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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

Anterior segment photographs showing diffuse, multifocal, punctate epithelial keratitis.
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Figure 2: Anterior segment photographs showing diffuse, multifocal, punctate epithelial keratitis.

Mentions: The results are summarized in Table 1. Of the 204 corneal epithelial scrapings performed for suspected microsporidial keratoconjunctivitis examined between November 2006 to February 2008, 24 (11.8%) were positive for microsporidia. Gram-stain smears and cultures of these scrapings did not reveal any other microorganisms. There was a male preponderance (male:female 10:1), with a median age of 27 years (mean age 30.3 years, range 15 – 76 years). Two patients (9.1%) had bilateral involvement, while the rest were unilateral. Seven patients (31.8%) were contact lens users and 17 (77.3%) reported foreign body contamination between 5 to 14 days (mean 6.8 days) prior to presentation. The mean duration of symptoms at presentation was 6.2 days (range 2 – 14 days). Mud or soil were the predominant ocular contaminants (88.2%), reportedly occurring during sporting activities such as soccer (80.0%) or rugby (13.3%) in muddy fields (Table 2), prior to onset of symptoms, which included redness, foreign body sensation in the eye, tearing, clear discharge and blurring of vision (Table 3). Presenting visual acuity (VA) ranged from 6/6 to 6/24 with 18/24 (75%) with VA of 6/12 or better. Diffuse, multifocal, punctate epithelial keratitis with subepithelial infiltrates (Fig. 2) was observed in all eyes, with 2 eyes (8.3%) having deeper stromal infiltrates. Stromal infiltrates were observed to be centrally located, anterior to mid stromal opacities. Mild non-granulomatous anterior uveitis with fine keratitic precipitates, and anterior chamber activity ranging from 0.5+ (5 eyes) to 1+ (3 eyes) was present in 8 eyes (33.3%).7 No patients had any symptoms or signs of systemic microsporidia infection.


Microsporidial keratoconjunctivitis in the tropics: a case series.

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

Anterior segment photographs showing diffuse, multifocal, punctate epithelial keratitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Anterior segment photographs showing diffuse, multifocal, punctate epithelial keratitis.
Mentions: The results are summarized in Table 1. Of the 204 corneal epithelial scrapings performed for suspected microsporidial keratoconjunctivitis examined between November 2006 to February 2008, 24 (11.8%) were positive for microsporidia. Gram-stain smears and cultures of these scrapings did not reveal any other microorganisms. There was a male preponderance (male:female 10:1), with a median age of 27 years (mean age 30.3 years, range 15 – 76 years). Two patients (9.1%) had bilateral involvement, while the rest were unilateral. Seven patients (31.8%) were contact lens users and 17 (77.3%) reported foreign body contamination between 5 to 14 days (mean 6.8 days) prior to presentation. The mean duration of symptoms at presentation was 6.2 days (range 2 – 14 days). Mud or soil were the predominant ocular contaminants (88.2%), reportedly occurring during sporting activities such as soccer (80.0%) or rugby (13.3%) in muddy fields (Table 2), prior to onset of symptoms, which included redness, foreign body sensation in the eye, tearing, clear discharge and blurring of vision (Table 3). Presenting visual acuity (VA) ranged from 6/6 to 6/24 with 18/24 (75%) with VA of 6/12 or better. Diffuse, multifocal, punctate epithelial keratitis with subepithelial infiltrates (Fig. 2) was observed in all eyes, with 2 eyes (8.3%) having deeper stromal infiltrates. Stromal infiltrates were observed to be centrally located, anterior to mid stromal opacities. Mild non-granulomatous anterior uveitis with fine keratitic precipitates, and anterior chamber activity ranging from 0.5+ (5 eyes) to 1+ (3 eyes) was present in 8 eyes (33.3%).7 No patients had any symptoms or signs of systemic microsporidia infection.

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