Gugnani H C, Gupta S, Talwar R S
Mycopathologia. 1978 Dec 18;65(1-3):155-66. doi: 10.1007/BF00447186.
The importance of opportunistic fungal pathogens in causing ocular infections is emphasized. A study was conducted over a period of 4 years (1974--1977) to investigate the role of opportunistic fungi in causing mycotic keratitis and to elucidate certain aspects of epidemiology of this disease in Nigeria. Fifty-nine cases of corneal ulcers of suspected mycotic etiology were investigated. Fungal etiology was confirmed in 42 of these cases. The predominant etiological agent was Fusarium solani in 14 cases (33.33%) followed by Penicillium citrinum in 8 cases (19.04%) and Aspergillus fumigatus in 5 cases (11.90%). The yeasts were responsible for only 3 cases (7.14%) i.e. one each caused by Candida albicans, C. parapsilosis and C. guilliermondii. Among the remaining 12 cases, one was caused by F. moniliforme, 3 by A. flavus, 2 each by A. niger, Penicillium expansum and Penicillium sp., and one each by Cladosporium cladosporioides and Cladosporium sp. The clinical features of the cases are briefly described. The incidence of mycotic keratitis in relation to sex, age, occupation, trauma and other factors has been analysed. Corneal trauma appeared to be an important predisposing factor as 27 (67.28%) of the patients gave a history of injuries to the eye. Notably, a large number of patients were farmers and trauma was most often from palm tree leaf, thorn, kernel or other plant objects. Topical application of corticosteroids or broad spectrum antibiotics did not seem to play an important role in the etiology of keratomycosis. Cases were recorded throughout the year although the number of cases was higher in the months of March--May, and November--December than that during the rest of the year. The isolates of the causative agents were studied in detail for their morphological and cultural characters. The isolates of F. solani grew well at 37 degrees C and survived at 40 degrees C for more than 3 weeks. In vitro drug sensitivity tests indicated good antifungal activity of pimaricin and econazole for F. solani, clotrimazole and econazole for Aspergillus fumigatus. A. flavus and Penicillium citrinum, and 5-fluorocytosine for Candida spp. Investigations on the incidence of fungi in normal healthy eyes of 450 persons comprising 204 adults and 246 children yielded 204 isolates belonging to 21 genera of fungi. Cladosporium was most frequent (12.88%) followed by Penicillium (10.22%) and Aspergillus (6.66%). Another important fungus was Fusarium represented by 10 isolates, viz. 4 of F. solani, 2 of F. moniliforme, 1 of F. exysporum, and 3 of Fusarium sp. The yeasts were represented by two isolates each of Candida tropicalis, C. pseudotropicalis, C. krusei, Trichosporon sp and Cryptococcus albidus, and one of Candida guilliermondii. Successive culturing of fungi from normal eyes in a small group indicated that fungi occur in the outer eye generally as transients. The epidemiology of mycotic keratitis has been discussed in relation to the present findings and in comparison with observations of other investigators.
机会性真菌病原体在引起眼部感染中的重要性得到了强调。在1974年至1977年的4年期间进行了一项研究，以调查机会性真菌在引起真菌性角膜炎中的作用，并阐明尼日利亚这种疾病的某些流行病学方面。对59例疑似真菌病因的角膜溃疡病例进行了调查。其中42例确诊为真菌病因。主要病原体为茄病镰刀菌14例（33.33%），其次是桔青霉8例（19.04%）和烟曲霉5例（11.90%）。酵母菌仅导致3例（7.14%），即白色念珠菌、近平滑念珠菌和季也蒙念珠菌各1例。在其余12例中，1例由串珠镰刀菌引起，3例由黄曲霉引起，黑曲霉、扩展青霉和青霉属各2例，枝孢枝孢霉和枝孢属各1例。简要描述了这些病例的临床特征。分析了真菌性角膜炎与性别、年龄、职业、创伤和其他因素的关系。角膜创伤似乎是一个重要的诱发因素，因为27例（67.28%）患者有眼部受伤史。值得注意的是，大量患者是农民，创伤最常来自棕榈树叶、刺、果仁或其他植物物体。局部应用皮质类固醇或广谱抗生素在真菌性角膜炎的病因中似乎不起重要作用。尽管3月至5月和11月至12月的病例数高于一年中的其他时间，但全年都有病例记录。对病原体分离株的形态和培养特征进行了详细研究。茄病镰刀菌分离株在37℃生长良好，在40℃存活超过3周。体外药敏试验表明，匹马霉素和益康唑对茄病镰刀菌、克霉唑和益康唑对烟曲霉、黄曲霉和桔青霉具有良好的抗真菌活性，5-氟胞嘧啶对念珠菌属具有良好的抗真菌活性。对450名包括204名成年人和246名儿童的正常健康眼睛中的真菌发生率进行调查，共获得204株属于21个真菌属的分离株。枝孢属最常见（12.88%），其次是青霉属（10.22%）和曲霉属（6.66%）。另一种重要真菌是镰刀菌，由10株分离株代表，即茄病镰刀菌4株、串珠镰刀菌2株、尖孢镰刀菌1株和镰刀菌属3株。酵母菌由热带念珠菌、假热带念珠菌、克柔念珠菌、丝孢酵母属和浅白隐球菌各2株以及季也蒙念珠菌1株代表。在一小群人中对正常眼睛中的真菌进行连续培养表明，真菌在外眼通常以暂住菌的形式出现。结合目前的研究结果并与其他研究者的观察结果进行比较，讨论了真菌性角膜炎的流行病学。
