Mycotic Keratitis, A Study on Etiologic Agents, Predisposing Factors and the Result of Treatment among 44 Patients

Document Type : Research Paper


eneral Practitioner, Mashhad University of Medical Sciences, Mashhad, Iran


Mycotic Keratitis is a suppurative, usually ulcerative, and sight threatening infection of cornea that sometimes leads to loss of vision. The peak of incidence is observed in the tropical and subtropical regions. To investigate the etiological agent, predisposing factors and treatment follow up of mycotic keratitis; this study was undertaken over a period of 2 years in Mashhad.
Materials and Methods
In this prospective, cross sectional study, among 466 individuals suffering from keratitis,65 patients , highly suspected to mycotic keratitis were examined by direct fresh smear (KOH 10%) and culture in Mycology Media. The results were analyzed by SPSS method.
Among 65 clinically suspected individuals, the results of direct smear and culture of 44 patients were positive.
of patients, 21 were male (47.1%) and 24 were female (52.3%). The patients were between 8 to 84 years old. More than 40% of them were farmers. Trauma was the most common predisposing factor in more than 47% of cases due to vegetable materials. Molds and Yeasts were isolated from 86.4% and 13.6% of the samples respectively. Fusarium spp. were the most frequent isolates (44.4%).Others included Aspergillus spp. (21.8%), Acremonium spp. (8.3%), Penicillium spp. (5.6%) and Candida albicans (13.9%). Tearing and redness were the most common symptoms observed (93.2%). Amphotricin B was used in patients with Aspergillus and Candida Keratitis, but for Fusarium and other molds keratitis, Natamycin was used for 6 to 12 weeks. In one patient with Fusarium Keratitis, medical therapy was failed and therapeutic penetrating keratoplasty was performed. Six months follow up showed that prognosis was good in all of the patients.
In relation to the last decade, the incidence of Mycotic Keratitis is increased in Mashhad. Keratitis due to the molds is more prevalent than yeast keratitis. Entrance of foreign body (Plant particles) is the most common predisposing factor. However, it needs long term therapy but the prognosis is good.


1- Shokoohi T. Laboratory study of 3 cases of mycotic keratitis members. J Guilan Univ Med Sci 1999; 8:89-95.
2- Barry MA, Pendarvis J, Rosenberg J, Chen S, Mshar P, Leguen F, et al. Centers for disease control and prevention
(CDC) . Fusarium keratitis – Multiple states, 2006; 55:400-401.
3- Rumpa saha,Shukla Das. Mycological profile of infectious keratitis from Dehli. Indian J Med Res 2006; 123:159-164.
4- Bharathi M Jayahar, Ramakrishnan R, Vasu S, Meenakshi R, Palaniappan R. Epidemiological characteristics and
laboratory diagnosis of fungal keratitis- A three-years study. Indian J Ophthalmol 2003; 51:315-321.
5- Agarwal pankaj K, Roy Pranatosh, Das Amitava, Banerjee Anita, Maity PraSanta K , Banerjee Asit R. Efficacy of
topical and Systemic itraconazole as a broad – Spectrum antifungal agent in mycotic corneal ulcer. A Preliminary
Study. Indian J Ophthalmol 2001; 46:173-179.
6- Berenji F, Elahi R, Fata A, Khakshoor H, Derakhshan A. Mycotic keratitis among patients referred to mycology
labratory, Emam Reza hospital. J Med School 1982-2001; 45:51-56.
7- Fata A, Derakhshan A, Kouhian H. First report of mycotic kerititis due to fusarium in Khorasan province and
successful penetrating keratoplasty. Med J Mashhad Univ Med Sci 2001; 44:125-129.
8- Yanoff M, Duker JS. Ophtalmology. 2nded. Spain: Mosby; 2003.vol 1.p.482-485.
9- Riordan P, Eva J, Whitcher P. Vaughan & Asbury’s. General Ophtalmology. 6nd
 ed .New York: McGraw-hill;
2004.p.7-9, 50,129-130,135.
10- Chander J, Sharma A. Prevelance of fungal corneal ulcer in Northern India. Infection 1994; 22: 267-269.
11- Shenoy R, Shenoy UA, Al mahrooqui ZH. Keratomycosis due to Trichophyton mentagrophytes. Mycoses 2003;
12- Doczi I, Gyetvai T, Kredics L, Nagy E.Involvement of fusarium SPP. in fungal keratitis. Clin Microbiol Infect
2004; 10:773-776.
13- Thomas PA. Fungal infections of the cornea. Eye 2003; 17:852-862.
14- Ritterbamd DC, Seedor JA, Shah MK, Koplin RS, McCormick SA.Fungal keratitis at the new york eye and ear
infirmary. Cornea 2006; 25:264-267.
15- Deshpande SD, Koppikar GV. A study of mycotic keratitis in Mumbai. Indian J pathol Microbial 1999; 42:81-87.
16- Kumari N, Xess A, Shahi SK.A Study of keratomycosis: our experience. Indian J Pathol Microbiol 2002; 45:299.
17- Panda A, Sharma N, Das G, Kumar N, Satpathy G. Mycotic keratitis in children: epidemiologic and microbiologic
evaluation. Cornea 1997; 16:295-299.
18- Usui T, Misawa Y, Honda N, Tomidokoro A, Yamagami S, Amano S. Nontraumatic keratomycosis
caused by Alternaria in a glaucoma Patient. lnt ophtalmol 2008. Available at: http://www. Accessed 2008 Sep 17.
19- Mendicute J, Orbegozo J, Ruiz M, Saiz A, Eder F, Aramberri J. Keratomycosis after cataraet surgery. J Cataract
Refract surg 2000; 26:1660-1666.
20- Xie L, Dong X, Shi w.Treatment of fungal keratitis by Peneteration keratoplasty. Br J ophthalmol 2001; 85:1070-1074.
21- D’hondt K,Parys-VAN,Ginderdeuren R,Foets B.Fungal keratitis Cauaed by Pseudallescheriaboydii (scedosporium
apiospermum).Bull Soc Belge Ophtalmol 2000;53-56.
22- Le Liboux MJ, Ibara SA, Quinio D, Moalic E. Fungal keratitis in a daily disposable soft contact lens wearer. J Fr
Ophtalmol 2004; 27:401-403.
23- Choi DM, Gold Stein MH, Salierno A, Driebe WT. Fungal keratitis in a daily disposale soft contact lens wearer.
CLAO J 2001; 27:111-112.
24- Moriyama AS, Hofling- Lima AL.Contact lens-associated microbial keratitis.Arq Bras Oftalmol 2008; 11:32-36.
25- Javadi MA,Hemati R,Mohammadi MM,Sajjadi SH.Causes of fungal keratitis and its management review of 11
cases from Labbafi Nejad Medical center. J Iran Soci Ophthalmol 1991; 3:33-16.
26- Zahra LV, Mallia D, Hardie JG, Bezzine A, Fenech T. Case report keratomycosis due to alternaria alternate in a
diabetic patient. Mycoses 2002; 45:512-514.
27- Parentin F, Liberali T, Perissutti P. Polymicrobial keratomycosis in a three years old child. Ocul Immunol Inflamm
2006; 14:129-131.
28- Tixier J, Bourcier T, Borderie V, Laroehe L. Infectous keratitis after penetrating keratoplasty. J Fr ophtalmol 2001;
29- Mselle J. Use of topical clotrimazale in human keratomycosis. Ophthalmologica 2001; 215:357-360.
30- Lee SJ, Lee JJ, Kim SD. Topical and oral voriconazole in the treatment of fungal keratitis. Korea J Ophthalmol
2009; 23:46-48.
31- Saure A, Abry F, Lhermitte B, Candolfi E, Speeq-schatz C, Bourcier T. Purulent corneal melting secondary to multidrugresistant
Fusarium oxyporum aggrativated by topical corticosteroid therapy. J Fr Ophtalmol 2008; 31:534-535.