The Case for Fungal Keratitis to Be Accepted as a Neglected Tropical Disease

Abstract

Amongst the treatable cause of blindness among young people, fungal keratitis ranks high. There are an estimated 1,051,787 to 1,480,916 eyes affected annually, with 8-11% of patients having to have the eye removed. Diagnosis requires a corneal scraping, direct microscopy and fungal culture with a large number of airborne fungi implicated. Treatment involves the intensive application of antifungal eye drops, preferably natamycin, often combined with surgery. In low-resource settings, inappropriate corticosteroid eye drops, ineffective antibacterial therapy, diagnostic delay or no diagnosis all contribute to poor ocular outcomes with blindness (unilateral or bilateral) common. Modern detailed guidelines on fungal keratitis diagnosis and management are lacking. Here, we argue that fungal keratitis should be included as a neglected tropical disease, which would facilitate greater awareness of the condition, improved diagnostic capability, and access to affordable antifungal eye medicine.

Keywords: blindness; fungal keratitis; neglected tropical diseases.

Figure 1

Corneal ulcer caused by Fusarium spp. at first presentation. Source: Mycotic Ulcer Treatment Trial, Aravind Eye Hospital, Tamil Nadu, India.

Figure 2

Corneal ulcer caused by Fusarium spp. 1 month later. Source: Mycotic Ulcer Treatment Trial, Aravind Eye Hospital, Tamil Nadu, India.

Figure 3

Corneal ulcer caused by Fusarium spp. at 3 months. Source: Mycotic Ulcer Treatment Trial, Aravind Eye Hospital, Tamil Nadu, India.