Penetrating ; microbiology ; Female ; Fusarium ; pathogenicity ; Humans ; Infant ; Male ; Retina ; microbiology ; Retrospective Studies ; Staphylococcus ; pathogenicity ; Streptococcus ; pathogenicity ; Vitrectomy