Microbial Keratitis in Nepal: Predicting the Microbial Aetiology from Clinical Features

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dc.contributor.authorHoffman, Jeremy J.
dc.contributor.authorYadav, Reena
dc.contributor.authorSanyam, Sandip Das
dc.contributor.authorChaudhary, Pankaj
dc.contributor.authorRoshan, Abhishek
dc.contributor.authorKumar Singh, Sanjay
dc.contributor.authorArunga, Simon
dc.contributor.authorHu, Victor H.
dc.contributor.authorMacleod, David
dc.contributor.authorLeck, Astrid
dc.contributor.authorBurton, Matthew J.
dc.date.accessioned2023-03-24T18:12:48Z
dc.date.available2023-03-24T18:12:48Z
dc.date.issued2022
dc.description.abstractFungal corneal infection (keratitis) is a common clinical problem in South Asia. However, it is often challenging to distinguish this from other aetiologies, such as bacteria or acanthamoeba. In this prospective study, we investigated clinical and epidemiological features that can predict the microbial aetiology of microbial keratitis in Nepal. We recruited patients presenting with keratitis to a tertiary eye hospital in lowland eastern Nepal between June 2019 and November 2020. A structured assessment, including demographics, history, and clinical signs, was carried out. The aetiology was investigated with in vivo confocal microscopy and corneal scrape for microscopy and culture. A predictor score was developed using odds ratios calculated to predict aetiology from features. A fungal cause was identified in 482/642 (75.1%) of cases, which increased to 532/642 (82.9%) when including mixed infections. Unusually, dematiaceous fungi accounted for half of the culture-positive cases (50.6%). Serrated infiltrate margins, patent nasolacrimal duct, raised corneal slough, and organic trauma were independently associated with fungal keratitis (p < 0.01). These four features were combined in a predictor score. The probability of fungal keratitis was 30.1% if one feature was present, increasing to 96.3% if all four were present. Whilst microbiological diagnosis is the “gold standard” to determine the aetiology of an infection, certain clinical signs can help direct the clinician to find a presumptive infectious cause, allowing appropriate treatment to be started without delay. Additionally, this study identified dematiaceous fungi, specifically Curvularia spp., as the main causative agent for fungal keratitis in this region. This novel finding warrants further research to understand potential implications and any trends over time.en_US
dc.identifier.citationHoffman, J.J.; Yadav, R.; Sanyam, S.D.; Chaudhary, P.; Roshan, A.; Singh, S.K.; Arunga, S.; Hu, V.H.; Macleod, D.; Leck, A.; et al. Microbial Keratitis in Nepal: Predicting the Microbial Aetiology from Clinical Features. J. Fungi 2022, 8, 201. https://doi.org/10.3390/jof8020201en_US
dc.identifier.urihttps://doi.org/10.3390/jof8020201
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/8289
dc.language.isoenen_US
dc.publisherJournal of Fungien_US
dc.subjectMicrobial keratitisen_US
dc.subjectFungal keratitisen_US
dc.subjectDematiaceous fungien_US
dc.subjectClinical diagnosisen_US
dc.subjectMicrobiologyen_US
dc.subjectNepalen_US
dc.subjectCurvularia sppen_US
dc.subjectFusarium sppen_US
dc.titleMicrobial Keratitis in Nepal: Predicting the Microbial Aetiology from Clinical Featuresen_US
dc.typeArticleen_US
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