R Husain

Chittagong Eye Infirmary & Training Complex, Chittagong Ghat, Chittagong, Bangladesh

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Publications (5)6.73 Total impact

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    ABSTRACT: The management of suppurative keratitis due to filamentous fungi presents severe problems in tropical countries. The aim was to demonstrate the efficacy of chlorhexidine 0.2% drops as an inexpensive antimicrobial agent, which could be widely distributed for fungal keratitis. Successive patients presenting to the Chittagong Eye Institute and Training Complex with corneal ulcers were admitted to the trial when fungal hyphae had been seen on microscopy. They were randomised to drop treatment with chlorhexidine gluconate 0.2% or the standard local treatment natamycin 2.5%. The diameters, depths, and other features of the ulcers were measured and photographed at regular intervals. The outcome measures were healing at 21 days and presence or absence of toxicity. If there was not a favourable response at 5 days, "treatment failure" was recorded and the treatment was changed to one or more of three options, which included econazole 1% in the latter part of the trial. 71 patients were recruited to the trial, of which 35 were randomised to chlorhexidine and 36 to natamycin. One allocated to natamycin grew bacteria and therefore was excluded from the analysis. None of the severe ulcers was fully healed at 21 days of treatment, but three of those allocated to chlorhexidine eventually healed in times up to 60 days. Of the nonsevere ulcers, 66.7% were healed at 21 days with chlorhexidine and 36.0% with natamycin, a relative efficacy (RE) of 1.85 (CL 1.01-3.39, p = 0.04). If those ulcers were excluded where fungi were seen in the scraping but did not grow on culture, the estimated efficacy ratio does not change but becomes less precise because of smaller numbers. Equal numbers of Aspergillus (22) and Fusarium (22) were grown. The Aspergillus were the most resistant to either primary treatment. Chlorhexidine may have potential as an inexpensive topical agent for fungal keratitis and warrants further assessment as a first line treatment in situations where microbiological facilities and a range of antifungal agents are not available.
    British Journal of Ophthalmology 09/1998; 82(8):919-25. · 2.73 Impact Factor
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    ABSTRACT: Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.
    Australian and New Zealand Journal of Ophthalmology 06/1994; 22(2):105-10.
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    ABSTRACT: Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary, Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.
    Australian and New Zealand Journal of Ophthalmology 04/1994; 22(2):105 - 110.
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    ABSTRACT: A case of Dichotomophthoropsis nymphaearum, a dematiaceous hyphomycete, is described from Bangladesh. This species has not previously been reported as a human pathogen. Hyphae were observed in Gram stained corneal scrapings and the species was grown from cultured corneal material. Treatment with topical econazole and subconjunctival injections of miconazole was successful in the short term but long-term outcome could not be determined. The results of sensitivity tests for six antifungal drugs are reported for the isolate.
    Mycoses 01/1990; 33(9-10):477-81. · 1.28 Impact Factor
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    ABSTRACT: Experience in setting up an inexpensive microbiology laboratory in the Bangladesh National Society for the Blind Eye Hospital and Training Complex at Chittagong is presented, together with the results of a pilot study to identify organisms responsible in 33 consecutive cases of suppurative keratitis in the Chittagong area of Bangladesh. Of the 33 cases 21 were positively identified by means of Gram stain and/or culture. Two-thirds of the responsible organisms were bacteria, and one-third were fungi. The bacterial causes included Streptococcus pneumoniae and Pseudomonas aeruginosa. The fungi isolated were Aspergillus fumigatus, Aspergillus ochraceus, and Fusarium solani. Among the causes of failure to diagnose the organism was chronicity of infection and previous treatment. The value of the study in the planning of future treatment regimens, and the implications of setting up similar relatively cheap microbiology laboratory facilities in developing countries, are discussed.
    British Journal of Ophthalmology 05/1987; 71(4):315-21. · 2.73 Impact Factor

Publication Stats

135 Citations
6.73 Total Impact Points

Institutions

  • 1994
    • Chittagong Eye Infirmary & Training Complex
      Chittagong Ghat, Chittagong, Bangladesh