Clinical profile of atypical mycotic keratitis in a tertiary eye care centre.The evolving trends.

Abstract

Purpose : Fungi happen to be one of the most important causes of microbial keratitis. A myriad of cases have been reported till date but many cases caused by rare & atypical fungi still remain unreported, misdiagnosis being one of the many possible reasons.This case series shall provide an insight into the risk factors and clinical presentation of rare & unusual mycotic keratis, attributable fungal species with an intent to evaluate their management and outcome.

Methods : 6 cases of unusual & rare mycotic keratitis,their socio-demographic pattern, risk factors & clinical features were studied. Slit lamp examination was done & corneal scraping samples were evaluated for Gram’s staining, KOH mount & culture/sensitivity. Cases were meticulously managed in accordance to clinical picture and microbiological analysis. All patients were followed up for 6 months to analyse prognosis with reference to instated treatment

Results : We report six cases of atypical fungal keratitis viz. 2 cases of Schizophyllum commune & Fusarium Solani & one case each of Acremonium & Curvularia.The mean age of patients was 39+/- 21.37 years among which 4 cases were males & 2 females. All belonged to rural setting with most important risk factor being ocular trauma with vegetative matter.Other attributable factors found to be associated with these atypical mycotic keratitis were uncontrolled diabetes mellitus and chronic steroid usage. Fusarium species were managed successfully with medical treatment while Shizophyllum cases were found to be refractory to medical treatment and progressed to corneal melting & perforation. They were managed surgically by therapeutic keratoplasty in addition to medical management. Acremonium and Curvularia. species were treated with medical therapy followed by optical PK at a later date

Conclusions : Atypical mycotic keratitis cases are not of frequent occurrence in clinical practice.They can be difficult to treat owing to misdiagnosis, delay in diagnosis and management, leading to grave visual prognosis thereby hampering the psycho-social wellbeing of patients. Our case series throws a light on varied clinical presentations& possible outcomes, so to add to literature a better understanding of such atypical fungi.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Microbiological culture and clinical photograph- Schizophyllum commune

 

Microbiological staining and clinical photograph - Curvularia.