Table 1.
Global epidemiology of fungal keratitis (FK), most frequently isolated fungal organisms and summary results of select papers on risk factors for developing FK, grouped as per their geographical region (as defined by the UN).
| Country | Year | % FK # | % Culture Negative Cases ~ | Age (Mean) | % Male | % Trauma | % Steroid | % TEM | % CL | % OSD |
% HIV |
% DM |
Distance from Equator (km) | N (All MK Cases) |
Organism 1 (%) | Organism 2 (%) | Reference |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AFRICA | |||||||||||||||||
| Egypt (Zagazig) | 2012 | 55 | - | - | - | 63.6 | 6.1 | - | 12.1 | - | - | 18.2 | 3401 | 60 | Penicillium spp. (24.2) | Aspergillus spp. (21.2) | [37] |
| Egypt (Mansoura) | 2013–2015 | 65.5 | 55.5 | - | 66.1 | 51.4 | 5.3 | - | 2.4 | 4.5 | - | 15.1 | 3452 | 247 | Aspergillus (41.0) | - | [38] |
| Egypt (Tanta) | 2011–2013 | 43.3 | 15.5 | 49.2 | 65.9 | 58.4 | 32.7 | - | - | - | - | - | 3424 | 834 | Aspergillus flavus (29.1) | Aspergillus niger (16.1) | [39] |
| Ethiopia | 2014–2015 | 45.1 | - | - | 58.0 | 78.3 | 5.8 | - | - | - | - | 7.2 | 1003 | 153 | Fusarium spp. (27.6) | Aspergillus spp. (25.0) | [40] |
| Ghana | 1995 | 56.1 | 42.7 | 36.3 | 69.3 | - | - | - | - | - | - | - | 900 | 199 | Fusarium spp. (52.3) | Aspergillus spp. (15.3) | [41] |
| Ghana | 1999-2001 | 74.7 | 60.0 | - | - | - | - | - | - | - | - | - | 900 | 290 | Fusarium spp. (42.2) | Aspergillus spp. (17.4) | [7] |
| Libya | 2008–2010 | 32.9 | ^ | - | 60.7 | 78.5 | 3.6 | - | 21.4 | - | - | 17.8 | 3114 | 85 | Aspergillus spp. (50.0) | Fusarium spp. (39.3) | [42] |
| Sierra Leone | 2005–2006 | 37.7 | 5.5 | - | - | - | - | - | - | - | - | - | 941 | 73 | UFF (69.2) | Aspergillus spp. (15.4) | [35] |
| South Africa | 1982-1983 | 3.7 | - | - | - | 0 | 0 | - | 0 | - | 33.3 | 50.0 | 2913 | 164 | Curvularia spp. (33.3) | - | [43] |
| South Africa | 2013–2015 | 2.2 | - | - | - | - | - | - | - | - | - | - | 3399 | 46 | - | - | [44] |
| Tanzania | 2008–2010 | 51.6 | 45.6 | - | - | - | - | - | - | - | - | - | 667 | 170 | UFF (87.5) | Candida spp. (12.5) | [1] |
| Tanzania | 2013 | 40.2 | 8.9 | - | - | - | - | - | - | - | - | - | 755 | 202 | Candida spp. (60.8) | UFF (39.6) | [45] |
| Tunisia | 1995-2012 | 12.4 | 7 | 47.2 | 63.3 | 61.6 | 18.3 | 3.3 | 3.3 | 10.0 | - | 5 | 3862 | 483 | Fusarium spp. (49.0) | Aspergillus spp. (22.0) | [46] |
| Tunisia | 2010–2015 | 30.0 | 40 | 48.9 | 56.6 | 43.3 | 3.3 | - | 3.3 | - | - | 10 | 4124 | 30 | Fusarium spp. (50.0) | Aspergillus spp. (33.3) | [47] |
| Tunisia | 1996–2004 | 21.6 | 58 | - | - | 50.0 | - | - | - | 25 | - | - | 4094 | 100 | Fusarium spp. (87.5) | Acremonium spp. (12.5) | [48] |
| ASIA | |||||||||||||||||
| Bangladesh | 2008 | 39.2 | 5 | - | - | 49 | - | - | - | - | - | - | 2752 | 120 | - | - | [49] |
| Bangladesh | 1994 | 36 | 18.3 | - | - | - | - | - | - | - | - | - | 2483 | 142 | Aspergillus spp. (40.0) | Fusarium spp. (21.0) | [50] |
| China | 2009–2013 | 45.7 | 53.9 | - | - | - | - | - | - | - | - | - | 2504 | 2973 | Fusarium spp. (29.3) | Aspergillus spp. (24.1) | [51] |
| China | 1999-2004 | 61.9 | - | - | - | - | - | - | - | - | - | - | 4012 | 1054 | Fusarium spp. (73.3) | Aspergillus spp. (12.1) | [52] |
| China (Hong Kong) | 1997-1998 | 6.4 | 65.0 | - | - | 20 | 20 | - | - | - | - | - | 2491 | 223 | Fusarium spp. (60.0) | Penicillium spp. (20.0) | [53] |
| China (Hong Kong) | 2004–2013 | 10.7 | 67.7 | - | - | - | - | - | - | - | - | - | 2491 | 260 | Fusarium spp. (33.3) | Candida spp. (25.0) | [54] |
| China (Taiwan) | 1992-2001 | 13.5 | 51.0 | - | - | - | - | - | - | - | - | - | 2758 | 453 | Fusarium spp. (29.4) | Candida spp. (29.4) | [55] |
| China (Taiwan) | 2012–2014 | 8.2 | 69 | - | - | - | - | - | - | - | - | - | 2669 | 233 | - | - | [56] |
| India (West Bengal) | 2007–2011 | 58.9 | 27.0 | - | 61.7 | 88.7 | 16.3 | - | - | 6.0 | - | 11.8 | 2510 | 928 | Aspergillus spp. (37.8) | Fusarium spp. (20.3) | [57] |
| India (West Bengal) | 2008 | 38.1 | 32.7 | 53 | 65.0 | 48.0 | 16.0 | 16.0 | - | - | - | - | 2510 | 289 | Aspergillus spp. (55.4) | Fusarium spp. (10.8) | [58] |
| India (Odisha) | 2006–2009 | 35.5 | 18.6 | - | 70.0 | 40.2 | - | - | - | - | - | 2.2 | 2253 | 997 | Aspergillus spp. (27.9) | Fusarium spp. (23.2) | [59] |
| India (Assam) | 2007–2009 | 60.6 | - | - | 68.8 | 76.40 | - | - | - | 1.5 | - | 2.5 | 3056 | 310 | Fusarium spp. (25.0) | Aspergillus spp. (19.0) | [60] |
| India (Delhi) | 2010–2015 | 68 | 65 | - | 76 | 89.4 | - | - | - | 5.3 | - | 1.3 | 3188 | 400 | Aspergillus spp. (30.8) | Fusarium spp. (27.6) | [61] |
| India (Chandigarh) | 2005–2011 | Ψ | 49 | - | - | 66.5 | 2 | - | - | 11.7 | - | - | 3418 | 765 | Aspergillus spp. (47.6) | Dematiaceous fungi (21.9) | [62] |
| India (Rajasthan) | 2005–2012 | 68.2 | 45 | - | 71.7 | 62.8 | - | - | 3.9 | - | 1.1 | 8.9 | 3116 | 480 | Aspergillus spp. (63.3) | Alternaria spp. (8.3) | [63] |
| India (Chandigarh) | 1999-2003 | 41.5 | 46.9 | - | 80.5 | 43.8 | 7.8 | - | - | - | - | - | 3418 | 64 | Aspergillus spp. (41.2) | Fusarium spp. (23.5) | [64] |
| India (Delhi) | 2007–2011 | 58.9 | 27 | - | 61.7 | 88.7 | 16.3 | - | - | 19 | - | 11.8 | 3188 | 928 | Aspergillus spp. (37.8) | Dematiaceous fungi (23.8) | [65] |
| India (Delhi) | 2000–2004 | 22.3 | - | - | 77.9 | 32.4 | 16.2 | 2.7 | 0 | - | - | - | 3188 | 346 | Aspergillus spp. (55.9) | Dematiaceous fungi (7.8) | [66] |
| India (Madurai) | 2012–2013 | 79 | 14.5 | 50 | 64 | 70 | 9 | 19 | 8 | 1103 | 252 | Fusarium spp. (39.0) | Aspergillus spp. (18.0) | [67] | |||
| India (Madurai) | 1999–2002 | 52.1 | 29.4 | - | 65 | 92.1 | 1.2 | - | 0 | 6.7 | - | 15.7 | 1103 | 3183 | Fusarium spp. (41.9) | Dematiaceous fungi (26.9) | [68] |
| India (Madurai) | 1994 | 51.8 | 31.6 | - | 61.3 | - | - | - | - | - | - | - | 1103 | 434 | Fusarium spp. (47.1) | Aspergillus spp. (16.1) | [4] |
| India (Hyderabad) | 1991–2000 | 39.8 | ^ | 40.4 | 71.2 | 54.4 | 5.9 | - | - | 11.7 | - | 6.4 | 1933 | 3399 | Fusarium spp. (37.2) | Aspergillus spp. (30.7) | [69] |
| India (Hyderabad) | 1991–2001 | 44.8 | 39.6 | 30.9 | - | 81.9 | 2.4 | - | 0.3 | 18.2 | - | - | 1933 | 5897 | Fusarium spp. (35.6) | Aspergillus spp. (26.8) | [70] |
| India (Madurai) | 2006–2009 | 63 | 42 | - | - | - | - | - | - | - | - | - | 1103 | 6967 | Fusarium spp. (42.3) | - | [71] |
| India (Bangalore) | 2012–2014 | 55.5 | 62.5 | - | - | - | - | - | - | - | - | 1442 | 312 | Fusarium spp. (31.0) | Aspergillus spp. (11.0) | [72] | |
| India (Tamil Nadu) | 1999–2001 | 44 | 31 | - | - | - | - | - | - | - | - | - | 1223 | 800 | Aspergillus spp. (39.9) | Fusarium spp. (21.5) | [7] |
| India (Maharashtra) | 2004–2009 | 57.9 | 37 | - | - | - | - | - | - | - | - | - | 2120 | 852 | Fusarium spp. (35.0) | Aspergillus spp. (18.0) | [12] |
| India (Gujarat) | 2006–2008 | 65 | 60 | 54 | 73 | - | - | - | - | - | - | 2498 | 100 | Aspergillus spp. (70.0) | Fusarium spp. (12.0) | [73] | |
| India (Gujarat) | 2003–2005 | 51.8 | 45 | - | - | - | - | - | - | - | - | - | 2498 | 200 | Fusarium spp. (29.8) | Aspergillus spp. (21.1) | [74] |
| India (Gujarat) | 2007–2008 | 34.9 | 40.7 | - | - | - | - | - | - | - | - | - | 2561 | 150 | Aspergillus spp. (35.4) | Fusarium spp. (22.5) | [75] |
| India (West Bengal) | 2001–2003 | 62.7 | 32 | - | - | - | - | - | - | - | - | - | 2669 | 1198 | Aspergillus spp. (59.9) | Fusarium spp. (21.2) | [76] |
| India (Delhi) | 2005 | 49.1 | 43.2 | - | - | - | - | - | - | - | - | - | 3183 | 1000 | Aspergillus spp. (41.6) | Fusarium spp. (19.8) | [77] |
| India (Hyderabad) | 2002 | 19.4 | 33.5 | - | - | - | - | - | - | - | - | - | 1933 | 170 | Fusarium spp. (72.7) | - | [78] |
| Iran (Tehran) | 2011–2013 | Ψ | 94.4 | 79.3 | - | - | - | - | - | - | - | 3969 | 2180 | Fusarium spp. (49.6) | Aspergillus spp. (26.4) | [79] | |
| Iran (Sari) | 2004–2005 | 77.8 | 59.1 | 61.5 | 71.4 | 28.6 | 0 | - | 0 | 14.3 | - | 14.3 | 4065 | 22 | Fusarium spp. (50.0) | Aspergillus spp. (50.0) | [80] |
| Iraq | 2002–2005 | 31.9 | 41.4 | - | - | 90 | - | - | 0 | 6.8 | - | - | 3707 | 396 | Aspergillus spp. (56.8) | Fusarium spp. (27.0) | [81] |
| Iraq | 2013–2014 | 6.8 | 30.5 | - | - | - | - | - | - | - | - | - | 3707 | 105 | Aspergillus spp. (60.0) | Alternaria spp. (40.0) | [82] |
| Iraq | 2017–2018 | 37 | ^ | 73 | 61 | - | - | - | - | - | - | 41 | 3707 | 234 | Aspergillus spp. (70.0) | Penicillium spp. (13.0) | [83] |
| Japan | 1999–2003 | 6.1 | 41.5 | - | - | - | - | - | - | - | - | - | 3991 | 122 | Candida spp. (83.3) | - | [84] |
| Japan | 2003 | 10.6 | 56.7 | - | - | - | - | - | - | - | - | - | 3969 | 261 | - | - | [85] |
| Korea (RO) | 2003–2008 | 26.9 | 37.3 | - | - | - | - | - | - | - | - | - | 4177 | 83 | Candida spp. (57.0) | Aspergillus spp. (28.6) | [86] |
| Malaysia | 2007–2011 | 25.3 | 12.8 | - | 61.7 | 48.9 | 17.0 | - | 4.3 | 10.6 | - | 10.6 | 371 | 186 | Fusarium spp. (46.0) | Aspergillus spp. (9.8) | [87] |
| Malaysia | 2017 | 36.4 | 59.9 | - | - | - | - | - | - | - | - | - | 367 | 137 | Fusarium spp. (60.0) | - | [88] |
| Nepal (Dharan) | 2004–2008 | 61.1 | 20.8 | - | - | - | - | - | - | 2980 | 351 | Aspergillus spp. (33.3) | Fusarium spp. (12.7) | [89] | |||
| Nepal (Dharan) | 1998–1999 | 65.5 | 32.6 | - | - | - | - | - | - | - | - | - | 2980 | 86 | Aspergillus spp. (60.5) | Fusarium spp. (13.2) | [90] |
| Nepal (Nepalgunj) | 2011–2012 | 36 | ^ | - | 59.3 | 58 | 12 | - | - | 6 | - | - | 3120 | 1880 | Fusarium spp. (31.9) | Curvularia spp. (17.7) | [91] |
| Nepal (Dharan) | 2007–2008 | 60 | 54.5 | - | - | - | - | - | - | - | - | - | 2980 | 44 | Aspergillus spp. (66.6) | - | [92] |
| Nepal (Kathmandu) | 2014 | 44 | 55.4 | - | - | - | - | - | - | - | - | - | 3080 | 101 | Fusarium spp. (24.0) | Aspergillus spp. (20.0) | [93] |
| Nepal (Kathmandu) | 1981 | 25 | 50 | - | - | - | - | - | - | - | - | - | 3080 | 133 | - | - | [94] |
| Nepal (Biratnagar) | 2011 | 70 | - | - | - | - | - | - | - | - | - | 2944 | 1644 | No culture performed, microscopy only | [95] | ||
| Oman | 2004–2007 | 31.3 | 57.9 | - | 59.4 | 25 | 31.3 | 15.6 | - | 18.8 | - | 9.4 | 2510 | 242 | Fusarium spp. (50.0) | Aspergillus spp. (34.4) | [96] |
| Oman | 2000–2006 | 11.8 | 56.9 | - | - | - | - | - | - | - | - | - | 2510 | 188 | - | - | [97] |
| Pakistan | 2010 | 64 | 32.3 | - | - | - | - | - | - | - | - | - | 2788 | 133 | - | - | [98] |
| Saudi Arabia | 1984–2004 | 10.3 | 69.4 | 55 | 79 | 20.9 | 16.9 | - | 0.8 | 8.87 | - | 12 | 2746 | 1200 | Aspergillus spp. (37.0) | Trichophyton spp. (20.0) | [99] |
| Singapore | 1991–2005 | Ψ | ^ | 40 | 79.3 | 55 | 24 | - | 7 | 14 | - | - | 143 | 29 | Fusarium spp. (52.0) | Aspergillus spp. (17.0) | [100] |
| Singapore | 2012–2014 | 0.7 | - | - | - | - | - | - | - | - | - | - | 143 | 531 | - | - | [56] |
| Sri Lanka | 1976–1981 | 81.5 | 59.1 | - | - | - | - | - | - | - | - | - | 811 | 66 | UFF (63.6) | Aspergillus spp. (18.0) | [36] |
| Thailand (Central) | 1988–2000 | 24.6 | 52.7 | - | - | - | - | - | - | - | - | - | 1529 | 292 | Fusarium spp. (34.3) | Aspergillus spp. (20.0) | [101] |
| Thailand (South) | 1982–2003 | 15.3 | - | 46.4 | 72.3 | 66 | - | - | - | - | - | - | 800 | 556 | Fusarium spp. (64.5) | Aspergillus spp. (10.5) | [102] |
| Thailand (North) | 2003–2006 | 50.8 | 74.4 | - | - | - | - | - | - | - | - | - | 2090 | 305 | Fusarium spp. (58.1) | Aspergillus spp. (12.9) | [103] |
| Thailand (Central) | 2001–2004 | 38 | ^ | - | 67.7 | 77.5 | - | - | 0 | 9.68 | - | - | 1529 | 127 | Fusarium spp. (26.0) | Dematiaceous fungi (20.0) | [104] |
| Turkey (Adana) | 2014–2015 | 9.4 | - | 39.3 | 50 | 50 | - | - | 25 | - | - | - | 4115 | 64 | Aspergillus spp. (66.7) | Fusarium spp. (33.3) | [105] |
| Turkey (West Anatolia) | 1990–2005 | 22.5 | 63.8 | - | - | - | - | - | - | - | - | - | 4278 | 620 | Fusarium spp. (50.0) | Aspergillus spp. (20.0) | [106] |
| Vietnam (North) | 2008 | 59.6 | 47.2 | - | 44.1 | 83.8 | 1.4 | 1.4 | - | - | - | - | 2338 | 1153 | Fusarium spp. (40.7) | Aspergillus spp. (25.9) | [30] |
| Vietnam | 1974–1982 | 23.6 | - | - | - | - | - | - | - | - | - | - | 2338 | 1219 | - | - | [107] |
| EUROPE | |||||||||||||||||
| Netherlands | 2002–2004 | 1.8 | 42.0 | - | - | - | - | - | - | 50 | 50 | - | 5823 | 156 | Candida albicans (100) | - | [108] |
| Netherlands | 2014–2017 | 14.0 | 50 | - | - | - | - | - | - | - | - | - | 5809 | 185 | - | - | [34] |
| UK (SW England) | 2006–2017 | 6.9 | 61.9 | - | - | - | - | - | - | - | - | - | 5721 | 2116 | UFF (54.2) | Candida spp. (45.8) | [109] |
| UK (London) | 2007–2014 | - | 34.8 | 47.2 | 41.4 | 11.6 | 32.1 | - | 57.1 | 22.3 | - | - | 5727 | 112 | Fusarium spp. (41.8) | Candida spp. (38.0) | [28] |
| UK (NE England) | 2008–2017 | 4.2 | 55.5 | 55.3 | 65 | - | - | - | - | - | - | - | 6113 | 407 | UFF (50.0) | Candida spp. (50.0) | [110] |
| UK – (NW England) | 2004–2015 | 7.1 | 67.4 | - | - | - | - | - | - | - | - | - | 5980 | 4229 | Candida spp. (53.2) | Fusarium spp. (25.7) | [111] |
| LATIN AMERICA AND THE CARRIBEAN | |||||||||||||||||
| Brazil (São Paulo) | 1975–2007 | 11 | 51.4 | - | - | - | - | - | - | - | - | - | 2547 | 6804 | Fusarium spp. (51.9) | Candida spp. (17.6) | [112] |
| Brazil (Uberlandia) | 2001–2004 | 56.3 | 50.8 | - | - | 55.6 | - | - | 0 | 0 | - | - | 2104 | 65 | Fusarium spp. (61.1) | Aspergillus spp. (16.7) | [113] |
| Brazil (São Paulo) | 2000–2004 | 13.8 | 63.4 | 40.7 | 80.3 | - | - | - | - | - | - | - | 2547 | 478 | Fusarium spp. (66.7) | Aspergillus spp. (10.6) | [114] |
| Brazil (São Paulo) | 2003–2010 | 25 | 82.4 | 43 | 74 | 49.3 | - | - | - | - | - | - | 2547 | 599 | Fusarium spp. (83.3) | Aspergillus spp. (16.7) | [115] |
| Mexico | 2013–2014 | 33.3 | 47.1 | - | - | - | - | - | - | - | - | - | 2161 | 51 | Fusarium spp. (44.4) | Aspergillus spp. (22.2) | [116] |
| Paraguay | 1988–2001 | 49 | 21 | - | - | - | - | - | - | - | - | - | 2814 | 660 | Acremonium spp. (40.0) | Fusarium spp. (15.0) | [117] |
| Paraguay | 2009–2011 | 72.1 | 10.4 | - | 71 | - | - | - | - | - | - | - | 2814 | 48 | Fusarium spp. (34.0) | Aspergillus spp. (16.1) | [118] |
| NORTH AMERICA | |||||||||||||||||
| USA (N California) | 1976–1999 | 8.4 | 62 | - | - | - | - | - | - | - | - | - | 4201 | 1121 | Candida spp. (30.5) | - | [119] |
| USA (Florida) | 1968–1977 | 35.8 | 44.0 | - | - | - | - | - | - | - | - | - | 2865 | 663 | Fusarium spp. (62.0) | Candida spp. (7.5%) | [120] |
| USA (Florida) | 1999–2006 | - | 29.8 | 48 | 75 | 43 | 29 | - | 44 | 8.3 | - | 7.1 | 3298 | 84 | Fusarium spp. (41.0) | Candida spp. (14.0) | [121] |
| USA (S California) | 1998–2008 | 1.4 | ^ | 56.1 | 54 | 14 | - | - | 24 | 12.7 | 1.6 | 16 | 3638 | 4651 | UFF (64.0) | Candida spp. (32.0) | [122] |
| USA (New York) | 1987–2003 | 1.2 | ^ | 47 | 35 | 11 | 7 | - | 10 | 23 | 25 | 7 | 4528 | 5083 | Candida spp. (66.0) | Aspergillus spp. (12.0) | [33] |
| OCEANIA | |||||||||||||||||
| Australia (Brisbane) | 1999–2004 | 8 | 35 | - | - | - | - | - | - | - | - | - | 3054 | 231 | Fusarium spp. most commonly isolated | - | [123] |
| Australia (Queensland) | 1996–2016 | - | ^ | 48 | 65 | - | - | - | - | - | - | - | 3054 | 215 | Fusarium spp. (33.3) | Aspergillus spp. (13.0) | [124] |
| Australia (Sydney) | 2009–2017 | - | 6 | 60 | 65 | 24 | 54 | - | 26 | 34 | - | - | 3764 | 51 | Candida spp. (33.0) | Fusarium spp. (28.0) | [125] |
| Australia (Queensland) | 2005–2015 | 6 | ^ | - | - | - | - | - | - | - | - | - | 3054 | 3182 | UFF (75.9) | Candida spp. (24.1) | [126] |
| Australia (Sydney) | 2012–2016 | 3.3 | 31 | 63.5 | 67 | 25 | 46 | - | 28 | 25 | - | 8 | 3764 | 1052 | Candida spp. (30.4) | Fusarium spp. (21.7) | [127] |
| New Zealand | 2003–2007 | 1.7 | 34.4 | - | - | - | - | - | - | - | - | - | 4097 | 265 | Fusarium spp. (66.7) | Candida spp. (33.3) | [128] |
# Confirmed fungal keratitis cases as a percentage of all culture positive microbial keratitis cases, including mixed bacterial-fungal infections. If diagnosis was based on microscopy (culture unavailable), this is a percent of all microbial keratitis cases examined by microscopy, and the results of these are given in italics. ~ Culture negative rate of all cultures taken within the study. - Data not presented. Ψ Studies that only included cases of FK and did not report the number of MK cases. ^ Studies that only included cases that were culture positive and did not report the overall culture negative rate. FK, fungal keratitis; TEM, traditional eye medication; CL, contact lens; OSD, ocular surface disease; HIV, Human Immunodeficiency Virus; DM, diabetes mellitus; MK, microbial keratitis; UFF, unspecified filamentous fungi.