The Clinical and Microbiological Characteristics of Fungal Keratitis in COVID-19 Period

Abstract

Context: In India, the incidence of fungal keratitis ranges from 44% to 47%, due to its tropical environment and huge at-risk agricultural population. The emergence of COVID-19 has influenced the medical management of fungal keratitis. Aim: The aim of this study was to assess the clinical and microbiological characteristics of fungal corneal ulcers during COVID-19 period. Settings and Design: This was a cross-sectional study of 1-year duration. Subjects and Methods: Fifty-two KOH mount-positive and fungal culture-positive patients were included in the study. Ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, fluorescent staining was done, Anterior segment optical coherence tomography (ASOCT). Corneal scraping was sent for 10% KOH mount and fungal cultures with Sabouraud’s dextrose agar for growth. Statistical Analysis Used: The Statistical Package for the Social Sciences (Version 20) was used for statistical analysis. Results: Fifty-two KOH mount and fungal culture-positive patients were included, with a mean age of 50.88 years. 53.8% were farmers. 55.6% had a history of trauma with organic matter. The common signs noted were an irregular, dry looking, central corneal ulcer measuring 2-5mm extending 20-50% deep, mid stromal infiltration, satellite lesions and surrounding stromal oedema. Eleven presented with perforation. The best-corrected visual acuity was hand movements (32.7%). The KOH mount positive among the screened patients was 46.7%, of which 52 were culture positive. Aspergillus fumigatus (61.5%) was the predominant cause of mycotic keratitis. Conclusion: Mycotic keratitis was mostly caused by filamentous fungus and was most frequently observed among farmers. COVID-19 has increased the cases of perforated corneal ulcers, and ASOCT was the noninvasive, feasible tool to assess the cornea.