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The Etiologic Diagnosis of Corneal Ulcers at a Tertiary Eye Center in Kathmandu, Nepal.

The Etiologic Diagnosis of Corneal Ulcers at a Tertiary Eye Center in Kathmandu, Nepal. Michael R. Feilmeier, MD Geoffrey C. Tabin, MD Kavitha R. Sivaraman, BA Matthew Oliva, MD Reeta Gurung, MD The authors have no financial interest in the material presented in this electronic poster.

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The Etiologic Diagnosis of Corneal Ulcers at a Tertiary Eye Center in Kathmandu, Nepal.

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  1. The Etiologic Diagnosis of Corneal Ulcers at a Tertiary Eye Center in Kathmandu, Nepal. Michael R. Feilmeier, MD Geoffrey C. Tabin, MD Kavitha R. Sivaraman, BA Matthew Oliva, MD Reeta Gurung, MD The authors have no financial interest in the material presented in this electronic poster.

  2. Purpose • To determine the etiologic diagnosis of infectious corneal ulcers at Tilganga Institute of Ophthalmology (TIO), a tertiary referral and teaching hospital in Kathmandu, Nepal

  3. Materials and Methods • Study Design: Retrospective Consecutive Case Series Analysis • Corneal scrapings were obtained from all patients with suspected infectious keratitis presenting to TIO from August 2006-July 2009. • Material from scrapings was innoculated directly on to blood, chocolate, and Saboraud dextrose agars as well as brain-heart infusion broth. • A portion of each sample was examined with Gram stain and KOH prep. • Antibiotic cultures were examined at 24-hour intervals and considered negative if there was no growth at 96 hours. • Fungal cultures were incubated at 27 C for four weeks. • Bacterial were identified based on morphological, staining, and biochemical properties and fungi based on colony characteristics and microscopic appearance.

  4. Results: Demographics (n=440)

  5. Results: Corneal Scaping Results at TIO: Smear Microscopy in Culture + Cases

  6. Results: Culture Positive Organism Distribution

  7. Results: Comparison to the Literature

  8. Results: Antibiotic Sensitivity Testing: Percentage of Isolates Sensitive

  9. Results: Antibiotic Sensitivity Testing: Percentage of Isolates Not Resistant (At least partially sensitive)

  10. Conclusion • In this population, fungi are the most common cause of infectious keratitis. • Aspergillus sp. is the most common fungus implicated in this setting • S. pneumoniae was the most common single pathogen identified. • No seasonal variation in infectious etiology was noted in this study • Vancomycin resistant organisms were identified in this study, which is in support of previous microbiologic studies in this region of the world.

  11. References • Upadhyay MP, Rai NC, Shrestha RB. Corneal ulcers in Nepal. Graefe’s Arch Clin Exp Ophthalmol 1982;219:55-59. • Upadhyay MP, et al. Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal. Am J Ophthalmol 1991;111:92-99. • Leck AK, Thomas PA, Hagan M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002 86: 1211-1215. • Bharathi MJ, et al. Microbial Keratitis in South India: Influence of Risk Factors, Climate, and Geographical Variation. Ophthalmic Epidemiology 2007;14: 61-69. • Saeed A, et al. Risk Factors, Microbiological Findings, and Clinical Outcomes in Cases of Microbial Keratitis Admitted to a Tertiary Referral Center in Ireland. Cornea 2009;28:285–292 • Sirikul T. Predisposing Factors and Etiologic Diagnosis of Ulcerative Keratitis. Cornea 2008;27:283–287. • Laspina F, et al. Epidemiological characteristics of microbiological results on patients with infectious corneal ulcers: a 13-year survey in Paraguay. Graefe’s Arch Clin Exp Ophthalmol • (2004) 242:204–209 • Poole TRG, Hunter DL, Maliwa EMK. Aetiology of microbial keratitis in northern Tanzania. Br J Ophthalmol 2002 86: 941-942. • Basak SK, Basak S, Mohanta A, Bhowmick A. Epidemiologic and microbiologic diagnosis of suppurative keratitis in Gangetic West Bengal, Eastern India. Indian J Ophthal 2005;53:17-22. • Panda A, Satpathy G, Nayak N, Kumar S, Kumar A. Demographic pattern, predisposing factors and management of ulcerative keratitis: evaluation of one thousand unilateral cases at a tertiary care centre. Clinical and Experimental Ophthalmology 2007; 35: 44–50 • Pachigolla G, Blomquist P, Cavanagh HD. Microbial Keratitis Pathogens and Antibiotic Susceptibilities: A 5-Year Review of Cases at an Urban County Hospital in North Texas. Eye & Contact Lens 2007; 33(1): 45–49. • Keay L, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology 2006;113(1):109-16. • Manikandan P, Bhaskar M, Revathy R, John RK, Narendran K, Narendran V. Speciation of coagulase negative staphylococcus causing bacterial keratitis. Indian J Ophthalmol 2005; 53:59-60.

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