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Microsporidial keratoconjunctivitis in the tropics: a case series.

Tung-Lien Quek D, Pan JC, Krishnan PU, Zhao PS, Teoh SC - Open Ophthalmol J (2011)

Bottom Line: All cases resolved without visually significant sequelae.Soil contamination is an important risk factor.Treatment with debridement, fluoroquinolones, hexamidine diisethionate with or without systemic albendazole is effective, with steroids reserved for any associated anterior uveitis.

View Article: PubMed Central - PubMed

Affiliation: Singapore National Eye Centre, Singapore.

ABSTRACT

Purpose: To present a series of microsporidial keratoconjunctivitis in 24 eyes.

Methods: Retrospective non-comparative observational case series. Medical records were retrieved and individuals evaluated based on symptoms, risk factors, visual acuity, slit lamp biomicroscopy and pathological examination of cornea epithelial scrapings. Demographic features, clinical course, predisposing factors, microbiological profile, treatment, final clinical outcome and visual acuity were recorded.

Results: Of the 22 patients, 90.9% were men, with a mean age of 30.3 years (range 15 - 76 years). Two (9.1%) had bilateral involvement, 15 (68.2%) were non-contact lens users, 17 (77.3%) reported contamination with mud within 2 weeks (mean 6.8 days) of onset of symptoms. All patients presented with conjunctivitis and coarse, multifocal, punctate epithelial keratitis. Two out of 24 eyes (8.3%) had anterior stromal infiltrates, while 8 (33.3%) had anterior uveitis. Microsporidial spores were identified on modified trichrome staining of corneal epithelial scrapes in all eyes. All eyes were treated with epithelial debridement, topical fluoroquinolone and hexamidine diisethionate, 7 (31.8%) patients received oral albendazole, and all eyes with anterior uveitis received topical steroids. All cases resolved without visually significant sequelae.

Conclusion: Microsporidial keratoconjunctivitis occurred mainly in males, is usually unilateral, presents as conjunctivitis and coarse, multifocal, punctate epithelial keratitis, and may incite anterior uveitis. Soil contamination is an important risk factor. Treatment with debridement, fluoroquinolones, hexamidine diisethionate with or without systemic albendazole is effective, with steroids reserved for any associated anterior uveitis.

No MeSH data available.


Related in: MedlinePlus

Low (x10) magnification light microscopy appearance of microsporidial spores.
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Figure 1: Low (x10) magnification light microscopy appearance of microsporidial spores.

Mentions: Corneal epithelial scapings were performed on patients presenting to the Ophthalmology unit at Tan Tock Seng Hospital with symptoms and signs suggestive of microsporidia keratoconjunctivitis [4]. The results of all corneal epithelial scrapings for microsporidia microscopy for a 17-month period from October 2006 to February 2008 were examined. Subtotal corneal epithelial scrapings were obtained using a 27-gauge hypodermic needle, air dried on a glass slide, and fixed in methanol for five minutes. The slides were subsequently placed in modified trichome stain for 10 minutes at 50 degrees Celsius, then rinsed in acid alcohol for 10 seconds, followed by 95% alcohol and finally in distilled water [6]. The slides were examined for 100 to 300 fields at a magnification of 100X. Microsporidial spores were identified as ovoid, refractile bodies measuring 0.9 to 1.5 micrometers in size, each with a reddish-pink cellular wall and a horizontal or diagonal stripe representing the polar tube (Fig. 1).


Microsporidial keratoconjunctivitis in the tropics: a case series.

Tung-Lien Quek D, Pan JC, Krishnan PU, Zhao PS, Teoh SC - Open Ophthalmol J (2011)

Low (x10) magnification light microscopy appearance of microsporidial spores.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104614&req=5

Figure 1: Low (x10) magnification light microscopy appearance of microsporidial spores.
Mentions: Corneal epithelial scapings were performed on patients presenting to the Ophthalmology unit at Tan Tock Seng Hospital with symptoms and signs suggestive of microsporidia keratoconjunctivitis [4]. The results of all corneal epithelial scrapings for microsporidia microscopy for a 17-month period from October 2006 to February 2008 were examined. Subtotal corneal epithelial scrapings were obtained using a 27-gauge hypodermic needle, air dried on a glass slide, and fixed in methanol for five minutes. The slides were subsequently placed in modified trichome stain for 10 minutes at 50 degrees Celsius, then rinsed in acid alcohol for 10 seconds, followed by 95% alcohol and finally in distilled water [6]. The slides were examined for 100 to 300 fields at a magnification of 100X. Microsporidial spores were identified as ovoid, refractile bodies measuring 0.9 to 1.5 micrometers in size, each with a reddish-pink cellular wall and a horizontal or diagonal stripe representing the polar tube (Fig. 1).

Bottom Line: All cases resolved without visually significant sequelae.Soil contamination is an important risk factor.Treatment with debridement, fluoroquinolones, hexamidine diisethionate with or without systemic albendazole is effective, with steroids reserved for any associated anterior uveitis.

View Article: PubMed Central - PubMed

Affiliation: Singapore National Eye Centre, Singapore.

ABSTRACT

Purpose: To present a series of microsporidial keratoconjunctivitis in 24 eyes.

Methods: Retrospective non-comparative observational case series. Medical records were retrieved and individuals evaluated based on symptoms, risk factors, visual acuity, slit lamp biomicroscopy and pathological examination of cornea epithelial scrapings. Demographic features, clinical course, predisposing factors, microbiological profile, treatment, final clinical outcome and visual acuity were recorded.

Results: Of the 22 patients, 90.9% were men, with a mean age of 30.3 years (range 15 - 76 years). Two (9.1%) had bilateral involvement, 15 (68.2%) were non-contact lens users, 17 (77.3%) reported contamination with mud within 2 weeks (mean 6.8 days) of onset of symptoms. All patients presented with conjunctivitis and coarse, multifocal, punctate epithelial keratitis. Two out of 24 eyes (8.3%) had anterior stromal infiltrates, while 8 (33.3%) had anterior uveitis. Microsporidial spores were identified on modified trichrome staining of corneal epithelial scrapes in all eyes. All eyes were treated with epithelial debridement, topical fluoroquinolone and hexamidine diisethionate, 7 (31.8%) patients received oral albendazole, and all eyes with anterior uveitis received topical steroids. All cases resolved without visually significant sequelae.

Conclusion: Microsporidial keratoconjunctivitis occurred mainly in males, is usually unilateral, presents as conjunctivitis and coarse, multifocal, punctate epithelial keratitis, and may incite anterior uveitis. Soil contamination is an important risk factor. Treatment with debridement, fluoroquinolones, hexamidine diisethionate with or without systemic albendazole is effective, with steroids reserved for any associated anterior uveitis.

No MeSH data available.


Related in: MedlinePlus