Introduction:

When we hear of tropical diseases, our thoughts often turn to well-known illnesses like malaria or dengue fever. However, there is a hidden menace lurking in the shadows of the tropics that deserves greater attention – fungal keratitis. This debilitating eye infection can lead to severe vision loss if left untreated and predominantly affects individuals in tropical regions. In this blog post, we will explore what fungal keratitis is, its impact on patients, and the compelling reasons why the World Health Organization (WHO) should recognize it as a ‘neglected tropical disease’.

Understanding Fungal Keratitis

Fungal keratitis is an infection that primarily targets the cornea, the transparent outer layer of the eye responsible for focusing light onto the retina. The condition is caused by various types of fungi, with Fusarium, Aspergillus or Candida being the most common culprits. Typically, fungal keratitis develops when the cornea is damaged or compromised, allowing fungi to invade and multiply.

In tropical and subtropical regions, factors like warm and humid climates, agricultural practices, and lack of proper eye care contribute to the higher prevalence of fungal keratitis. Moreover, fungal spores found in soil, plant material, and water sources can easily come into contact with the eyes, leading to infection.

Impact on Patients

Credit: Sushil Dawka, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Fungal keratitis poses a significant threat to ocular health, often resulting in painful symptoms and, in severe cases, permanent vision loss. Patients may experience:

1. Eye Pain, Discharge and Redness: Fungal keratitis can cause intense pain, leading to discomfort and redness in the affected eye.
2. Photophobia: Patients often become highly sensitive to light, experiencing discomfort even in normal indoor lighting conditions.
3. Blurred Vision: As the cornea becomes inflamed and infected, vision becomes increasingly blurred, affecting daily activities like reading and driving.
4. Corneal Ulcers: Fungal infection can lead to the development of corneal ulcers, which can be vision-threatening if not treated promptly.
5. Scarring and Vision Loss: In severe cases, fungal keratitis can lead to corneal scarring and permanent vision loss, impacting an individual’s quality of life and livelihood.

Diagnosis and Treatment Challenges

Early diagnosis is vital to prevent irreversible corneal destruction in fungal keratitis. However, the lack of technical skill in community workers to perform corneal scraping for microscopy and culture, particularly in low- and middle-income countries, hinders timely diagnosis. Traditional microbiological techniques have limitations, making it essential to develop new diagnostic tools that are cost-effective and accessible in resource-limited settings.

Medical management with specific antifungal drugs and surgical interventions are the mainstay of treatment for fungal keratitis. Surgical procedures are often required when medical therapy fails, but access to specialized ophthalmologists for such interventions is also challenging in low-resource settings.

Public Health Consequences:

Fungal keratitis disproportionately affects the working-age population, causing unilateral blindness and hindering individuals’ economic productivity. This condition results in severe disability, reduced quality of life, and increased risk of work-related injuries. The impact extends beyond the individual, affecting their families and communities, perpetuating the cycle of poverty. The social and economic ramifications of fungal keratitis are far-reaching, making it crucial for WHO to address it as a neglected tropical disease.

WHY WHO Should Recognize Fungal Keratitis as a ‘Neglected Tropical Disease’

1. Burden on Public Health: Fungal keratitis represents a substantial public health burden, especially in resource-limited tropical regions. Without proper recognition and targeted interventions, the disease may continue to ravage communities, leading to preventable blindness and disability.
2. Lack of Awareness and Research: Compared to other eye diseases, fungal keratitis often receives inadequate attention in terms of research funding and public awareness campaigns. WHO recognition would stimulate increased research efforts, leading to improved diagnostics, treatments, and preventive strategies.
3. Strengthened Global Collaboration: By classifying fungal keratitis as a neglected tropical disease, WHO can encourage collaboration between governments, healthcare organizations, and non-governmental organizations to address the issue comprehensively.
4. Access to Essential Medications: WHO recognition can pave the way for increased availability and affordability of antifungal medications, making them more accessible to affected communities.
5. Empowering Healthcare Professionals: With WHO’s recognition, healthcare professionals will receive additional training and resources to effectively diagnose and treat fungal keratitis, reducing the risk of misdiagnosis and delayed treatment.

Prevention and The Road to Recognition

To reduce the incidence of fungal keratitis, public health campaigns, early recognition, and prompt referral to healthcare facilities are essential. Prophylactic treatment for corneal abrasions and protective eyewear in high-risk populations could help prevent ocular trauma and subsequent infections. Education of primary healthcare workers and contact lens wearers on proper practices would also aid in early detection and management.

The designation of fungal keratitis as a neglected tropical disease by the World Health Organization (WHO) and other global health agencies would bring much-needed attention to this ocular menace. NTD status would catalyze the implementation of prevention and awareness programs, educate healthcare workers on early signs, and spur the development of more effective antifungal agents.

Top image Credit:Sushil Dawka, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons