A comparison study of infective corneal ulceration in Non HIV and HIV infected patients at Muhimbili National Hospital Dar es Salaam

Abstract

This cross sectional descriptive and comparative study was conducted at Muhimbili National Hospital from May 2007 to May 2008. The study population included 186 patients who attended the ophthalmology department during the study period who were diagnosed to have infective corneal ulceration. The main objective was to determine the clinical presentation of infective corneal ulceration and correlate it to the HIV serological status of the patients. Social, demographic data and information pertaining to risk factors were recorded. Patients underwent clinical examination to determine the visual acuity, size, depth of the corneal ulcer and the presence of hypopyon and perforation. Corneal scraping was performed and specimen sent for the laboratory analysis. ELISA test to screen for HIV infection after pretest counseling was performed in each participant. Most (85.9%) affected patients were in the age range between 20-49 years with a peak at 30-39 years comprising 41.9% (Table. 1) There were hundred twenty four (66.7%) males and sixty two (33.3%) females. More than half of the study populations were petty traders while 19.4% were peasant. Most (72.0%) of the corneal ulcer patients were either cohabiting or single.

One hundred eleven (59.7%) of the study population were HIV seropositive and seventy five (40.3%) were HIV seronegative.

Bacteria were the most common cause of corneal ulceration affecting (46.24%) of the study population. The second commonest cause of the corneal ulceration was fungal infection which accounted for 39.2%.

The commonest cause of corneal ulceration In HIV seropositive patients was Fungus which occurred in 53.2% of patients.

Most (72.0%) of the 25 viral corneal ulceration were in HIV seropositve patients. Compared to ulcers in HIV seronegative patients, ulcers in HIV seropositive patients were more severe in clinical presentation and poor post treatment visual outcome.

In conclusion the study has shown that more than half of patients with corneal ulceration are HIV seropositive. The ulcers in these patients are severe in clinical presentation and have poor post treatment visual outcome. Although bacteria are the commonest cause of corneal ulcers, fungal infection dominates in HIV seropositive patients.

Efforts to screen for HIV in all patients presenting with corneal ulceration in order to offer multi-displinary approach to their management is recommended.