{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:37Z","timestamp":1792788757122,"version":"4.5.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Research Unit,Indira Gandhi Institute of Medical Sciences, Patna (Bihar) India","award":["IGIMS\/MRU\/17\/2024"],"award-info":[{"award-number":["IGIMS\/MRU\/17\/2024"]}],"id":[{"id":"https:\/\/ror.org\/049pcfs17","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the demographics, predisposing factors, microbiological profile, management, and outcomes of pediatric microbial keratitis in Eastern India, with particular emphasis on age-related differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This prospective study included children with clinically diagnosed microbial keratitis between April 2024 and September 2025. Clinical, microbiological, nutritional, treatment, and outcome data were recorded. Children were categorized into two age groups:\u2009\u2264\u20095 years and &gt;5 years for comparative analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-nine eyes of 86 children were analyzed. The mean age was 5.9\u2009\u00b1\u20094.8 years, and 42 of 86 children were aged \u22645 years. Bilateral keratitis was observed exclusively in children \u22645 years (p\u2009&lt;\u20090.05). Systemic risk factors such as undernutrition and vitamin A deficiency, diarrhea, and fever were significantly more common in children \u22645 years; in contrast, corneal injury was the predominant risk factor in children &gt;5 years. Mean duration of presentation, ulcer size, and ulcer severity did not differ significantly between the two age groups, although perforation at presentation was more frequent in children &gt;5 years. Fungal keratitis was significantly more common in children &gt;5 years, whereas unidentified cases were more frequent in \u22645 years. Corneal ulcers resolved with medical therapy alone in 59.6% of eyes. Surgery was required in 40.4% of eyes overall, including 18.2% of eyes in children \u22645 years and 22.2% in children &gt;5 years. At 3 months, corneal opacity was the most common outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pediatric microbial keratitis showed clear age-related differences. Younger children were more often affected by systemic and nutritional vulnerability with predominantly sterile or bacterial keratitis, whereas older children had more trauma-related and fungal disease. Early referral, improved nutritional support, and timely globe-preserving management may reduce visual loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conference presentation<\/jats:title>\n                    <jats:p>This research work has been selected for presentation at ARVO 2026, Denver, Colo. May 3 - 7<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359943","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:29:12Z","timestamp":1791998952000},"page":"e0359943","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age-related differences in the clinical and microbiological profile of pediatric microbial keratitis in Eastern India"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9253-5755","authenticated-orcid":true,"given":"Rakhi","family":"Kusumesh","sequence":"first","affiliation":[{"name":"Cornea and ocular surface services, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences","place":["Patna, Bihar, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2572-0456","authenticated-orcid":true,"given":"Nancy","family":"Panday","sequence":"additional","affiliation":[{"name":"Cornea and ocular surface services, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences","place":["Patna, Bihar, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalan Kumar","family":"Arya","sequence":"additional","affiliation":[{"name":"Microbiology services, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences","place":["Patna, Bihar, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizwan","family":"Ahmar","sequence":"additional","affiliation":[{"name":"Indira Gandhi Institute of Medical Sciences","place":["Patna, Bihar, India"],"department":["Department of 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Ophthalmol"},{"issue":"2","key":"pone.0359943.ref006","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.sjopt.2011.10.002","article-title":"Non-viral microbial keratitis in children","volume":"26","author":"AG Al-Otaibi","year":"2012","journal-title":"Saudi J Ophthalmol"},{"key":"pone.0359943.ref007","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1471-2415-13-54","article-title":"Clinical and microbiological profile of infectious keratitis in children","volume":"13","author":"P Chirinos-Salda\u00f1a","year":"2013","journal-title":"BMC Ophthalmol"},{"issue":"2","key":"pone.0359943.ref008","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/01.ico.0000167881.78513.d9","article-title":"Microbial keratitis at extremes of age","volume":"25","author":"P Parmar","year":"2006","journal-title":"Cornea"},{"issue":"4","key":"pone.0359943.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajo.2011.03.010","article-title":"Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular micRorganisms (ARMOR) 2009 surveillance study","volume":"152","author":"W Haas","year":"2011","journal-title":"Am J Ophthalmol"},{"issue":"12","key":"pone.0359943.ref010","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1136\/bjophthalmol-2015-307631","article-title":"Clinical and microbiological study of paediatric infectious keratitis in South India: a 3-year study (2011-2013)","volume":"100","author":"L Aruljyothi","year":"2016","journal-title":"Br J Ophthalmol"},{"issue":"6","key":"pone.0359943.ref011","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1136\/bjo.2009.169607","article-title":"Geographic variations in microbial keratitis: an analysis of the peer-reviewed literature","volume":"95","author":"A Shah","year":"2011","journal-title":"Br J Ophthalmol"},{"issue":"3","key":"pone.0359943.ref012","doi-asserted-by":"crossref","first-page":"185","DOI":"10.47102\/annals-acadmedsg.V35N3p185","article-title":"Multivariate analysis of childhood microbial keratitis in South India","volume":"35","author":"G Singh","year":"2006","journal-title":"Ann Acad Med Singap"},{"issue":"3","key":"pone.0359943.ref013","doi-asserted-by":"crossref","first-page":"434","DOI":"10.4103\/ijo.IJO_928_19","article-title":"Demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India","volume":"68","author":"M Singh","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"pone.0359943.ref014","article-title":"Bacterial keratitis","volume-title":"StatPearls","author":"B Gurnani","year":"2026"},{"key":"pone.0359943.ref015","volume-title":"Performance standards for antimicrobial susceptibility testing, 21st informational supplement","author":"Clinical and Laboratory Standards Institute","year":"2011"},{"key":"pone.0359943.ref016","unstructured":"Ministry of Health and Family Welfare, Government of India. National Immunization Schedule. National Health Mission website. Accessed 2026 April 9."},{"key":"pone.0359943.ref017","unstructured":"World Health Organization. Malnutrition in children. https:\/\/www.who.int\/data\/nutrition\/nlis\/info\/malnutrition-in-children Accessed 2026 April 9."},{"key":"pone.0359943.ref018","volume-title":"Vitamin A supplementation in children 6\u201359 months of age with severe acute malnutrition","author":"World Health Organization","year":"2019"},{"issue":"11","key":"pone.0359943.ref019","doi-asserted-by":"crossref","first-page":"3964","DOI":"10.4103\/jfmpc.jfmpc_600_21","article-title":"Socioeconomic status scales: Revised Kuppuswamy, BG Prasad, and Udai Pareekh\u2019s scale updated for 2021","volume":"10","author":"S Majumder","year":"2021","journal-title":"J Family Med Prim Care"},{"issue":"3","key":"pone.0359943.ref020","doi-asserted-by":"crossref","first-page":"841","DOI":"10.4103\/ijo.IJO_1314_22","article-title":"A study on childhood microbial keratitis in South India","volume":"71","author":"MP Chandratreya","year":"2023","journal-title":"Indian J Ophthalmol"},{"issue":"5","key":"pone.0359943.ref021","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1097\/00003226-199909000-00009","article-title":"Risk factors for pediatric presumed microbial keratitis: a case-control study","volume":"18","author":"RB Vajpayee","year":"1999","journal-title":"Cornea"},{"issue":"1","key":"pone.0359943.ref022","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12348-024-00414-0","article-title":"Infectious keratitis in pediatric population aged less than two years: a tertiary eye institute experience","volume":"14","author":"M Soleimani","year":"2024","journal-title":"J Ophthalmic Inflamm Infect"},{"issue":"2","key":"pone.0359943.ref023","doi-asserted-by":"crossref","first-page":"136","DOI":"10.5301\/EJO.2011.8338","article-title":"Pediatric microbial keratitis: a tertiary hospital study","volume":"22","author":"X Song","year":"2012","journal-title":"Eur J Ophthalmol"},{"issue":"2","key":"pone.0359943.ref024","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/S0161-6420(98)92899-8","article-title":"Microbial keratitis in children","volume":"105","author":"DY Kunimoto","year":"1998","journal-title":"Ophthalmology"},{"issue":"6","key":"pone.0359943.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajo.2011.01.006","article-title":"Immunization and nutritional profile of cases with atraumatic microbial keratitis in preschool age group","volume":"151","author":"V Jhanji","year":"2011","journal-title":"Am J Ophthalmol"},{"key":"pone.0359943.ref026","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ajo.2016.08.031","article-title":"Survival of Primary Penetrating Keratoplasty in Children","volume":"171","author":"R Karadag","year":"2016","journal-title":"Am J Ophthalmol"},{"issue":"4","key":"pone.0359943.ref027","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1136\/adc.72.4.330","article-title":"Childhood blindness due to vitamin A deficiency in India: regional variations","volume":"72","author":"JS Rahi","year":"1995","journal-title":"Arch Dis Child"},{"issue":"3","key":"pone.0359943.ref028","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1097\/00003226-199905000-00009","article-title":"Indications for pediatric keratoplasty in India","volume":"18","author":"T Dada","year":"1999","journal-title":"Cornea"},{"issue":"2","key":"pone.0359943.ref029","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.survophthal.2008.12.011","article-title":"Pediatric keratoplasty","volume":"54","author":"M Vanathi","year":"2009","journal-title":"Surv Ophthalmol"},{"issue":"5","key":"pone.0359943.ref030","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1136\/bjo.71.5.331","article-title":"Corneal ulceration, measles, and childhood blindness in Tanzania","volume":"71","author":"A Foster","year":"1987","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0359943.ref031","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10792-025-03703-2","article-title":"Clinical and histologic characterization of vitamin A deficiency in children undergoing penetrating keratoplasty","volume":"45","author":"DR Baker","year":"2025","journal-title":"Int Ophthalmol"},{"issue":"1","key":"pone.0359943.ref032","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S1350-9462(97)00001-3","article-title":"Xerophthalmia and vitamin A status","volume":"17","author":"A Sommer","year":"1998","journal-title":"Prog Retin Eye Res"},{"issue":"3","key":"pone.0359943.ref033","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1093\/clinids\/19.3.489","article-title":"Vitamin A, immunity, and infection","volume":"19","author":"RD Semba","year":"1994","journal-title":"Clin Infect Dis"},{"key":"pone.0359943.ref034","volume-title":"Vitamin A deficiency and its consequences: a field guide to detection and control","author":"A Sommer","year":"1995","edition":"3"},{"key":"pone.0359943.ref035","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1023\/A:1017939725776","article-title":"Keratitis","volume":"21","author":"S Sharma","year":"2001","journal-title":"Biosci Rep"},{"key":"pone.0359943.ref036","doi-asserted-by":"crossref","DOI":"10.1301\/00296640260130722","article-title":"Micronutrient malnutrition, infection, and immunity: an overview","volume":"60","author":"P Bhaskaram","year":"2002","journal-title":"Nutr Rev"},{"issue":"4","key":"pone.0359943.ref037","first-page":"383","article-title":"Mortality and morbidity pattern in measles in Tanga District, Tanzania","volume":"27","author":"BM Gupta","year":"1975","journal-title":"Trop Geogr Med"},{"issue":"10","key":"pone.0359943.ref038","doi-asserted-by":"crossref","first-page":"2771","DOI":"10.1007\/s10792-020-01451-z","article-title":"A global perspective of pediatric non-viral keratitis: literature review","volume":"40","author":"A Di Zazzo","year":"2020","journal-title":"Int Ophthalmol"},{"issue":"11","key":"pone.0359943.ref039","doi-asserted-by":"crossref","first-page":"3506","DOI":"10.4103\/IJO.IJO_1605_23","article-title":"Epidemiological and microbiological profiles of microbial keratitis in a tertiary eye center in Eastern India (Bihar)","volume":"71","author":"R Kusumesh","year":"2023","journal-title":"Indian J Ophthalmol"},{"issue":"7","key":"pone.0359943.ref040","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1097\/ICO.0000000000000138","article-title":"Neonatal infectious keratitis","volume":"33","author":"S Chaurasia","year":"2014","journal-title":"Cornea"},{"issue":"9","key":"pone.0359943.ref041","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1097\/ICO.0000000000002957","article-title":"Pediatric Microbial Keratitis: Identification of Clinical Biomarkers for Prognosis and Outcome of 218 Cases From 2009 to 2019","volume":"41","author":"A Di Zazzo","year":"2022","journal-title":"Cornea"},{"issue":"11","key":"pone.0359943.ref042","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1136\/bjophthalmol-2016-310119","article-title":"Paediatric infectious keratitis: a case series of 107 children presenting to a tertiary referral centre","volume":"101","author":"JD Rossetto","year":"2017","journal-title":"Br J Ophthalmol"},{"issue":"7","key":"pone.0359943.ref043","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1097\/ICO.0000000000003105","article-title":"Trends in the Microbiological Spectrum of Nonviral Keratitis at a Single Tertiary Care Ophthalmic Hospital in India: A Review of 30 years","volume":"42","author":"J Joseph","year":"2023","journal-title":"Cornea"},{"issue":"1","key":"pone.0359943.ref044","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/0974-620X.149862","article-title":"Graft rejection in pediatric penetrating keratoplasty: Clinical features and outcomes","volume":"8","author":"R Kusumesh","year":"2015","journal-title":"Oman J Ophthalmol"},{"issue":"3","key":"pone.0359943.ref045","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/S0161-6420(90)32586-1","article-title":"Penetrating keratoplasty in infants and children","volume":"97","author":"JW Cowden","year":"1990","journal-title":"Ophthalmology"}],"container-title":["PLOS 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