Epidemiology of Microbial Keratitis in Uganda: A Cohort Study

ABSTRACT

Purpose: To describe the epidemiology of Microbial Keratitis (MK) in Uganda.

Methods: We prospectively recruited patients presenting with MK at two main eye units in Southern Uganda between December 2016 and March 2018. We collected information on clinical history and presentation, microbiology and 3-month outcomes. Poor vision was defined as vision < 6/60).

Results: 313 individuals were enrolled. Median age was 47 years (range 18–96) and 174 (56%) were male. Median presentation time was 17 days from onset (IQR 8–32). Trauma was reported by 29% and use of Traditional Eye Medicine by 60%. Majority presented with severe infections (median infiltrate size 5.2 mm); 47% were blind in the affected eye (vision < 3/60). Microbiology was available from 270 cases: 62% were fungal, 7% mixed (bacterial and fungal), 7% bacterial and 24% no organism detected. At 3 months, 30% of the participants were blind in the affected eye, while 9% had lost their eye from the infection. Delayed presentation (overall p = .007) and prior use of Traditional Eye Medicine (aOR 1.58 [95% CI 1.04–2.42], p = .033) were responsible for poor presentation. Predictors of poor vision at 3 months were: baseline vision (aOR 2.98 [95%CI 2.12–4.19], p < .0001), infiltrate size (aOR 1.19 [95%CI 1.03–1.36], p < .020) and perforation at presentation (aOR 9.93 [95% CI 3.70–26.6], p < .0001).

Conclusion: The most important outcome predictor was the state of the eye at presentation, facilitated by prior use of Traditional Eye Medicine and delayed presentation. In order to improve outcomes, we need effective early interventions.

KEYWORDS:

• Microbial keratitis
• bacterial keratitis
• fungal keratitis
• keratitis
• blindness
• Uganda

Acknowledgments

The authors would like to appreciate Mr Gilbert Arinda, Ms Pauline Boonabaana, Mr Martin Bukenya, Mr Bernard Beinomugisha, Mr Martin Bukenya, and Ms Allen Asiimwe for helping in data collection.

Conflict of interest

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Submission statement

This submission has not been published anywhere previously and that it is not simultaneously being considered for any other publication.

Supplementary material

Supplemental data for this article can be accessed publisher’s website.

Additional information

Funding

SA is supported by a Research Fellowship from the Commonwealth Eye Health Consortium, funded by The Queen Elizabeth Diamond Jubilee Trust. MJB is supported by the Wellcome Trust (098481/Z/12/Z and 207472/Z/17/Z). The funding organizations were not involved in the design, collection, analysis, and review of this manuscript.