title: Etiologic diagnosis of corneal ulceration at a tertiary eye center in Kathmandu, Nepal.
abstract: OBJECTIVE
  To determine the etiologic diagnosis of infectious corneal ulcers at Tilganga Institute of Ophthalmology, a tertiary teaching hospital in Kathmandu Nepal, from 2006-2009.
  
  
  METHODS
  This study involved a review of all microbiology records at Tilganga Institute of Ophthalmology from August 2006 through July 2009. Microbiologic records from the corneal scrapings of all patients suspected of having infectious corneal ulcers were included.
  
  
  RESULTS
  Corneal scrapings were obtained from 468 patients. The average patient age was 52 years, and 55% of the affected cases were males. Microorganisms were grown from 185 of the corneal scrapings (40%). Pure bacterial cultures were obtained from 72 patients (39%), and pure fungal cultures were obtained from 113 patients (61%). Gram stain was 75% sensitive (95% confidence interval, 0.632-0.841) in identifying bacterial infection, whereas KOH prep was 80.5% sensitive (95% confidence interval, 0.718-0.871) in identifying fungal organisms. Of 72 bacterial isolates, 50 isolates (69%) were Streptococcus pneumoniae, the most common organism isolated in this study. Of 113 fungal isolates, 40 of isolates (35%) were identified as Aspergillus sp.
  
  
  CONCLUSIONS
  Fungal organisms (61%) are the most common cause of infectious keratitis in this patient population. Of all organisms, S. pneumoniae was the most common organism identified. Smear microscopy is reliable in rapidly determining the etiology of the corneal infection and can be used to help guide initial therapy in this setting.
authors.affiliation: John A Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, UT 84132, USA. mike.feilmeier@utah.hsc.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Feilmeier
authors.forename: Kavitha R
authors.initials: KR
authors.lastname: Sivaraman
authors.forename: Matt
authors.initials: M
authors.lastname: Oliva
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Tabin
authors.forename: Reeta
authors.initials: R
authors.lastname: Gurung
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003906:Developing Countries; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D005840:Gentian Violet; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010619:Phenazines; D017678:Sex Distribution
chemical_list: D000900:Anti-Bacterial Agents; C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet