Bilateral Candida keratitis in an HIV patient with asymptomatic genitourinary candidiasis in Uganda

Arunga, Simon; Kwaga, Teddy; Leck, Astrid; Hu, Victor; Burton, Matthew J.

doi:10.1016/j.mmcr.2018.07.007

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Fungal keratitis contributes to over 60% of all cases of microbial keratitis in Uganda. 112 , 113 Treatment remains a challenge, 114 with over 25% of the patients losing their sight or eye, with their overall and ocular quality of life grossly affected. 115 Across Africa, diagnostic procedures for sample collection for pathogen identification remain a major limitation in the diagnosis of fungal keratitis.…”

Section: Discussionmentioning

confidence: 99%

Re-estimation of the burden of serious fungal diseases in Uganda

Bongomin,

Kwizera,

Namusobya

et al. 2024

Therapeutic Advances in Infection

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Background: It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective: We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods: Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results: With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion: Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.

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Section: Discussionmentioning

confidence: 99%

Re-estimation of the burden of serious fungal diseases in Uganda

Bongomin,

Kwizera,

Namusobya

et al. 2024

Therapeutic Advances in Infection

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“… 34 This particular patient was a previously undiagnosed HIV positive patient, he presented a few weeks later with another infiltrate in his only remaining eye which we successfully treated with topical amphotericin B 0.15%. 35 …”

Section: Discussionmentioning

confidence: 99%

Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

et al. 2021

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ObjectiveFungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis.MethodsThis study was nested within a large cohort study of people presenting with microbial keratitis in Uganda. We enrolled patients with recalcitrant fungal keratitis not improving with topical natamycin 5% and commenced chlorhexidine 0.2%. Follow-up was scheduled for 3 months and 1 year. The main outcome measures were healing, visual acuity and scar size at final follow-up.ResultsThirteen patients were followed in this substudy. The patients were aged 27–73 years (median 43 years). Filamentous fungi were identified by microscopy of corneal scrape samples in all cases. Isolated organisms included Aspergillus spp, Fusarium spp, Candida spp, Bipolaris spp and Acremoninum spp. At the final follow-up, nine patients (75%) had healed; three had vision of better than 6/18. Three patients lost their eyes due to infection. In the remaining nine cases, corneal scarring was variable ranging from 4.6 to 9.4 mm (median 6.6 mm, IQR 5.9–8.0 mm); of these five had dense scars, three had moderate scars and one had a mild scar. None of the patients demonstrated signs of chlorhexidine toxicity during the follow-up.ConclusionChlorhexidine 0.2% was found to be a useful sequential adjunctive topical antifungal in cases of fungal keratitis not responding to natamycin 5%, which warrants further evaluation.

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“…There are rare case reports of bilateral C andida keratitis, presenting in a sequential fashion. 11 A recent report suggested a urogenital source for the eye infection. Our patient was tested for a urogenital source, and her culture was negative.…”

Section: Discussionmentioning

confidence: 99%

“…The patient in that article also turned out to be HIV positive. 11 HIV has been implicated in other cases of fungal keratitis as well. 12 Our patient reported recent negative testing and deferred repeat testing for HIV.…”

Section: Discussionmentioning

confidence: 99%