Temporal trends and shifting mycological spectrum of infectious keratitis in Egypt before, during and after the COVID-19 pandemic: a four-year laboratory-based surveillance study
In brief
Fungal keratitis rose to 80% of corneal infections post-COVID in Egypt
In a four-year review of 584 corneal scrapings, the share of fungal-positive cultures climbed from 49% before the pandemic to nearly 80% after it, with rural residence and eye trauma strongly linked to infection. The study also noted a widening variety of fungi, suggesting the pandemic altered both burden and species mix of this sight-threatening disease.
- Journal
- BMC infectious diseases (Q1)
- Published
- 18 August 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Rasha Mokhtar Elnagar, Somaia Abdalla Abouria, Nawal S Gouda, Habeeb Ali Baig, Mona S Abdelhafez
- PMID
- 42618901
- DOI
- 10.1186/s12879-026-14198-2
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 23 August 2026): Temporal trends in fungal keratitis before/after COVID‑19
Abstract
BACKGROUND: Fungal keratitis (FK) significantly contributes to corneal morbidity in tropical and subtropical environments; yet, longitudinal data describing post-pandemic epidemiologic changes remain limited. This study evaluated temporal trends and changes in the mycological spectrum of culture-confirmed FK in Egypt before, during and after the COVID-19 era. METHODS: We retrospectively inspected corneal scrapings collected between January 2019 and December 2022 at a major ophthalmic hospital in the Nile Delta, Egypt. Specimens were examined by direct microscopy and culture. Temporal patterns in fungal positivity, seasonal variation, species distribution and diversity were compared across pre-pandemic, pandemic, and post-pandemic periods. RESULTS: Of 584 specimens analyzed, 423 (72.4%) yielded microbial growth, and fungi accounted for 97.6% (413/423) of culture-positive isolates. The proportion of fungal-positive specimens increased from 49.0% pre-pandemic to 67.6% during the pandemic and 79.7% in the post-pandemic period (p < 0.001). In multivariable analysis, rural residence (aOR = 2.32, 95% CI: 1.53-3.53), history of ocular trauma (aOR = 6.70, 95% CI: 3.59-12.50), and study period were independently associated with fungal positivity. Spring and autumn were associated with higher odds of FK than summer. Shannon diversity index increased from 1.03 pre-pandemic to 1.35 during the pandemic and 1.78 post-pandemic, indicating expanding species diversity. Aspergillus fumigatus (29.5%) and A. niger (27.2%) were the dominant isolates, while Penicillium spp., Alternaria spp., and less common fungi emerged more frequently in later phases. CONCLUSIONS: Temporal changes in the burden and mycological spectrum of FK were observed across the pandemic and post-pandemic phases, with the pandemic era being associated with a sustained increase in FK burden and broader species diversity. Ongoing laboratory-based surveillance and future prospective multicenter studies that integrate molecular and clinical outcome are warranted for a deeper comprehension of the factors driving these epidemiological patterns.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.