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An analysis of the clinical behavior of mycotic keratitis caused by non sporing molds

An analysis of the clinical behavior of mycotic keratitis caused by non sporing molds. Dr. Revathi Rajaraman Aravind Eye Hospital Coimbatore. The authors have no financial interest in the subject matter of this poster. Purpose.

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An analysis of the clinical behavior of mycotic keratitis caused by non sporing molds

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  1. An analysis of the clinical behavior of mycotic keratitis caused by non sporing molds Dr. Revathi Rajaraman Aravind Eye Hospital Coimbatore The authors have no financial interest in the subject matter of this poster

  2. Purpose • A significant percentage of fungal isolates recovered from keratitis patients fail to sporulate by standard laboratory methods. • This group may consists of established ocular pathogens which behave differently due to unknown reasons and very rare or newer species. • This study analyzes whether keratitis caused by non sporulating filamentous fungi whose species could not be identified, differ in clinical features and response to standard antifungal treatment from that caused by species identified dematiaceous and hyaline fungi.

  3. Methods • A retrospective analysis of data collected from case records of culture proven mycotic keratitis between January 2007 December 2008 to assess - The incidence of NSM keratitis - The casual relationship between trauma, injuring agents and previous treatment - Presenting clinical features and response to standard treatment in comparison to those of species identified fungal isolates • Multiple logistic regression analysis was used to find the casual relationship to non-sporulation and associated clinical features and response to therapy was analyzed by Pearson Chi – Square

  4. Dematiaceous Freq ---------------------------------- NSDM (non sporing) 20 Curvularia 14 Bipolaris 19 Alternaria 7 Cladosporium 4 Collectotrichium 3 Exerohilum 8 Lasidiplodia 5 Nigrosporen 2 Aureobasidum 1 Exophila 1 -----------------+------------------- Total 84 Hyaline Freq. ---------------------------------------- NSHM ( non-sporing) 87 Fusarium 237 Aspergillus 81 Neocosmospora 1 Pencilium 4 Scedosporium 2 Trichothesium 2 --------------+------------------------- Total 414 Species Identified & Unidentified by spores Colony morphology on the solid medium Spore morphology A.Flavus Fusarium semitectum Aspergillus Flavus Fusarium semitectum Slide culture LPCB

  5. Results - Incidence NSM-nonsporing mold,SM-sporing mold, NSDM-non-sporing dematiaceus, NSHM-Nonsporing Hyaline

  6. Causative clinical factors for non-sporulation • There is no casual relationship between trauma, injuring agents and previous treatment • Multiple logistic regression analysis of these features, time lag before consultation and clinical features also failed to show any significance

  7. Multiple Logistic Regression - Presenting Clinical Features Non-Sporing & SporingDematiaceous Molds Non-Sporing & Sporing Hyaline molds In non-sporulating dematiaceous group hypopyon was significantly a rare presentation (P-0.003, OR 0.197 95 CI 0.067-0.579). Among hyaline fungi there was no difference in clinical features

  8. Response to Antifungal treatment UID - Dematiaceous Fungus HEALED ( P value – 0.042 ) *UIH - Hyaline Fungus HEALED ( P value – 0.294 ) *Unidentified demateaceous(NSDM) *Unidentified Hyaline (NSHM) Nonsporing Dematiaceous responded relatively better to therapy Nonsporing Hyaline molds responded similar to other hyaline fungi

  9. Discussion • Non-sporulating filamentous fungi constitute significant percentage among keratitis pathogens • No clinically significant causative factor for non-sporulation was found • Non-sporulating dematiaceous group presented rarely with hypopyon and healed better • But hyaline fungi did not showed any difference in presentation and outcome

  10. Conclusion • Non-sporing ocular fungal pathogens constitute an interesting area of research • Polymerase Chain Reaction based DNA sequencing of the ocular fungal isolates identified some newer emerging pathogens in addition to established ones • The reason for their non-sporing nature is not clear • Their sensitivity to the existing antifungal agents is yet to be studied • Clinically they behave almost similar to the established filamentous fungi

  11. References • R. Bagyalakshmi, K. L. Therese, S. Prasanna, and H. N. Madhavan. Newer Emerging Pathogens of Ocular Non-Sporulating Molds (NSM)Identified by Polymerase Chain Reaction (PCR)-Based DNA Sequencing Technique Targeting Internal Transcribed Spacer (ITS) Region Current Eye Research 2008; 33:139–147 • La´szlo´ Kredics, Ja´nos Varga, Sa´ndor Kocsube´, Revathi Rajaraman et al, Infectious Keratitis Caused by Aspergillus tubingensis. Cornea. 2009 Sep;28(8):951-4 • Srinivasan M, Gonzales CA, George C, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol. 1997;81:965–971. • Srinivasan M, Fungal keratitis. Curr Opin Ophthalmol 2004 Aug;15:321-7

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