Abstract
We investigated an outbreak of 47 probable and 6 confirmed cases of microsporidial keratoconjunctivitis involving participants of an international rugby tournament in Singapore in April 2012.The mode of transmission was eye contact with soil. Vittaforma corneae was identified in 4 of 6 corneal scrapings and in 1 of 12 soil water samples.
Highlights
Microsporidia are spore-forming single-cell intracellular parasites, which have recently been shown to be fungi on the basis of phylogenetic analyses [1]
Local case-patients identified by clubs and medical practitioners were interviewed by telephone or email by using a set of questionnaires to obtain relevant clinical and epidemiologic data such as age, sex, nationality, clinical signs and symptoms, date of onset of illness, medical treatment sought, and details of activities at the tournament
Corneal scrapings collected by ophthalmologists were tested by microscopy; modified trichrome staining was used to detect microsporidial sporelike structures
Summary
Among foreign participants, 4 confirmed cases were identified (Table 1). Besides these affected players, 5 probable cases among Singapore residents were identified, comprising 2 coaches, 2 spectators, and 1 referee. 6 probable sporadic cases were notified during the outbreak period; they were identified in persons who were not linked to the tournament but who had participated in other outdoor activities with exposure to mud (Figure). Symptoms developed from April 25 to May 18, 2012 Their ages ranged from 6 years to 17 years (median age, 12 years). Laboratory analysis of 3 corneal scrapings collected from 2 affected local players and 1 Malaysian player who sought treatment at a private eye center in Singapore revealed microsporidial sporelike structures by microscopy with modified trichrome staining.
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