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

Corynebacterium macginleyi is usually isolated from the eye surfaces and causes ocular infections such as conjunctivitis, keratitis, and endophthalmitis. However, cases that describe C. macginleyi as the causative agent for significant and life-threatening infections in immunocompromised patients are increasingly reported. Herein we report the first documented case of C. macginleyi pneumonia in a human immunodeficiency virus (HIV) patient. A 42-year-old homosexual man with HIV infection was hospitalized with a 1-month history of fever and dry cough. Chest radiograph revealed ill defined ground glass opacities in both lung fields. Methenamine silver stain of bronchoalveolar lavage fluid was negative. He showed clinical improvement after treatment with trimethoprim/sulfamethoxazole and prednisolone for three weeks, and was discharged. One month later, he presented with dyspnea and more progressive pulmonary infiltrations. Bronchial washing fluid culture yielded >100,000 colonies/mL of C. macginleyi, and he was given a 14-day course of antibiotic therapy with vancomycin, after which the patient fully recovered. This case suggest the importance of not overlooking the significance of positive cultures for C. macginleyi obtained from representative clinical samples in patients with signs and symptoms of bacterial infection.
Adult ; Bacterial Infections ; Bronchoalveolar Lavage Fluid ; Conjunctivitis ; Corynebacterium ; Cough ; Dyspnea ; Endophthalmitis ; Eye ; Eye Infections ; Fever ; Glass ; HIV ; HIV Infections ; Homosexuality ; Humans ; Immunocompromised Host ; Keratitis ; Lung ; Methenamine ; Pneumonia ; Prednisolone ; Thorax ; Vancomycin

PURPOSE: To evaluate the factors affecting treatment outcome of graft infection following penetrating keratoplasty (PKP). METHODS: In this retrospective study, 28 patients who underwent PKP between January 2005 and January 2013 and who were diagnosed with graft infection were classified into a treatment success group or a treatment failure group. Demographic and clinical characteristics, as well as the results of the microbiologic investigation, were analyzed and compared. A subsequent binary logistic regression analysis was performed to identify the prognostic factors affecting treatment outcome. RESULTS: Graft infection occurred at a mean of 38.29 +/- 36.16 months (range, 1 to 96 months) after PKP. Seventeen patients developed bacterial keratitis, and 11 patients developed fungal keratitis. Overall, of the 28 patients, nine (32.1%) were classified in the treatment failure group. Multivariate analysis identified pre-existing graft failure (p = 0.019), interval longer than 72 hours between donor death and PKP (p = 0.010), and fungal infection (p = 0.026) as significant risk factors for treatment failure. CONCLUSIONS: Pre-existing graft failure, extended interval between donor death and PKP, and fungal infection were important risk factors for treatment failure of graft infection following PKP.
Adult ; Aged ; Aged, 80 and over ; Eye Infections, Bacterial/diagnosis/*etiology ; Eye Infections, Fungal/diagnosis/*etiology ; Female ; *Graft Survival ; Humans ; Keratoplasty, Penetrating/*adverse effects ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection/diagnosis/*etiology ; Treatment Outcome

PURPOSE: To describe the successful treatment of a series of fungal ocular infections with voriconazole. METHODS: A retrospective chart review was conducted for six eyes of five patients: four eyes of four patients with fungal keratitis, and two eyes of one patient with fungal endophthalmitis who were treated with topical and intracameral voriconazole. A battery of analyses on corneal isolates, clinical outcomes, duration of treatment, time to remission, complications, concomitant medication, and visual acuity at the initial and last visits was performed. RESULTS: Six eyes of five patients were treated in total. Three eyes with fungal keratitis were treated with 5% topical voriconazole, and infection was controlled. Therapeutic penetrating keratoplasty was performed on one eye with fungal keratitis due to impending corneal perforation; this eye was treated successfully with topical voriconazole without recurrent inflammation. Both eyes of one patient with fungal endophthalmitis were given an intracameral voriconazole (100 microgram/0.1 cc) injection twice in the right eye and once in the left eye, and infection was controlled with continued topical voriconazole therapy. There was no clinically remarkable corneal epithelial toxicity from topical application. No corneal endothelial toxicity was observed after an intracameral injection of voriconazole. CONCLUSIONS: Voriconazole is known to penetrate efficiently into ocular tissues. As shown in our case series, voriconazole is a new, promising therapy for intractable fungal ocular infection.
Endophthalmitis ; Eye ; Eye Infections, Fungal ; Humans ; Inflammation ; Keratitis ; Keratoplasty, Penetrating ; Pyrimidines ; Retrospective Studies ; Time-to-Treatment ; Triazoles ; Visual Acuity

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

In recent years, numerous cases of intraocular fungal infections have been reported. Mycotic infections of eyes have occurred after surgery, trauma, and topical antibiotics or cortisone therapy, which are considered the infections produced by exogenous origin. To know ocular mycotic infection, the normal fungal flora of the eyes becomes extremely important, because these organisms may be the source of the infection. We cultured, fungi from normal conjunctival sac by Sabouraud glucose agar media at Chonnam National University Hospital and the results obtained as follows. The results were as follows: 1. The mycotic flora of the conjunctival sac was investigated in following five groups: group I: neonates to less than 2months of eyes(44 cases), group II: 2 months to 19 years(34 cases), group III: 20 to 39 years(84 cases), group IV: 40 years and over(95 cases), group V: controls(257 cases). 2. Positive cultures were observed in 13.2% of total cases. Cultures from the group I were positive in 2 cases(4.5%), the group II were positive in 8 cases (3.5%), the group III were positive in 9 cases(10.7%), and the group IV were positive in 15 cases(15.8%). The lowest positivity(4.5%) was observed in the group I, and the highst(23.5%) in the group II. 3. There was no significant differences in positive culture rate between male and female group, as 11.4% in male and 15.4% in female group. 4. Fungi cultured were identified as the following species: Penicillium SP.(8 cases), Aspergillus SP.(6 cases), Candida SP.(6 cases), Mucor SP.(6 cases), Trichophyton(5 cases) and Cephalosporium SP.(3 cases).
Acremonium ; Agar ; Anti-Bacterial Agents ; Aspergillus ; Candida ; Cortisone ; Eye Infections, Fungal ; Female ; Fungi ; Glucose ; Humans ; Infant, Newborn ; Jeollanam-do ; Male ; Mucor ; Penicillium ; Trichophyton

In recent years, numerous cases of intraocular fungal infections have been reported. Mycotic infections of eyes have occurred after surgery, trauma, and topical antibiotics or cortisone therapy, which are considered the infections produced by exogenous origin. To know ocular mycotic infection, the normal fungal flora of the eyes becomes extremely important, because these organisms may be the source of the infection. We cultured, fungi from normal conjunctival sac by Sabouraud glucose agar media at Chonnam National University Hospital and the results obtained as follows. The results were as follows: 1. The mycotic flora of the conjunctival sac was investigated in following five groups: group I: neonates to less than 2months of eyes(44 cases), group II: 2 months to 19 years(34 cases), group III: 20 to 39 years(84 cases), group IV: 40 years and over(95 cases), group V: controls(257 cases). 2. Positive cultures were observed in 13.2% of total cases. Cultures from the group I were positive in 2 cases(4.5%), the group II were positive in 8 cases (3.5%), the group III were positive in 9 cases(10.7%), and the group IV were positive in 15 cases(15.8%). The lowest positivity(4.5%) was observed in the group I, and the highst(23.5%) in the group II. 3. There was no significant differences in positive culture rate between male and female group, as 11.4% in male and 15.4% in female group. 4. Fungi cultured were identified as the following species: Penicillium SP.(8 cases), Aspergillus SP.(6 cases), Candida SP.(6 cases), Mucor SP.(6 cases), Trichophyton(5 cases) and Cephalosporium SP.(3 cases).
Acremonium ; Agar ; Anti-Bacterial Agents ; Aspergillus ; Candida ; Cortisone ; Eye Infections, Fungal ; Female ; Fungi ; Glucose ; Humans ; Infant, Newborn ; Jeollanam-do ; Male ; Mucor ; Penicillium ; Trichophyton

Endophthalmitis ; diagnosis ; drug therapy ; etiology ; Eye Infections, Fungal ; diagnosis ; drug therapy ; etiology ; Humans ; Infant, Newborn ; Infant, Premature ; Male

Humans ; Endophthalmitis/microbiology* ; Eye Infections, Bacterial/microbiology* ; Anti-Bacterial Agents/therapeutic use* ; Retrospective Studies