Study of the clinico-etiological profile of fungal keratitis in a tertiary care hospital in North India

Introduction: Given the rise in cases of fungal keratitis in recent years, this study was performed to better elucidate the clinical and microbiological profile, risk factors and intervention rates of fungal keratitis at a tertiary referral center in Uttarakhand. Methods: Corneal scraping was collected from 53 consecutive cases of suspected fungal keratitis and was subjected to direct staining and culture. Results: This was a prospective observational study conducted over a period of 1 year after approval from the institutional ethical committee. All the patients which appeared to be fungal or mixed keratitis on clinical examination were included in this study. Out of 53 patients, 37 (69.8%) were males and 16 (30.2%) females with a mean age of 46.04 ± 16.23 years. Maximum patients 18 (33.96%) had the onset of symptoms and signs in the months of July-September. Of all the corneal ulcer which appeared fungal on clinical examination, KOH and culture was positive in 50.9% patients. While 18.9% were mixed type having both KOH and Gram stain positive. Out of 53 patients, 23 had presence of 3 or more typical clinical features of fungal keratits. There was significant association between number of clinical features and KOH and culture positivity. Fusarium and Curvularia species were the most common etiological agents in our region. Conclusions : Predominant outdoor agricultural activity and trauma with vegetative matter was the principal causative factor for corneal injury. Corneal ulcers complicated due to prior treatment by village healers and hence another important concern. The information regarding regional etiology will help empirical management as many eye clinics do not have microbiological facilities.