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Rare and emerging bacterial and fungal pathogens in infectious keratitis

Prathishtha Pitchyaiah1, Rachel A F Wozniak1

  • 1Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, United States.

The Ocular Surface
|July 15, 2026
PubMed

Insights

Infectious keratitis (corneal infection) is a leading cause of blindness. This review details rare and emerging bacterial and fungal pathogens, aiding diagnosis and treatment of this vision-threatening disease.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Infectious keratitis (IK) is a significant global cause of blindness, often resulting from bacterial, fungal, viral, or protozoan infections.
  • While common pathogens are well-documented, advancements in diagnostics reveal rare and emerging organisms, complicating patient management and treatment.
  • Shifting IK epidemiology necessitates continuous updates on causative agents and their clinical impact.

Purpose of the Study:

  • To synthesize current literature on rare and emerging bacterial and fungal pathogens causing infectious keratitis between 2015-2025.
  • To provide insights into global distribution, risk factors, interventions, and outcomes for these challenging IK cases.
  • To enhance the accurate diagnosis and effective treatment of vision-threatening infectious keratitis.

Main Methods:

  • Comprehensive literature review focusing on infectious keratitis pathogens reported between 2015-2025.
  • Categorization of pathogens into 'rare' (<3 cases/10 years) and 'emerging' (≥3 cases/10 years).
  • Analysis of global distribution, clinical risk factors, medical/surgical interventions, and patient outcomes.

Main Results:

  • Identified 26 rare and 9 emerging bacterial pathogens, alongside 42 rare and 10 emerging fungal pathogens associated with IK.
  • Detailed the global epidemiology and specific clinical characteristics of these identified rare and emerging IK pathogens.
  • Summarized current medical and surgical management strategies and their associated clinical outcomes.

Conclusions:

  • Rare and emerging pathogens represent a growing challenge in infectious keratitis diagnosis and treatment.
  • Understanding the epidemiology and clinical features of these organisms is crucial for improving patient outcomes.
  • This review provides a critical update for clinicians managing complex cases of infectious keratitis.
Keywords:
Corneal ulcersEmerging pathogensInfectious keratitis

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