The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance
Lawson Ung1, Paulo J M Bispo2, Swapna S Shanbhag3
1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Abstract:
Microbial keratitis is a potentially blinding condition that must be treated emergently to preserve vision. Although long recognized as a significant cause of corneal blindness, our understanding of its true global scale, associated burden of disease, and etiological patterns remains somewhat limited. Current epidemiological data suggest that microbial keratitis may be epidemic in parts of the world-particularly within South, South-East, and East Asia-and may exceed 2 million cases per year worldwide. Etiological patterns vary between economically developed and developing countries, with bacterial predominance in the former and fungal predominance in the latter. The key to effective management lies in timely diagnosis; however, the current gold standard of stain and culture remains time consuming and often yields no clinically useful results. For this reason, there are attempts to develop highly sensitive and accurate molecular diagnostic tools to provide rapid diagnosis, inform treatment decision making, and minimize the threat of antimicrobial resistance. We provide an overview of these key areas and of avenues for further research toward the goal of more effectively addressing the problem of microbial keratitis on both an individual and public health level.
Insights
Microbial keratitis, a leading cause of corneal blindness, affects over 2 million people annually. Rapid molecular diagnostics are crucial for timely treatment and preventing vision loss.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Epidemiology
Background:
- Microbial keratitis is a significant cause of corneal blindness globally.
- Epidemiological data suggest over 2 million cases annually, with higher prevalence in Asia.
- Etiological patterns differ between developed (bacterial) and developing (fungal) countries.
Purpose of the Study:
- To review the global scale and etiological patterns of microbial keratitis.
- To highlight the limitations of current diagnostic methods.
- To discuss the development and importance of molecular diagnostic tools.
Main Methods:
- Literature review of epidemiological data and diagnostic techniques.
- Analysis of etiological patterns based on economic development.
- Overview of advancements in molecular diagnostics for microbial keratitis.
Main Results:
- Microbial keratitis may be epidemic, exceeding 2 million cases yearly.
- Bacterial infections dominate in developed nations, while fungi are more prevalent in developing countries.
- Current diagnostics (stain and culture) are slow and often inconclusive.
Conclusions:
- Timely diagnosis is critical for managing microbial keratitis and preserving vision.
- Molecular diagnostic tools offer rapid and accurate detection, improving treatment decisions.
- Further research is needed to combat microbial keratitis effectively on a public health level.
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