Pythium Keratitis In Eastern India: Incidence, Clinical Characteristics, Management, And Treatment Recommendation

To study the demographic profile, clinical features and treatment outcome, of microbiologically proven Pythium keratitis in Eastern India.

Tertiary eye care center of eastern India

A retrospective analysis of clinical records of microbiologically proven Pythium keratitis at a tertiary eye care referral center in Eastern India from January 2022 to December 2024 was performed. Demographic details, predisposing risk factors, detailed microbiological investigations, clinical protocol, and visual outcome were analyzed.

Forty five patients with microbiologically proven Pythium keratitis were identified. The mean age was found 48 years and 50% had contact with unclean water like river and pond. Corneal scraping samples stained with KOH and CFW showed 93.8% positivity and Iodine-potassium iodide-sulfuric acid showed 100% positivity. Culture and pcr positivity found 58% and 88%. Antibiotic sensitivity was done by Kirby-Bauer disc diffusion method and showed mean zone of inhibition as 28mm for Linezolid.  Medical management was initied with topical linezolid and oral azithromycin. Therapeutic penetrating keratoplasty (TPK) was done in 15 eyes (33%), repeat TPK in 4 eyes. Late presenters had more complications and worse final visual outcome.

Pythium keratitis can be differentiated from fungal keratitis by its clinical appearance on slit-lamp examination, smear, culture, and histopathology. Early presentation, detection, and treatment with antibacterial medication like linezolid and azithromycin results in a better prognosis. Early full-thickness corneal transplant should be considered for Pythium keratitis not responding to treatment.