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Bacterial and Fungal Keratitis: Current Trends in Its Diagnosis and Management

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Abstract

Purpose of Review

Infectious keratitis is the fifth most prevalent cause of blindness worldwide. The primary diagnostic test to identify the pathogenic organism is the culture of corneal scraping. However microbial culture positivity is low and varies widely due to many underlying factors. Therefore, there is a need to understand the prevalence of such cases and what modern tools can be employed to diagnose them.

Recent Findings

Contact lens usage, ocular injuries, and ocular surface disease have been reported to be primary risk factors for keratitis with infection of pathogens such as Staphylococcus spp., Pseudomonas aeruginosa, Fusarium spp., Candida spp., and Acanthamoeba spp. Advanced imaging techniques, such as in vivo confocal microscopy and anterior segment optical coherence tomography (OCT), and polymerase chain reaction (PCR) and other molecular techniques have been used to identify the specific causative agents of infectious keratitis more rapidly and accurately than traditional culture methods. However, microbial culture positivity is low and varies widely due to many underlying factors.

Summary

In vivo confocal microscopy and polymerase chain reaction (PCR) testing can support the diagnosis of infectious keratitis. Initial treatment for bacterial keratitis (BK) is with antimicrobials primarily fluoroquinolones, while topical natamycin (an antifungal anti-protozoal) is the drug of choice for fungal keratitis. Additionally, PCR and other molecular methods are utilized to corroborate the initial diagnosis or where routine microbial cultures are negative. This review provides current information for diagnosing microbial culture negative keratitis patients. Earlier diagnosis with modern tools could decrease incidence of corneal opacity, vision loss, or even the loss of an eye in keratitis patients.

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Acknowledgements

Authors are thankful to their respective institutes for providing the requisite platform to write this manuscript.

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Authors and Affiliations

  1. Department of Bio-Sciences and Technology, Maharishi Markandeshwar (Deemed to Be University), Mullana-Ambala, 133207, Haryana, India

    Surya Prakash Sharma

  2. Eye Research Lab, Advanced Eye Centre, PGIMER, Chandigarh, India

    Surya Prakash Sharma

  3. Chandigarh Cornea Clinic, Bharat Vikas Parishad Charitable Medical Centre, Inside Indira Holiday Home Sector 24, Chandigarh, 160023 U.T., India

    Sujata Dwivedi

  4. Department of Microbiology, Graphic Era Deemed to be University, Dehradun, Uttarakhand, India

    Sunil Kumar

  5. Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, UP, India

    Kuldeep Dhama

  6. Department of Biotechnology, Amity University, Sector-82-A, IT City Road, Mohali, Punjab, India, 140306

    Anil Kumar Sharma

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  1. Surya Prakash Sharma
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  2. Sujata Dwivedi
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  3. Sunil Kumar
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  4. Kuldeep Dhama
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Contributions

SPS: conceptualization, data curation, writing original draft, reviewing and editing. SD and SK: data curation, figure preparation, reviewing and editing. KD: analysis, reviewing and editing. Anil K. Sharma: reviewing and editing, visualization, supervision.

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Correspondence to Anil Kumar Sharma.

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Sharma, S.P., Dwivedi, S., Kumar, S. et al. Bacterial and Fungal Keratitis: Current Trends in Its Diagnosis and Management. Curr Clin Micro Rpt 10, 266–278 (2023). https://doi.org/10.1007/s40588-023-00210-9

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