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 ~  Abstract
 ~  Case report
 ~  Discussion
 ~  Acknowledgment
 ~  References

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CASE REPORT
Year : 2004  |  Volume : 22  |  Issue : 2  |  Page : 126-127
 

Keratomycosis due to exserohilum rostratum - A case report


Department of Microbiology, BLDEA's Shri BM Patil Medical College, Bijapur - 586 103, Karnataka, India

Correspondence Address:
Department of Microbiology, BLDEA's Shri BM Patil Medical College, Bijapur - 586 103, Karnataka, India

 ~ Abstract 

We report here a case of keratomycosis by Exserohilum rostratum. An 18-year old female patient presented with pain and watery discharge from the left eye since 10 days. Clinically the case was diagnosed as keratomycosis. Gram stain and KOH preparation of corneal scrapings revealed fungal elements. Fungal isolate was identified as Exserohilum rostratum by standard techniques.

How to cite this article:
Peerapur B V, Rao S D, Patil S, Mantur B G. Keratomycosis due to exserohilum rostratum - A case report. Indian J Med Microbiol 2004;22:126-7


How to cite this URL:
Peerapur B V, Rao S D, Patil S, Mantur B G. Keratomycosis due to exserohilum rostratum - A case report. Indian J Med Microbiol [serial online] 2004 [cited 2019 Aug 18];22:126-7. Available from: http://www.ijmm.org/text.asp?2004/22/2/126/8087


Mycotic keratitis is an infection of the cornea by the fungus that causes ulceration and inflammation, usually following trauma or treatment for a bacterial infection with steroid and antibiotics. More than 70 genera of moulds and yeasts have been associated with keratomycosis.[1] Hyaline moulds like Aspergillus, Fusarium, Cephalosporium, Acremonium and Penicillium are more frequently isolated as causative agents than phaeoids (dematiaceous) moulds like Alternaria, Curvularia, Bipolaris and Exserohilum species.[2],[3],[4] Exserohilum species cause phaeohy-phomycosis affecting skin, subcutaneous tissue, nose and paranasal sinuses, rarely endocarditis, osteomyelitis and keratitis. Occasional reports are available on corneal infection by E.rostratum.[5]

 ~ Case report Top

An 18 years old female patient presented with pain and watery discharge from the left eye since 10 days. No history of injury and use of topical steroids preceding the ocular complaints was present.
On ocular examination, central corneal ulcer (7mm) with brownish black pigment on the surface with characteristic feathery edges in the left eye was seen. Bulbar and palpebral conjunctiva was diffusely congested and vision was impaired in that eye. Right eye was ophthalmologically normal. For microbiological examination, corneal scrapings were collected under aseptic conditions and topical itraconazole therapy was started.
Potassium hydroxide (KOH) preparation revealed thick, brown, septate hyphae and Gram stain revealed hyphae with few pus cells and no bacteria. On Sabouraud dextrose agar (SDA), after five days of incubation at room temperature, velvety, gray to green fungal colony developed, which turned in to velvety dark brown after eight days of incubation [Figure - 1].
In lactophenol cotton blue preparation, brown septate hyphae and elliptical conidia with multiple septae were observed. Slide culture revealed thick, smooth surfaced, ellipsoid, brown septate hyphae (dematiaceous) with multiseptate conidia (7 to 8 septae) having predominant hylum, which was protruding and truncated were produced sympodially [Figure:2]. The septae at the hylum and at the tip of conidia were characteristically thick and dark brown. Growth at 37C was comparatively less. The isolate was identified as E.rostratum.

 ~ Discussion Top

Incidence of Mycotic keratitis in south India is 22.7% to 46%.[4],[6] Aspergillus and Fusarium are the commonest cause of Mycotic keratitis in India.[3],[6] Phaeohyphomycotic agents belonging to the genera Bipolaris and Exserohilum have been previously reported under the names Drechslera and Helminthosporium. Leonard and suggs (1974) transferred Helminthosporium rostrate (Drechslera), which had been described in 1923 as graminicolous fungus, to their new genera Exserohilum. The genus Exserohilum currently accommodates three pathological species, E.rostratum, E.longistratum, E.mcginnissi. All the three species have characteristic protruding hilum. They can be differentiated by morphological features of their conidia. In the present case there was no history of predisposing factors. Corneal epithelium might have been damaged by dust particles leading to corneal ulcer. Itraconazole can be effectively used for keratomycosis as reported by Agarwal et al.[7] Our patient responded to topical itraconazole indicating its use in the management of keratomycosis due to E. rostratum.

 ~ Acknowledgment Top

Authors gratefully acknowledge, Dr. BM Hemashettar, Hi-Tech Health care services, Belgaum, for confirming the identification of the isolate. 

 ~ References Top

1.Prajna NV, Rao RA, Mathen MM, Prajna L, George C, Srinivasan M. Simultaneous bilateral Fungal Keratitis caused by different fungi. Indian J Opthalmol 2002;50:213-214.  Back to cited text no. 1    
2.Vijaya D, Sumathi, Malini. Keratomycosis due to Fusarium oxysporum - A case report. Indian J Pathol Microbial 2001;44(3):337-338.  Back to cited text no. 2    
3.Deshapande SD, Koppikar GV. A study of Mycotic keratitis in Mumbai. Indian J Pathol Microbial 1999;42(1):81-87.  Back to cited text no. 3    
4.Kotigadde S, Ballal M, Jyothirlatha, Kumar A, Rao SRN, Shivananda PG. Mycotic keratitis: A study in costal Karnataka. Indian J Ophthalmol 1992;40(1):31-33.  Back to cited text no. 4    
5.Anandi V, George JA. Phaeohyphomycosis of the eye caused by Exserohilum rostratum in India. Mycoses 1991;34:489-491.  Back to cited text no. 5    
6.Venugopal PV, Venugopal TV, Gomathi A, Ramakrishna ES, Ilavarasi S. Mycotic keratitis in Madras. Indian J Pathol Microbial 1989;32(3):190- 197.  Back to cited text no. 6    
7.Agarwal PK, Roy P, Das A, Banerjee A, Anita, Maity PK, Banerjee AR. Efficacy of topical and systemic itraconazole as a borad spectrum antifungal agent in Mycotic corneal ulcers: A preliminary study. Indian J Optholmol 2001;49:173-176.  Back to cited text no. 7    
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2004 - Indian Journal of Medical Microbiology
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