Microsporidial Keratoconjunctivitis in the Tropics: A Case Series

Desmond Tung-Lien Quek

doi:10.2174/1874364101105010042

Desmond Tung-Lien Quek

Open Access

https://doi.org/10.2174/1874364101105010042

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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.

Highlights

Microsporidia are obligate, intracellular, spore-forming protozoan parasites belonging to the phylum Microspora, a species-rich group of minute, single-celled, intra-cellular parasites
Recent series have reported multifocal coarse punctate epithelial keratitis caused by microsporidia in immunocompetent individuals [4,5]
We report a series of 24 eyes of 22 patients with microsporidial spores identified on corneal epithelial scrapings, including risk factors, clinical presentations, treatment regimes and visual outcomes

Summary

Introduction

Microsporidia are obligate, intracellular, spore-forming protozoan parasites belonging to the phylum Microspora, a species-rich group of minute, single-celled, intra-cellular parasites. Lacking normal mitochondria and with unique cytology, microsporidia have sometimes been thought to be a lineage of ancient eukaryotes. More recently (2005), phylogenetic studies have revealed many other molecules suggesting instead a relationship with fungi [1]. Microsporidia are opportunistic pathogens initially reported to cause two distinct clinical entities: deep corneal stromal infection in immunocompetent patients and bilateral diffuse punctate epithelial keratopathy in immunocompromised patients and patients with AIDS [2,3]. Recent series have reported multifocal coarse punctate epithelial keratitis caused by microsporidia in immunocompetent individuals [4,5]. Risk factors for microsporidial keratoconjunctivitis include systemic or local immunosuppression, ocular trauma and exposure to unclean river

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