Infectious corneal ulceration: a proposal for neglected tropical disease status

Ung, Lawson; Acharya, Nisha R.; Agarwal, Tushar; Alfonso, Eduardo C.; Bagga, Bhupesh; Bispo, Paulo José Martins; Burton, Matthew J.; Dart, John; Doan, Thuy; Fleiszig, Suzanne M. J.; Garg, Prashant; Gilmore, Michael S.; Gritz, David C.; Hazlett, Linda D.; Iovieno, Alfonso; Jhanji, Vishal; Kempen, John H.; Lee, Cecilia S.; Lietman, Thomas M.; Margolis, Todd P.; McLeod, Stephen D.; Mehta, J. S.; Miller, Darlene; Pearlman, Eric; Lalitha, Prajna; Prajna, Namperumalsamy Venkatesh; Seitzman, Gerami D.; Shanbhag, Swapna S; Sharma, Namrata; Sharma, Savitri; Srinivasan, Muthiah; Stapleton, Fiona; Tan, Donald; Tandon, Radhika; Taylor, Hugh R.; Tu, Elmer Y.; Tuli, Sonal S.; Vajpayee, Rasik B; Gelder, Russell N. Van; Watson, Stephanie; Zegans, Michael E.; Chodosh, James

doi:10.2471/blt.19.232660

Cited by 56 publications

(40 citation statements)

References 8 publications

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“…IK is a common yet potentially vision-threatening ophthalmic condition, characterised by acute ocular pain, decreased vision, corneal ulceration, and/or stromal infiltrates [ 5 ]. Previously, it has been recognised as a “silent epidemic” in the developing world [ 3 ], and recently, a consortium-led proposal has suggested the designation of IK as a “neglected tropical disease (NTD)” [ 7 ], adding on to the list of NTDs in ophthalmology (i.e. trachoma, onchocerciasis and leprosy).…”

Section: Introductionmentioning

confidence: 99%

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Ting

Deshmukh

et al. 2021

Eye

203

193

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Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5–2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral and Acanthamoeba keratitis are less common, they represent important causes for corneal blindness in the developed countries. Contact lens wear, trauma, ocular surface diseases, lid diseases, and post-ocular surgery have been shown to be the major risk factors for IK. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though its effectiveness is being challenged by the emergence of antimicrobial resistance, including multidrug resistance, in some parts of the world. In this review, we aim to provide an updated review on IK, encompassing the epidemiology, causative microorganisms, major risk factors and the impact of antimicrobial resistance.

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Section: Introductionmentioning

confidence: 99%

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Ting

Deshmukh

et al. 2021

Eye

203

193

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“…Unfortunately, for most people who have FK, access to appropriate diagnosis and treatment is very limited. 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%

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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“…Infectious or microbial keratitis, one of the most serious eye infections, has long been acknowledged as the leading cause of visual impairment and blindness worldwide [2]. Very appropriately, infectious keratitis is now included among neglected tropical diseases by world health organization [3]. Due to the non-specific signs and symptoms, and rapid progression, microbial keratitis is diagnostically challenging for physicians [4].…”

Section: Introductionmentioning

confidence: 99%

Distribution, prevalence, and causative agents of fungal keratitis: A systematic review and meta-analysis (1990 to 2020)

Ahmadikia

Gharehbolagh

Fallah

et al. 2021

Preprint

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Fungal keratitis is a sight-threatening infection with global distribution. In this systematic review and meta-analysis we collected all the articles with data on the prevalence of fungal keratitis among various patient groups from January 1, 1990 to May 27, 2020. The 169 eligible articles were divided into 6 groups. The pooled prevalence was variable with values ranging from 0.05% among post-keratoplasty patients to 43.01% among patients with a clinical suspicion of fungal keratitis. Except for post-keratoplasty cases (yeast: 51.80%), in all patient groups moulds were more common than yeasts. Although more than 50 distinct species of fungi have been found to cause fungal keratitis, Fusarium species followed by Aspergillus species were the most common causes of the disease. In general, 9.29% (95% CI 6.52, 12.38) of fungal keratitis cases were mixed with bacterial agents.

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Infectious corneal ulceration: a proposal for neglected tropical disease status

Cited by 56 publications

References 8 publications

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Mycotic Keratitis—A Global Threat from the Filamentous Fungi

Distribution, prevalence, and causative agents of fungal keratitis: A systematic review and meta-analysis (1990 to 2020)

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