Skip to main content
SpringerLink
Log in

Fungal Keratitis in North India: Spectrum of Agents, Risk Factors and Treatment

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

To assess the prevalence of fungal keratitis, we conducted a retrospective study over 7 years (2005 through 2011) at a tertiary care center in North India. Effort has been made to analyze the disease burden, spectrum of agents and treatment history. The findings were compared with an earlier study at the same center for any change in the epidemiology of the disease. Microbiology records were screened at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, to identify fungal keratitis cases, and available clinical records of those cases were analyzed. Of 2459 clinically suspected fungal keratitis cases, 765 (31 %) cases were direct microscopy confirmed. Of these microscopy-confirmed cases, fungi were isolated in 393 (51.4 %), with Aspergillus spp. ranked top (n = 187, 47.6 %), followed by melanized fungi (n = 86, 21.9 %) and Fusarium spp. (n = 64, 16 %). A male predominance of 78.7 % was noted with a peak in the incidence of fungal keratitis during post-monsoon season (September to November). A delay in diagnosis was significantly associated (p < 0.001) with keratitis cases due to melanized fungi. In comparison with an earlier study, higher isolation of melanized fungi was noted with a widening of the spectrum of agents identified. Thus, fungal keratitis due to Aspergillus spp. remains a serious ocular illness among the active male population in North India with relative rise of keratitis due to melanized fungi. The spectrum of agents causing fungal keratitis has broadened with many rare fungi that are implicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Whitcher JP, Srinivasan M. Corneal ulceration in the developing world—a silent epidemic. Br J Ophthalmol. 1997;81:622–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ. 2001;79:214–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Chowdhary A, Singh K. Spectrum of fungal keratitis in North India. Cornea. 2005;24:8–15.

    Article  PubMed  Google Scholar 

  4. Dunlop AA, Wright ED, Howlader SA, et al. Suppurative corneal ulceration in Bangladesh. A study of 142 cases examining the microbiological diagnosis, clinical and epidemiological features of bacterial and fungal keratitis. Aust N Z J Ophthalmol. 1994;22:105–10.

    Article  CAS  PubMed  Google Scholar 

  5. Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN. The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India. Cornea. 2002;21:555–9.

    Article  PubMed  Google Scholar 

  6. Upadhyay MP, Karmacharya PC, Koirala S, et al. Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal. Am J Ophthalmol. 1991;111:92–9.

    Article  CAS  PubMed  Google Scholar 

  7. Xie L, Zhong W, Shi W, Sun S. Spectrum of fungal keratitis in north China. Ophthalmology. 2006;113:1943–8.

    Article  PubMed  Google Scholar 

  8. Thomas PA, Kaliamurthy J. Mycotic keratitis: epidemiology, diagnosis and management. Clin Microbiol Infect. 2013;19:210–20.

    Article  CAS  PubMed  Google Scholar 

  9. Rautaraya B, Sharma S, Kar S, Das S, Sahu SK. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. BMC Ophthalmol. 2011;11:39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Thomas PA. Fungal infections of the cornea. Eye. 2003;17:852–62.

    Article  CAS  PubMed  Google Scholar 

  11. Bandyopadhyay S, Das D, Mondal KK, Ghanta AK, Purkrit SK, Bhasrar R. Epidemiology and laboratory diagnosis of fungal corneal ulcer in the Sundarban Region of West Bengal, eastern India. Nepal J Ophthalmol. 2012;4:29–36.

    CAS  PubMed  Google Scholar 

  12. Chander J, Singla N, Agnihotri N, Arya SK, Deep A. Keratomycosis in and around Chandigarh: a five-year study from a north Indian tertiary care hospital. Indian J Pathol Microbiol. 2008;51:304–6.

    Article  PubMed  Google Scholar 

  13. Manikandan P, Varga J, Kocsube S, et al. Epidemiology of Aspergillus keratitis at a tertiary care eye hospital in South India and antifungal susceptibilities of the causative agents. Mycoses. 2013;56:26–33.

    Article  PubMed  Google Scholar 

  14. Tewari A, Sood N, Vegad MM, Mehta DC. Epidemiological and microbiological profile of infective keratitis in Ahmedabad. Indian J Ophthalmol. 2012;60:267–72.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chander J, Sharma A. Prevalence of fungal corneal ulcers in northern India. Infection. 1994;22:207–9.

    Article  CAS  PubMed  Google Scholar 

  16. de Hoog GS, Figueras MJ. Atlas of clinical fungi. 2nd ed. Washington, DC: ASM Publisher; 2001.

    Google Scholar 

  17. Rd SJ. Molecular cloning: a laboratory manual. New York: Cold Spring Harbor Laboratory Press; 2001.

    Google Scholar 

  18. White TJBT, Lee S, Taylor J. Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. New York: Academic Press; 1990.

    Book  Google Scholar 

  19. Sandhu DK, Randhawa IS, Singh D. The correlation between environmental and ocular fungi. Indian J Ophthalmol. 1981;29:177–82.

    CAS  PubMed  Google Scholar 

  20. Saha S, Banerjee D, Khetan A, Sengupta J. Epidemiological profile of fungal keratitis in urban population of West Bengal, India. Oman J Ophthalmol. 2009;2:114–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Satpathi P, Satpathi S. Study of microbial keratitis in central India. J Infect Dev Ctries. 2012;6:295–8.

    Article  PubMed  Google Scholar 

  22. Tilak R, Singh A, Maurya OP, Chandra A, Tilak V, Gulati AK. Mycotic keratitis in India: a five-year retrospective study. J Infect Dev Ctries. 2010;4:171–4.

    Article  PubMed  Google Scholar 

  23. Gopinathan U, Sharma S, Garg P, Rao GN. Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol. 2009;57:273–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rondeau N, Bourcier T, Chaumeil C, et al. Fungal keratitis at the Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts: retrospective study of 19 cases. J Fr Ophtalmol. 2002;25:890–6.

    CAS  PubMed  Google Scholar 

  25. Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivakumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol. 2007;14:61–9.

    Article  PubMed  Google Scholar 

  26. Basak SK, Basak S, Mohanta A, Bhowmick A. Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India. Indian J Ophthalmol. 2005;53:17–22.

    Article  PubMed  Google Scholar 

  27. Lin CC, Lalitha P, Srinivasan M, et al. Seasonal trends of microbial keratitis in South India. Cornea. 2012;31:1123–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kredics L, Narendran V, Shobana CS, Vagvolgyi C, Manikandan P, Indo-Hungarian Fungal Keratitis Working G. Filamentous fungal infections of the cornea: a global overview of epidemiology and drug sensitivity. Mycoses. 2015;58:243–60.

    Article  CAS  PubMed  Google Scholar 

  29. Kunimoto DY, Sharma S, Garg P, Gopinathan U, Miller D, Rao GN. Corneal ulceration in the elderly in Hyderabad, south India. Br J Ophthalmol. 2000;84:54–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Pm AEM. Clinical mycology. New York: Churchill Livingstone; 2009.

    Google Scholar 

  31. Stevens DA, Kan VL, Judson MA, et al. Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infecti Dis. 2000;30:696–709.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Anup K. Ghosh, Shivaprakash M. Rudramurthy, Saikat Paul, Vinay Kumar Hallur & Arunaloke Chakrabarti

  2. Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Amit Gupta

Authors
  1. Anup K. Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shivaprakash M. Rudramurthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saikat Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vinay Kumar Hallur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arunaloke Chakrabarti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arunaloke Chakrabarti.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 28 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghosh, A.K., Gupta, A., Rudramurthy, S.M. et al. Fungal Keratitis in North India: Spectrum of Agents, Risk Factors and Treatment. Mycopathologia 181, 843–850 (2016). https://doi.org/10.1007/s11046-016-0042-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-016-0042-3

Keywords

Search

Navigation