Elucidating fungi pathogens and multi-drug resistance in oculomycosis, and bioprospecting native plants as antifungal therapy

Background Ocular mycoses have a debilitating impact on ocular health and quality of life. However, the burden and etiology of ocular mycoses and the efficacy of clinical antifungal agents used in the management of ocular fungal infections remain unclear. The study assesses the prevalence of ocular fungal pathogens and multi-drug resistance patterns, and further explored native medicinal plants as a source of antifungal agents in Ghana. Methods In this multicenter, cross-sectional study, biographic, medical, and ophthalmic data were collected using a structured questionnaire, and conjunctival swabs and corneal samples were collected for microbiological characterization and antifungal susceptibility testing. Patient demographic and clinical data were stratified by sex and differences were tested using chi-squared analysis. Microbiological data were presented as proportions, means, and standard deviations. Bivariate logistic regression was used to test the association between patient characteristics and the likelihood of isolating fungal pathogens from the eyes of persons with presenting eye infections. Results Approximately ten percent (9.36%) of ocular specimens were positive for fungal culture with the predominant fungal etiology being Candida albicans. Multi-drug resistance was observed for clinically used antifungal agents; amphotericin B and fluconazole, itraconazole, terbinafine. Alternatively, ethanolic extracts of Cinnamomum verum ( C. verum ) and Syzygium aromaticum ( S. aromaticum ), demonstrated potent fungistatic and fungicidal activity against the common implicated pathogen, Candida albicans ( C. albicans ). Conclusion Overall, the study broadens our understanding of the pathogenesis of ocular mycoses in Ghana and the implications of clinical use of antifungal treatments. Leveraging on the medicinal plant screening, we propose characterization of the bioactive compound(s) in C. verum and S. aromaticum for clinical translation into ocular antifungal therapeutics.