Demographic pattern, clinical features and treatment outcome of patients with infective keratitis in the eastern region of Nepal

Abstract

Background: Corneal ulcer is one of the major causes of monocular blindness in developing countries. Objective:To determine demographic pattern, risk factors, microbiological pattern and treatment outcome of infective keratitis. Materials and methods:A retrospective analysis of hospital records of 44 patients with clinically-diagnosed infective keratitis presenting to B.P. Koirala Institute of Health Sciences in the eastern region of Nepal was carried out. Outcome measures:The parameters studied were risk factors and organisms responsible for keratitis. Results:The infective keratitis was mostly prevalent among the males between 21-40 years of age (50%). 79.5 % of them were engaged in agricultural work. A history of corneal injury was found in 30 eyes (68.1%). Vegetative matter was the most common agent of trauma in 17 (56.6%). Culture positivity for microorganisms was observed in 20 (45.5%) samples. Of these, 8 (40%) patients had purely bacterial corneal ulcer. Purely fungal growth was seen in 4 (20%) and mixed in 8 (40%). Staphylococcus aureus was the most commonly isolated bacteria (70%). The other bacteria included Pseudomonas species, E. coli and Acinetobactor. Aspergillus species was the most common fungal organism isolated in 8 (40%) samples. 65.9 % of the patients improved with medical treatment alone. Perforation, endophthalmitis and panophthalmitis were the common complications encountered in 11.3%, 4.5% and 4.5% respectively. Conclusion:Corneal ulcer is prevalent in males, predominantly amongst the farmers. Ocular trauma with vegetative matter is the commonest predisposing factor. Staphylococcus aureus and Aspergillus species are the most commonly isolated organisms in corneal ulcers.

Causative organisms in microbial keratitis, their sensitivity pattern and treatment outcome in western Nepal

“…This may be due to the climatic variations as Kathmandu is in hilly region with cold weather and the LEI in the sub-tropical low land. Similar findings were observed in the study done in eastern region of Nepal where only 20 % of cultures had fungal growth (Lavaju et al, 2009). Nepal J Ophthalmol 2012;4(7):119-127 Among the fungal positive cultures, 30.73 % cases were Fusarium spp, 10.06 % Aspergillus spp and the remaining were the mix of large number of fungal pathogens including unidentified hyaline fungi, unidentified dematiceous fungi spp.…”

Direct microscopy in suppurative keratitis: a report from tertiary level hospital in Nepal

“…Majority of keratitis cases were seen in the agricultural group (47.2%) similar to other studies done by Upadhyay MP et al (Upadhyay MP et al, 1991), Lavaju P et al (Lavaju P et al, 2009) 75% in Nepal and Samar K Basak et al (Basak SK et al, 2005) 57.6%; but a marked contrast was found in a study done in Ghana (Hagan M et al, 1995)where only 16.1% were involved in agricultural activity.…”

“…Similarly, in a study conducted by U. Gopinathan et al it was seen that the mean age of patients with bacterial keratitis was 41.20 ± 20.36 years and that of patients with fungal keratitis was 30.90 ± 15.28 years, indicating a relatively increased occurrence of corneal infections in the middle age group (Gopinathan U et al, 2009) . In another study conducted by Lavaju P et al, it was seen that ulcers were more prevalent in the middle age groups, between 21-40 years of age (50%) (Lavaju P et al, 2009). Presentation in this age was more common due to the fact that persons belonging to this age group are more active and involve themselves in outdoor activities.…”

“…Ashok Narsani Kumar (Narsani AK et al, 2009) and colleagues also found that the most frequent organism isolated among the 240 cases of corneal ulcer was Staphylococcus aureus (n=75, 60%). A study done by Lavaju P et al (Lavaju P et al, 2009) showed that among the 44 patients of infective keratitis culture positivity was observed in 20 (45.5%) samples. Staphylococcus aureus was the most commonly isolated bacteria (70%) in this study also.…”

Telemedicine for corneal disease in rural Nepal

“…A study of patients with infectious keratitis in Eastern Nepal found that 80% were engaged in agricultural work and 68% recalled associated ocular trauma. [3] In addition, 11% had corneal perforation and 9% had endophthalmitis at the time of presentation, suggesting significant delays between the injury and medical evaluation. [3] Poor utilization of eye health services in Nepal has been attributed to limited education (particularly about eye disease) and significant distances between home and health facilities.…”