Delay Along the Care Seeking Journey of Patients with Microbial Keratitis in Uganda

Arunga, Simon; Kintoki, Guyguy M; Gichuhi, Stephen; Onyango, John; Newton, Robert; Leck, Astrid; Macleod, David; Hu, Victor; Burton, Matthew J.

doi:10.1080/09286586.2019.1616775

Cited by 15 publications

(22 citation statements)

References 24 publications

(34 reference statements)

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“…A study 249 from Uganda illustrates several challenges in integrating eye health services into primary health care and connecting people to secondary services ( appendix 2 p 11 ). This study documented the journey of people with severe corneal infections seeking health care.…”

Section: Section 6: Beyond 2020—delivering High-quality Universal Eyementioning

confidence: 99%

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

Burton

Ramke

Marques

et al. 2021

The Lancet Global Health

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Eye health is essential to achieve the Sustainable Development Goals; vision needs to be reframed as a development issue There is extensive evidence showing that improving eye health contributes directly and indirectly to achieving many Sustainable Development Goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. Improving eye health is a practical and cost-effective way of unlocking human potential. Eye health needs to be reframed as an enabling, cross-cutting issue within the sustainable development framework. Almost everyone will experience impaired vision or an eye condition during their lifetime and require eye care services; urgent action is necessary to meet the rapidly growing eye health need In 2020, 1•1 billion people had distance vision impairment or uncorrected presbyopia. By 2050, this figure is expected to rise to 1•8 billion. Most affected people live in low-income and middle-income countries (LMICs) with avoidable causes of vision impairment. During the life course, most people will experience vision impairment, even if just the need for reading glasses. Because of unmet needs and an ageing global population, eye health is a major public health and sustainable development concern which warrants urgent political action. Eye health is an essential component of universal health coverage; it must be included in planning, resourcing, and delivery of health care Universal health coverage is not universal without affordable, high quality, equitable eye care. In line with the WHO World report on vision, we urge countries to consider eye care as an essential service within universal health coverage. To deliver comprehensive services including promotion, prevention, treatment, and rehabilitation, eye care needs to be included in national strategic health plans and development policies, health financing structures, and health workforce planning. Coordinated intersectoral action is needed to systematically improve population eye health, also within healthy ageing initiatives, schools, and the workplace. Integration of eye health services with multiple relevant components of health service delivery and at all levels of the health system is of central importance.

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Section: Section 6: Beyond 2020—delivering High-quality Universal Eyementioning

confidence: 99%

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

Burton

Ramke

Marques

et al. 2021

The Lancet Global Health

Self Cite

646

572

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“…This adds to the challenge to accurately and confidently diagnose fungal keratitis on clinical grounds alone. Compounding this is the pleomorphic presentation as a result of late presentation, prior use of topical steroids or traditional eye remedies that unfortunately often occurs frequently in the regions where fungal keratitis is most prevalent [ 18 ].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…To help address this apparent “neglect”, there has been a recent push for fungal keratitis, as part of microbial keratitis, to be included in the World Health Organization’s list of neglected tropical diseases (NTDs), which would help focus global attention and funding [ 233 ]. As it stands, there are a number of key areas where there are challenges and significant unmet needs, where addressing these may greatly reduce the morbidity associated with FK: Delay in presentation leading to poor outcomes [ 1 , 18 ] Use of traditional eye medicine and inappropriate use of conventional medicines [ 1 , 19 , 20 ] Limited relevant ophthalmic formal training of front-line health workers [ 1 ] Limited or no access to appropriate diagnostic investigations Topical antifungals are frequently unavailable [ 1 ] FK is challenging to treat, and treatment failure is common [ 1 , 22 , 23 , 24 , 25 , 26 ] …”

Section: Unsolved Problems and Future Workmentioning

confidence: 99%

“…Unfortunately, presentation to an appropriate eye care provider is usually delayed, with patients often taking a convoluted journey to reach an ophthalmic clinician [ 18 ]. Compounding this is the fact that patients often self-medicate with traditional eye medicine which commonly contains non-sterile plant matter, or inappropriate conventional medication (such as topical corticosteroids), exacerbating disease [ 1 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Primary health-care workers have little training in recognising, treating or referring MK [ 21 ]. This delay leads to advanced infections, which have poor outcomes [ 1 , 18 ]. Accurate diagnosis remains challenging as it is frequently not possible to clinically distinguish bacterial and fungal MK.…”

Section: Introductionmentioning

confidence: 99%

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Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Hoffman

Burton

Leck

2021

JoF

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Mycotic or fungal keratitis (FK) is a sight-threatening disease, caused by infection of the cornea by filamentous fungi or yeasts. In tropical, low and middle-income countries, it accounts for the majority of cases of microbial keratitis (MK). Filamentous fungi, in particular Fusarium spp., the aspergilli and dematiaceous fungi, are responsible for the greatest burden of disease. The predominant risk factor for filamentous fungal keratitis is trauma, typically with organic, plant-based material. In developed countries, contact lens wear and related products are frequently implicated as risk factors, and have been linked to global outbreaks of Fusarium keratitis in the recent past. In 2020, the incidence of FK was estimated to be over 1 million cases per year, and there is significant geographical variation; accounting for less than 1% of cases of MK in some European countries to over 80% in parts of south and south-east Asia. The proportion of MK cases is inversely correlated to distance from the equator and there is emerging evidence that the incidence of FK may be increasing. Diagnosing FK is challenging; accurate diagnosis relies on reliable microscopy and culture, aided by adjunctive tools such as in vivo confocal microscopy or PCR. Unfortunately, these facilities are infrequently available in areas most in need. Current topical antifungals are not very effective; infections can progress despite prompt treatment. Antifungal drops are often unavailable. When available, natamycin is usually first-line treatment. However, infections may progress to perforation in ~25% of cases. Future work needs to be directed at addressing these challenges and unmet needs. This review discusses the epidemiology, clinical features, diagnosis, management and aetiology of FK.

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Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis

Gunasekaran,

Chandrasekaran,

Rajarathinam

et al. 2023

JAMA Ophthalmol

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ImportanceMicrobial keratitis (MK) is a common cause of unilateral visual impairment, blindness, and eye loss in low-income and middle-income countries. There is an urgent need to develop and implement rapid and simple point-of-care diagnostics for MK to increase the likelihood of good outcomes.ObjectiveTo evaluate the diagnostic performance of the Aspergillus-specific lateral-flow device (AspLFD) to identify Aspergillus species causing MK in corneal scrape and corneal swab samples of patients presenting with microbial keratitis.Design, Setting, and ParticipantsThis diagnostic study was conducted between May 2022 and January 2023 at the corneal clinic of Aravind Eye Hospital in Madurai, Tamil Nadu, India. All study participants were recruited during their first presentation to the clinic. Patients aged 15 years or older met the eligibility criteria if they were attending their first appointment, had a corneal ulcer that was suggestive of a bacterial or fungal infection, and were about to undergo diagnostic scrape and culture.Main Outcomes and MeasuresSensitivity and specificity of the AspLFD with corneal samples collected from patients with MK. During routine diagnostic scraping, a minimally invasive corneal swab and an additional corneal scrape were collected and transferred to aliquots of sample buffer and analyzed by lateral-flow device (LFD) if the patient met the inclusion criteria. Photographs of devices were taken with a smartphone and analyzed using a ratiometric approach, which was developed for this study. The AspLFD results were compared with culture reports.ResultsThe 198 participants who met the inclusion criteria had a mean (range) age of 51 (15-85) years and included 126 males (63.6%). Overall, 35 of 198 participants with corneal scrape (17.7%) and 17 of 40 participants with swab samples (42.5%) had positive culture results for Aspergillus species. Ratiometric analysis results for the scrape samples found that the AspLFD achieved high sensitivity (0.89; 95% CI, 0.74-0.95), high negative predictive value (0.97; 95% CI, 0.94-0.99), low negative likelihood ratio (0.12; 95% CI, 0.05-0.30), and an accuracy of 0.94 (95% CI, 0.90-0.97). Ratiometric analysis results for the swab samples showed that the AspLFD had high sensitivity (0.94; 95% CI, 0.73-1.00), high negative predictive value (0.95; 95% CI, 0.76-1.00), low negative likelihood ratio (0.07; 95% CI, 0.01-0.48), and an accuracy of 0.88 (95% CI, 0.73-0.96).Conclusions and RelevanceResults of this diagnostic study suggest that AspLFD along with the ratiometric analysis of LFDs developed for this study has high diagnostic accuracy in identifying Aspergillus species from corneal scrapes and swabs. This technology is an important step toward the provision of point-of-care diagnostics for MK and could inform the clinical management strategy.

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Delay Along the Care Seeking Journey of Patients with Microbial Keratitis in Uganda

Cited by 15 publications

References 24 publications

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis

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