Pythium Keratitis: An Underdiagnosed Disease in Bangladesh

Abstract

Introduction: Pythium keratitis is a newly emerging ocular disease caused by an organism, Pythium insidiosum (P. insidiosum). It is a sight-threatening disease with high morbidity. Objective: To study the clinical features, demographical profile, treatment outcome, and ocular morbidity of microbiologically proven pythium keratitis. Methods: This retrospective study, reviewed the medical case records of patients of Pythium keratitis attended at indoors and out-patient department in LV Prasad Eye Institute, Hyderabad, India, from January 2017 to October 2019. For the purpose of this study, only microbiologically confirmed either with Potassium Hydroxide (KOH) smear or culture positive cases were included. Results and Conclusion: The study was conducted on 153 cases, 62 males and 91 females. It comprises 6.4% of total keratitis reported within this period. Unlike fungal keratitis vegetative matter injury plays a minor role in this case. Pythium keratitis is more prone to develop in agriculture workers. The outbreak of pythium keratitis was more in rainy season peak in the month of June- October. Initial presentation was with typical features of Tentacles (56%), Dots like infiltrate (47%), Plaque like lesions (17%), Ring infiltrate (22%), Peripheral guttering (53%), Endo-exudates (37%), Hypopyon was present in almost all the cases. Most of the cases
were treated with antifungals and antibiotics before final diagnosis. Evisceration, loss of sight, and therapeutic penetrating keratoplasty rate were significantly reduced with the advent of medical treatment. Linezolid and Azithromycin showed greater zone of inhibition. An increase in awareness among the microbiologist and ophthalmologist is very important to manage pythium keratitis.