Incidence of fungal corneal ulcer in stick injuries

 

 

Abstract               Background: This study was undertaken to determine the risk factors which predisposes to fungal keratitis, especially the significant epidemiological factors. Materials and Method: This was a prospective study conducted for a period of one year from July 2017 to July 2018. Forty patients suffering from fungal keratitis were included in this study. Detailed personal history along with symptoms and associated risk factors was collected. Ocular examination and microbiological investigations were done for corneal scrapings to rule out the etiology. Data collected was tabulated and results obtained were analyzed by counts and percentages using MS Excel, 2007 version. Results: Out of 40 cases, 29 (72.5%) cases were male and 11 (27.5%) cases were female. The most common age group presenting with fungal corneal ulcer was 41 years to 65 years (21, 52.5%). The most common occupational group affected was farmers (23, 57.5%) and 77.5% were rural dwelling. Significant history of trauma with plant material (stick injury) was in 12 cases (30%). Conclusion: In our study, fungal corneal ulcers were more common in 41 years to 65 years age group and farmers. Higher incidence was seen in rural population and significant history of trauma with plant material (stick injury) predisposed to fungal keratitis.

Key Word: fungal corneal ulcer, stick injuries.

 

 

 

INTRODUCTION

According to WHO (World Health Organization), corneal diseases are among the major causes of vision loss and blindness today.¹ Fungal infections of the cornea are fewer in developed countries when compared to developing countries. Fungi are the organisms identified as ocular pathogens in agriculturist and tropical countries. In the tropics, corneal trauma is the commonest cause for fungal keratitis. Concurrent contamination with plant material adds to the risk for fungal keratitis.² Unlike other parts of the world, hot and humid climatic weather conditions in our country favour fungal infections than bacterial infections.^1,3,4 Fungal keratitis differs significantly from region to region in terms of the epidemiological characteristics, demography, predisposing factors, clinical and microbiological profile.⁵ Hence this study was undertaken to determine the risk factors which predisposes to fungal keratitis, and the significant epidemiological factors.

 

MATERIALS AND METHOD

This was a prospective study conducted at a tertiary care hospital in Kalaburagi region for the period of one year from July 2017 to July 2018. Forty patients suffering from fungal keratitis were included in this study. Detailed personal history along with presenting symptoms with associated risk factors was collected. Significant past history and treatment history were noted. Detailed ocular examination was done. Ocular investigations included flourescein staining of the fungal corneal ulcer. Microbiological investigations were done for corneal scrapings to rule out the etiology. Gram’s stain, KOH mount, bacterial culture and fungal culture were performed using standard microbiological techniques.⁷ Data collected was tabulated and results obtained were analyzed by counts and percentages using MS Excel, 2007 version. Ethical clearance for this study was obtained from the institutional ethical committee.

RESULTS

Total of 40 cases of fungal keratitis were studied for a period of one year, out of which, 29 (72.5%) cases were male and 11 (27.5%) cases were female. The most common age group presenting with fungal corneal ulcer was 41 yrs to 65 yrs (21, 52.5%), followed by 21 yrs to 40 yrs (14, 35%). The number of patients with corresponding age groups is displayed in Table 1.

Table 1: Age distribution in the study

The most common occupational group affected was farmers (23, 57.5%), followed by homemakers (6, 15.00%). The occupational groups of cases in study are displayed in the Figure1.
 

Figure 1: Distribution of different occupational groups in the study

Thirty one cases out of 40 were rural dwelling which accounts to 77.5% while the remaining 9 (22.5%) cases were from urban population. History of trauma was given by 33 patients (82.5%), out of the 40 cases. Significant history of trauma with plant material (stick injury) was in 12 cases (30%), with stone was 11 cases (27.5%) and others were 10 cases (25%). Ocular examination findings revealed right eye involvement in 24 cases (60 %) and the remaining 16 cases (40%) showed left eye involvement.

DISCUSSION

Total of 40 cases of fungal keratitis were studied for a period of one year, out of which, 29 (72.5%) cases were male and 11 (27.5%) cases were female. This finding is comparable to study done by Jadhav et al which shows 71.25% to be male remaining 24.78% to be female.⁸ This could be because of males exposed to hot and humid climate with more outdoor activities when compared to females. The most common age group presenting with fungal corneal ulcer was 41 yrs to 65 yrs (21, 52.5%), followed by 21 yrs to 40 yrs (14, 35%). This is comparable to study done by Sharma et al where the most common age group involved was between 20 to 60 years.⁹ The most common occupational group affected was farmers (23, 57.5%), followed by homemakers (6, 15.00%). This is similar to the study done by Mudhol R et al and Srinivas M et al.^5,10 The higher incidence of fungal keratitis in farmers is because they are more predisposed to contact with vegetative matter. Thirty one cases out of 40 were rural dwelling which accounts to 77.5% while the remaining 9 (22.5%) cases were from urban population. This finding corresponds to findings by Bharati MJ et al.¹¹ History of trauma was given by 33 patients (82.5%), out of the 40 cases. Significant history of trauma with plant material (stick injury) was in 12 cases (30%), with stone was 11 cases (27.5%) and others were 10 cases (25%), similar to study done by Gopinath U et al.¹² Ocular examination findings revealed right eye involvement in 24 cases (60 %) and the remaining 16 cases (40%) showed left eye involvement.

 

CONCLUSION

In our study, fungal corneal ulcers were more common in 41 years to 65 years age group. Farmers were most affected in our study. Higher incidence was seen in rural population and significant history of trauma with plant material (stick injury) predisposed to fungal keratitis.

 

 

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