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2002
Ocular Microbiology and Immunology Group, Abstract 17
OMIG
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Unusual
Plaque Presentation of Dematiaceous Fungal Keratitis : A Clinical
and Histopathologic Study
Prashant Garg, MD, Geeta K. Vemuganti, MD, Samrat Chatarjee, MD,
Usha Gopinathan, PhD, Rishita Nutheti, MSc, Gullapalli N. Rao, MD
L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad
- 500 034.
Purpose:
To evaluate the clinical and histopathological features of pigmented
plaque-
like presentation of dematiaceous fungal keratitis.
Methods:
All microbiology-proven cases of dematiaceous fungal keratitis presenting
with the pigmented plaque were included in the study. The plaque
was removed surgically by superficial keratectomy unless contraindicated
and was subjected to histopathological examination. The clinical,
microbiology and histopathology data were compared with a control
group comprising dematiaceous fungal keratitis cases presenting
with clinical features other than the plaque.
Results:
The entire series consisted of 33 eyes, of which 'plaque' was seen
in 15 eyes (group 1) and diffuse keratitis without plaque lesion
in 18 eyes (group 2). The median duration of symptoms was 30 days
in group 1 (range 7-60 days, mean 27.6 ± 15.6) compared to
12.5 days in group 2 (range 4-90 days, mean 20.17 ± 20.93)
(P = 0.048) but the keratitis was less severe in the former. Microbiology
showed pigmented septate fungal filaments on smear examination in
66.7 % cases in group 1 compared to 5.6% in group 2 where non-pigmented
filaments predominated (83.3%). Histopathology revealed a carpet
of pigmented fungal filaments on the corneal surface associated
with mild to moderate inflammation (n = 11, 84.7%), and absence
of tissue necrosis in group 1 compared to the diffuse spread of
the non-pigmented fungal filaments into deeper layers (n = 10, 62.5%),
severe inflammation (n = 14, 77.8%), and stromal necrosis (n = 17,94.4%)
in group 2.
Conclusions:
The unique plaque-like presentation of dematiaceous fungal keratitis
represents surface colonization of fungal filaments, associated
with expression of pigmentation in the fungal cell wall and mild
to moderate inflammation in the underlying corneal stroma.
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