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Published on: May 12, 2020
Clinical and microbiological study of paediatric infectious keratitis in South India: a 3-year study (2011-2013)
Lokeshwari Aruljyothi1, Naveen Radhakrishnan1, Venkatesh N Prajna1
1Department of Cornea and Refractive Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Insights
Fungi, not bacteria, were the most common cause of infectious keratitis in children in this study. Prompt microbiological diagnosis and targeted therapy are crucial for successful treatment outcomes in pediatric infectious keratitis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Infectious keratitis is a significant cause of visual impairment in children.
- Understanding the etiological profile and risk factors is crucial for effective management.
Purpose of the Study:
- To investigate the risk factors, microbiological spectrum, and clinical outcomes of infectious keratitis in pediatric patients.
- To identify the predominant causative agents and assess treatment efficacy.
Main Methods:
- A retrospective case series design was employed.
- Case records of pediatric patients (0-16 years) diagnosed with infectious keratitis between January 2011 and December 2013 were reviewed.
- Demographic data, predisposing factors, microbiological results, clinical course, and visual outcomes were analyzed.
Main Results:
- Infectious keratitis affected 240 eyes of 234 children, with trauma noted in 53.4%.
- Fungi were the most common isolates (54.2%), followed by bacteria (40.8%). Fusarium was the most frequent fungal species.
- Successful healing occurred in 92.9% of eyes with medical therapy; 7.1% required therapeutic keratoplasty.
Conclusions:
- Fungal keratitis is more prevalent than bacterial keratitis in pediatric patients in this region, contrary to some previous reports.
- Microbiological investigations are vital for guiding empirical and targeted antimicrobial therapy in pediatric infectious keratitis.
- The findings highlight the importance of considering fungal etiology in empirical treatment strategies for children.
Purpose:
To study the risk factors, microbiological profile and clinical outcomes of infectious keratitis affecting paediatric patients.
Study Design:
Retrospective case series.
Methods:
Review of case records of paediatric patients (0-16 years) diagnosed with infectious keratitis who presented to Aravind Eye Hospital, Madurai, India during January 2011 to December 2013. Demographic details, predisposing factors, microbiological investigations, clinical course and visual outcome were analysed.
Results:
In this time period, 240 eyes of 234 children had a diagnosis of infectious keratitis. One hundred and twenty-five (53.4%) children had a history of trauma. Smears were obtained in 220 eyes, while culture was performed in 191 eyes. The culture results were positive in 142 (74.3%) eyes. Fungi was the most common infectious agent isolated in culture (54.2%) followed by bacteria (40.8%) and acanthamoeba (2.1%). Successful healing of the keratitis with appropriate medical therapy occurred in 223 (92.9%) eyes, while 17 (7.1%) eyes required therapeutic keratoplasty. Of the 151 patients with preliminary and final visual acuity, vision improved by 2 lines in 68 eyes (45%), stayed the same in 75 eyes (49.6%) and worsened in 8 eyes (5.3%).
Conclusions:
Contrary to previous reports, fungi are the most common aetiological organism in the causation of infectious keratitis in children in our study population. Fusarium was the most common fungal species isolated. These data are similar to the data obtained from adult patients with infectious keratitis in this region. While microbiological investigations are important to initiate appropriate antimicrobial therapy, the findings from our study need to be kept in mind, especially while initiating empirical therapy in this population.
