Skip to content
DraconiticResearch
Search Sources API
197,768 studies31 sourcesUpdated 19 min ago
Peer-reviewedCC BY-NCHealth science reports

Fungal Keratitis Among Patients With Microbial Keratitis or Corneal Ulcer in Africa: A Systematic Review and Meta-Analysis.

  • Mohamed Farah Ismail1
  • Intisar Khalafalla1
  • Sowda Abdikarim Sheikh Isse2
  • Fathi Abdi Farah2
  • Zakaria Omar Sheck1
  • Fadumo Mohamed Ahmed3
  • Mohamed Abdi Deheyeh2
  • Ibrahim Abdirahman Mohamed4
  • Mohamed Jayte5
  • Bahja Ahmed Mumin2
  • Theoneste Hakizimana2
5 affiliations
  1. 1Department of Ophthalmology Kampala International University Ishaka Uganda.
  2. 2Department of Obstetrics and Gynecology Kampala International University Ishaka Uganda.
  3. 3Department of Pediatrics Kampala International University Ishaka Uganda.
  4. 4Department of Orthopedics Kampala International University Ishaka Uganda.
  5. 5Department of Internal Medicine Kampala International University Ishaka Uganda.
Read full textPDFDOICite

Abstract

Background and aims

Fungal keratitis is a sight-threatening cause of microbial keratitis in tropical, resource-limited settings, but its burden in Africa has not been synthesized. We estimated the pooled prevalence of fungal keratitis among patients with microbial keratitis or corneal ulcer in Africa and summarized reported etiological patterns and risk factors.Methods

Following PRISMA 2020, we searched seven databases, including PubMed/MEDLINE, Scopus, Embase and African Journals Online, to 14 June 2026, and updated the search on 27 September 2026 (PubMed-indexed and publisher records, citation searching) with a citation-level screening log. Observational African studies reporting fungal keratitis cases with a defined denominator were included and appraised item by item with the JBI prevalence checklist. Prevalence was pooled with a DerSimonian-Laird random-effects model after Freeman-Tukey transformation; 95% prediction intervals (PIs), a logit-model sensitivity analysis, subgroup analyses, meta-regression and leave-one-out analysis were performed.Results

The 16 studies from 10 countries (701 fungal keratitis cases among 2150 patients) were included. Study-level prevalence ranged from 5.6% (16/284) to 61.9% (167/270). The pooled prevalence was 33.6% (95% CI = 23.6%-44.4%), with very high heterogeneity (I ² = 96.1%) and a 95% PI of 1.8%-79.6%. The logit model gave 32.3% (95% CI = 23.6%-42.5%). Prevalence did not differ significantly by region (Sub-Saharan Africa 35.7% vs North Africa 25.5%; p = 0.50), denominator type (p = 0.77), population definition, sampling, sample size or publication year, so heterogeneity remained unexplained. Filamentous fungi, mainly Fusarium and Aspergillus, predominated; ocular trauma, especially with vegetative matter, and delayed presentation were the most frequently reported risk factors.Conclusion

On average, about one in three patients with microbial keratitis or corneal ulcer in the included African studies had fungal keratitis, but prevalence in any individual setting is highly uncertain, as shown by the wide prediction interval. Setting-specific microbiological surveillance, strengthened corneal microbiology and reliable antifungal supply are needed.

Related

  1. Bacterial keratitis in patients with corneal lesions in southeastern Iran: microbial spectrum, demographic characteristics, and seasonal distribution.
    Mehdi Zarean, Ghodratollah Salehi Sangani, Mahsa Khodkari +2
    Tropical diseases, travel medicine and vaccinesPeer-reviewedCC BYFull textGeneral medicineEurope PMCPMC
  2. Fusarium falciforme keratitis in a corneal transplant recipient treated successfully with fosmanogepix and intracameral amphotericin B
    Ashley Zeoli, Christine Shieh, Karen C. Bloch +5
    ASM case reportsPeer-reviewedCC BYFull text2 citedGeneral medicineEurope PMCPMC
  3. Shifting microbial profiles and antimicrobial susceptibility in infectious keratitis: a 13-year longitudinal analysis at a Brazilian tertiary center
    Juliana Mika Kato, Maura Salaroli Oliveira, Luiza Manhezi Shin de Oliveira +6
    ClinicsPeer-reviewedCC BY 4.0Full textGeneral medicinePMC
  4. Age-related differences in the clinical and microbiological profile of pediatric microbial keratitis in Eastern India
    Rakhi Kusumesh, Nancy Panday, Lalan Kumar Arya +6
    PLOS OnePeer-reviewedCC BY 4.0Full textPhysiologyPLOS
  5. Antifungal Therapy for Fusarium Keratitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
    Richard Farnan, Alexander Ergun, Gordon Farnan +2
    CorneaPeer-reviewedCC BY 4.0Full text1 citedGeneral medicinePMC

Cite

BibTeXRIS
BibTeX
@article{ismail2026fungal,
  title = {{Fungal Keratitis Among Patients With Microbial Keratitis or Corneal Ulcer in Africa: A Systematic Review and Meta-Analysis.}},
  author = {Mohamed Farah Ismail and Intisar Khalafalla and Sowda Abdikarim Sheikh Isse and Fathi Abdi Farah and Zakaria Omar Sheck and Fadumo Mohamed Ahmed and Mohamed Abdi Deheyeh and Ibrahim Abdirahman Mohamed and Mohamed Jayte and Bahja Ahmed Mumin and Theoneste Hakizimana},
  journal = {Health science reports},
  year = {2026},
  month = oct,
  doi = {10.1002/hsr2.73437},
  url = {https://europepmc.org/article/MED/42948528},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Fungal Keratitis Among Patients With Microbial Keratitis or Corneal Ulcer in Africa: A Systematic Review and Meta-Analysis.
AU  - Mohamed Farah Ismail
AU  - Intisar Khalafalla
AU  - Sowda Abdikarim Sheikh Isse
AU  - Fathi Abdi Farah
AU  - Zakaria Omar Sheck
AU  - Fadumo Mohamed Ahmed
AU  - Mohamed Abdi Deheyeh
AU  - Ibrahim Abdirahman Mohamed
AU  - Mohamed Jayte
AU  - Bahja Ahmed Mumin
AU  - Theoneste Hakizimana
PY  - 2026
DA  - 2026/10/27
JO  - Health science reports
DO  - 10.1002/hsr2.73437
UR  - https://europepmc.org/article/MED/42948528
AB  - Background and aims  Fungal keratitis is a sight-threatening cause of microbial keratitis in tropical, resource-limited settings, but its burden in Africa has not been synthesized. We estimated the pooled prevalence of fungal keratitis among patients with microbial keratitis or corneal ulcer in Africa and summarized reported etiological patterns and risk factors.Methods  Following PRISMA 2020, we searched seven databases, including PubMed/MEDLINE, Scopus, Embase and African Journals Online, to 14 June 2026, and updated the search on 27 September 2026 (PubMed-indexed and publisher records, citation searching) with a citation-level screening log. Observational African studies reporting fungal keratitis cases with a defined denominator were included and appraised item by item with the JBI prevalence checklist. Prevalence was pooled with a DerSimonian-Laird random-effects model after Freeman-Tukey transformation; 95% prediction intervals (PIs), a logit-model sensitivity analysis, subgroup analyses, meta-regression and leave-one-out analysis were performed.Results  The 16 studies from 10 countries (701 fungal keratitis cases among 2150 patients) were included. Study-level prevalence ranged from 5.6% (16/284) to 61.9% (167/270). The pooled prevalence was 33.6% (95% CI = 23.6%-44.4%), with very high heterogeneity (I ² = 96.1%) and a 95% PI of 1.8%-79.6%. The logit model gave 32.3% (95% CI = 23.6%-42.5%). Prevalence did not differ significantly by region (Sub-Saharan Africa 35.7% vs North Africa 25.5%; p = 0.50), denominator type (p = 0.77), population definition, sampling, sample size or publication year, so heterogeneity remained unexplained. Filamentous fungi, mainly Fusarium and Aspergillus, predominated; ocular trauma, especially with vegetative matter, and delayed presentation were the most frequently reported risk factors.Conclusion  On average, about one in three patients with microbial keratitis or corneal ulcer in the included African studies had fungal keratitis, but prevalence in any individual setting is highly uncertain, as shown by the wide prediction interval. Setting-specific microbiological surveillance, strengthened corneal microbiology and reliable antifungal supply are needed.
SN  - 2398-8835
ER  -