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Sutton KM, Watts MR, Athavale DD, Lewis N, Petsoglou C, Hudson BJ, Fernando SL. Case Report: The Use of In Vivo Confocal Microscopy for Diagnosis and Monitoring in a Rare Case of Ancaliia algerae Microsporidial Keratitis in New South Wales, Australia. Am J Trop Med Hyg 2024; 110:87-89. [PMID: 37983904 DOI: 10.4269/ajtmh.23-0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/15/2023] [Indexed: 11/22/2023] Open
Abstract
We describe the successful management of Ancaliia Algerae microsporidial keratitis in an immunosuppressed 54-year-old woman with refractory linear IgA disease. The case highlights the challenges in diagnosis and management of this infection in immunocompromised individuals and emphasizes the usefulness of in vivo confocal microscopy as a novel, noninvasive tool to aid in the diagnosis and monitoring of microsporidial keratitis. We also discuss the possible mode of acquisition of this rare infection.
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Affiliation(s)
- Kathryn M Sutton
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Matthew R Watts
- Centre for Infectious Diseases and Microbiology Public Health, Westmead, Australia
- Institute for Clinical Pathology and Medical Research-New South Wales Health Pathology, Westmead, Australia
- University of Sydney, Sydney, Australia
| | - Daniel D Athavale
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia
| | - Noni Lewis
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
| | - Constantinos Petsoglou
- University of Sydney, Sydney, Australia
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
| | - Bernard J Hudson
- University of Sydney, Sydney, Australia
- Department of Clinical Microbiology and Infectious Diseases, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Uematsu M, Mohamed YH, Kusano M, Inoue D, Harada K, Tang D, Kitaoka T, Yagita K. Microsporidial keratoconjunctivitis - first outbreak in Japan. BMC Infect Dis 2023; 23:752. [PMID: 37915107 PMCID: PMC10621313 DOI: 10.1186/s12879-023-08767-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Most cases of microsporidial keratoconjunctivitis are found in the Southern hemisphere. Our purpose was to investigate the first outbreak of microsporidial keratoconjunctivitis in Japan among healthy, immunocompetent soccer players from the same team during a 1-month period. CASE PRESENTATION This study is an observational case series. The medical records were analyzed for five cases with microsporidial keratoconjunctivitis who presented within September 2022. All five cases were males between 28 and 36 years old. These previously healthy individuals belonged to the same football team. Their eyes were considered susceptible to contaminated water or dirt from the turf at game and practice sites. All cases involved unilateral conjunctivitis, with scattered round white lesions that showed positive fluorescein staining in the corneal epithelium. All cases experienced diminution of vision in the affected eye. In three cases, direct smears showed spores of approximately 2-3 μm in diameter. Polymerase chain reaction (PCR) analysis of corneal scrapes revealed partial amplification of microsporidial 18 S ribosomal RNA gene in four cases. Sequences of PCR products from all four cases showed 100% identity with strains of Vittaforma corneae previously reported from an outbreak in Singapore. All cases were treated with topical therapy, including voriconazole, fluorometholone, and levofloxacin. Four eyes underwent corneal scraping. After treatment, all eyes healed without residual opacities. CONCLUSIONS Only a few sporadic case reports of this disease have previously been reported in Japan. We detected V. corneae in our case series, representing what appears to be the first outbreak of microsporidial keratoconjunctivitis in Japan. Exposure to contaminated water or soil, in addition to inadequate sanitary facilities, represents a potential source of infection. Further investigations to clarify the characteristics of microsporidia seem warranted.
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Affiliation(s)
- Masafumi Uematsu
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yasser Helmy Mohamed
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Mao Kusano
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Daisuke Inoue
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kohei Harada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Diya Tang
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kenji Yagita
- Department of Parasitology, The National Institute of Infectious Diseases, Tokyo, Japan
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Mohanty A, Kelgaonkar A, Behera HS, Mallick A, Das S, Rekha Priyadarshini S, Chaurasia S, Sahu SK. Microsporidia-Associated Anterior Uveitis After Keratoconjunctivitis. Cornea 2023; 42:1439-1445. [PMID: 36727968 DOI: 10.1097/ico.0000000000003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to describe the clinical features and management of uveitis associated with microsporidial keratoconjunctivitis (MKC). METHODS The medical records of clinically diagnosed or microbiologically proven patients with MKC between July 2016 and August 2021 were reviewed. Patients with documented evidence of keratic precipitates (KPs) or anterior chamber cells were analyzed for their demography, clinical features, and treatment. Patients with microsporidial stromal keratitis and herpes simplex virus keratouveitis were excluded from the study. RESULTS Of the 2212 patients reviewed within the study period 171 of 172 eyes (7.7%) had documented evidence of KPs and/or anterior chamber cells. The patients' mean age was 43.8 ± 13.8 years, and there were more men (n = 120). The mean duration of appearance of KPs was 6.9 ± 5.5 days, and 28% (n = 48 of 171) appeared on the day of presentation. Superficial punctate keratitis was central and diffuse in 48 and 49 patients, respectively. The treatment was either lubricant alone (45.3%; 78 eyes) or combined with topical steroids (54.7%; 94 eyes). The mean duration of the resolution was longer in the "corticosteroid" than "no corticosteroid" group: KPs: 15.3 ± 6.5 days versus 12.3 ± 5.8 days ( P = 0.007) and superficial punctate keratitises: 15.4 ± 9.4 days versus 11.7 ± 6.2 days ( P = 0.01). The presenting visual acuity with a pinhole was 0.26 ± 0.26 (logMAR) and it improved to 0.03 ± 0.07 on resolution ( P < 0.0001, paired t test). CONCLUSIONS Uveitis after MKC is a self-limiting entity that often resolves without corticosteroid. One must exercise caution in using steroids in the presence of active corneal lesions.
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Affiliation(s)
- Amrita Mohanty
- Cornea and Anterior Segment Services, The Cornea Institute, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Anup Kelgaonkar
- Uveitis and Vitreo-retina Services, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Himansu Shekhar Behera
- Ocular Microbiology Services, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India; and
| | - Aparajita Mallick
- Ocular Microbiology Services, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India; and
| | - Sujata Das
- Cornea and Anterior Segment Services, The Cornea Institute, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Smruti Rekha Priyadarshini
- Cornea and Anterior Segment Services, The Cornea Institute, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Service, The Cornea Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Services, The Cornea Institute, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
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Motro Y, Wajnsztajn D, Michael-Gayego A, Mathur S, Marano RB, Salah I, Rosenbluh C, Temper V, Strahilevitz J, Moran-Gilad J. Metagenomic sequencing for investigation of a national keratoconjunctivitis outbreak, Israel, 2022. Euro Surveill 2023; 28:2300010. [PMID: 37535472 PMCID: PMC10401915 DOI: 10.2807/1560-7917.es.2023.28.31.2300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023] Open
Abstract
BackgroundEpidemics of keratoconjunctivitis may involve various aetiological agents. Microsporidia are an uncommon difficult-to-diagnose cause of such outbreaks.AimDuring the third quarter of 2022, a keratoconjunctivitis outbreak was reported across Israel, related to common water exposure to the Sea of Galilee. We report a comprehensive diagnostic approach that identified Vittaforma corneae as the aetiology, serving as proof of concept for using real-time metagenomics for outbreak investigation.MethodsCorneal scraping samples from a clinical case were subjected to standard microbiological testing. Samples were tested by calcofluor white staining and metagenomic short-read sequencing. We analysed the metagenome for taxonomical assignment and isolation of metagenome-assembled genome (MAG). Targets for a novel PCR were identified, and the assay was applied to clinical and environmental samples and confirmed by long-read metagenomic sequencing.ResultsFluorescent microscopy was suggestive of microsporidiosis. The most abundant species (96.5%) on metagenomics analysis was V. corneae. Annotation of the MAG confirmed the species assignment. A unique PCR target in the microsporidian rRNA gene was identified and validated against the clinical sample. The assay and metagenomic sequencing confirmed V. corneae in an environmental sludge sample collected at the exposure site.ConclusionsThe real-time utilisation of metagenomics allowed species detection and development of diagnostic tools, which aided in outbreak source tracking and can be applied for future cases. Metagenomics allows a fully culture-independent investigation and is an important modality for public health microbiology.
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Affiliation(s)
- Yair Motro
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- These authors contributed equally to the manuscript and share first authorship
| | - Denise Wajnsztajn
- Department of Ophthalmology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- These authors contributed equally to the manuscript and share first authorship
| | - Ayelet Michael-Gayego
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Shubham Mathur
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Roberto Bm Marano
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ikram Salah
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Chaggai Rosenbluh
- Department of Genetics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Violeta Temper
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Strahilevitz
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Rezaeian S, Taghipour A, Bahadory S, Mogharab V, Abdoli A. Global prevalence and genotype distribution of Microsporidia spp. in various consumables: a systematic review and meta-analysis. JOURNAL OF WATER AND HEALTH 2023; 21:895-914. [PMID: 37515561 PMCID: wh_2023_042 DOI: 10.2166/wh.2023.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Water and food sources play a major role in the distribution and transfer of microsporidia infection to animals and humans. So, this systematic review and meta-analysis aimed to assess the status and genetic diversity of microsporidia infection in water, vegetables, fruits, milk, cheese, and meat. The standard protocol of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was followed. Scopus, PubMed, Web of Science, and Google Scholar were searched from 1 January 2000 and 1 February 2023. The point estimates and 95% confidence intervals (CIs) were calculated using a random-effects model. Of the 1,308 retrieved studies, 35 articles were included in the final meta-analysis. The pooled prevalence of microsporidia infection in mixed water, mixed fruits, mixed vegetables, and milk was 43.3% (95% CI, 33-54.2%; I2, 94.86%), 35.8% (95% CI, 5.3-84.8%; I2, 0), 12% (95% CI, 4.9-26.6%; I2, 96.43%), and 5.8% (95% CI, 2.7-12%; I2, 83.72%), respectively. Considering the genotypes, microsporidia with genotype D in water sources and genotype CD6 in vegetables/fruits were the highest reported genotypes. Given the relatively high prevalence of microsporidiosis (especially in water sources), designing strategies for control, and prevention of microsporidia infection in these sources should be recommended.
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Affiliation(s)
- Sanaz Rezaeian
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran; Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran; These authors contributed equally to this work. E-mail:
| | - Ali Taghipour
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Saeed Bahadory
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Vahid Mogharab
- Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, Iran; These authors contributed equally to this work
| | - Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran; Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
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Mohanty A, Sahu SK, Sharma S, Mittal R, Behera HS, Das S, Lakhmipathy M. Past, present, and prospects in microsporidial keratoconjunctivitis- A review. Ocul Surf 2023; 28:364-377. [PMID: 34419638 DOI: 10.1016/j.jtos.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/19/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
Ocular microsporidiosis comprises two entirely different spectra of disease as keratoconjunctivitis and stromal keratitis. Microsporidial keratoconjunctivitis (MKC) has been increasingly reported in the past two decades, probably due to raised awareness, simpler diagnostic procedures, and a better understanding of the clinical presentation. It is characterized by the presence of raised, coarse, punctate, multifocal, round to oval, greyish-white corneal epithelial lesions which usually evolve into nummular scars before resolution. Conjunctivitis seen is non-purulent and of mild-moderate intensity, with mixed papillary-follicular reaction. The mode of transmission and pathogenesis is poorly understood. Despite lack of inflammatory response, uncommon associations reported were- endotheliitis, corneal edema, limbitis, uveitis, and sub-epithelial infiltrates. There has been no consensus on the management of MKC. It varies from the use of multiple antimicrobial agents to simple lubricants. The majority of the disease goes underdiagnosed or misdiagnosed and treated as adenoviral keratoconjunctivitis, with topical steroids or anti-virals empirically. Changing trends have been noticed in the pattern of infection, possibly with increasing evidence of Vittaforma corneae as causative organisms, previously reported to cause stromal keratitis. An elaborate review of the past and present literature on MKC is provided in this review article, along with gaps in knowledge, and future directions of research.
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Affiliation(s)
- Amrita Mohanty
- Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Ruchi Mittal
- Kanupriya Dalmia Ophthalmic Pathology Laboratory, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India; Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Himansu Sekhar Behera
- Ocular Microbiology Service, L.V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Sujata Das
- Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Meena Lakhmipathy
- Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Wei J, Fei Z, Pan G, Weiss LM, Zhou Z. Current Therapy and Therapeutic Targets for Microsporidiosis. Front Microbiol 2022; 13:835390. [PMID: 35356517 PMCID: PMC8959712 DOI: 10.3389/fmicb.2022.835390] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Microsporidia are obligate intracellular, spore-forming parasitic fungi which are grouped with the Cryptomycota. They are both opportunistic pathogens in humans and emerging veterinary pathogens. In humans, they cause chronic diarrhea in immune-compromised patients and infection is associated with increased mortality. Besides their role in pébrine in sericulture, which was described in 1865, the prevalence and severity of microsporidiosis in beekeeping and aquaculture has increased markedly in recent decades. Therapy for these pathogens in medicine, veterinary, and agriculture has become a recent focus of attention. Currently, there are only a few commercially available antimicrosporidial drugs. New therapeutic agents are needed for these infections and this is an active area of investigation. In this article we provide a comprehensive summary of the current as well as several promising new agents for the treatment of microsporidiosis including: albendazole, fumagillin, nikkomycin, orlistat, synthetic polyamines, and quinolones. Therapeutic targets which could be utilized for the design of new drugs are also discussed including: tubulin, type 2 methionine aminopeptidase, polyamines, chitin synthases, topoisomerase IV, triosephosphate isomerase, and lipase. We also summarize reports on the utility of complementary and alternative medicine strategies including herbal extracts, propolis, and probiotics. This review should help facilitate drug development for combating microsporidiosis.
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Affiliation(s)
- Junhong Wei
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
| | - Zhihui Fei
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
| | - Guoqing Pan
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Zeyang Zhou
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
- College of Life Sciences, Chongqing Normal University, Chongqing, China
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Matoba A, Goosey J, Chévez-Barrios P. Microsporidial Stromal Keratitis: Epidemiological Features, Slit-Lamp Biomicroscopic Characteristics, and Therapy. Cornea 2021; 40:1532-1540. [PMID: 33782266 DOI: 10.1097/ico.0000000000002704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Microsporidial stromal keratitis is a rare form of infectious keratitis, with only 7 cases reported in the United States to date. This study was performed to evaluate risk factors, clinical features, and response to therapy. METHODS A retrospective review of the medical records of all patients diagnosed with microsporidial stromal keratitis seen in the practices of the authors between 1999 and 2020 was performed. Diagnosis was determined by cytology or histopathology in corneal specimens. Risk factors, presence or absence of distinctive clinical features, and response to medical and surgical therapies were recorded. RESULTS Nine patients-7M:2F, aged 7 to 99 years-with microsporidial stromal keratitis were identified. Exposures to recreational water and hymenopteran insect bites, both epidemiologically linked risk factors for systemic microsporidial infection, were identified in our patients. Presence of stromal edema with features of disciform keratitis and a distinctive granular keratitis were observed in 6 of 9 and 5 of 9 patients, respectively. Poor response to medical therapy was noted. Penetrating keratoplasty was effective in curing the infection. Final visual acuity was 20/40 or better in 6 of 9 patients. CONCLUSIONS In patients with slowly progressive keratitis, history of exposure to recreational water or hymenopteran insects should be sought. In patients with corneal edema consistent with disciform keratitis, with evolution to a granular keratitis, microsporidia should be considered in the differential diagnosis. In cases of established microsporidial stromal keratitis, penetrating keratoplasty should be considered if prompt response to medical therapy is not noted.
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Affiliation(s)
- Alice Matoba
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX
| | | | - Patricia Chévez-Barrios
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX; and
- Departments of Pathology and Laboratory Medicine, and Ophthalmology, Weill Medical College of Cornell University, New York City, NY
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Huang AS, Cho JS, Bertram BA. Microsporidial Keratitis Related to Water Exposure: A Case Series. Cureus 2021; 13:e15760. [PMID: 34164251 PMCID: PMC8214417 DOI: 10.7759/cureus.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this retrospective study was to present a series of cases involving the rare ocular disease of microsporidia keratitis treated at a private practice clinic and describe the details regarding specific water exposure, clinical course, voriconazole treatment, and increased prevalence of this infection in Augusta, Georgia, USA. Our analysis was based on the accumulated data from all patients (n=15) diagnosed with microsporidia keratitis at our private practice clinic; the clinical course of three cases is discussed in detail in this article. Specific environmental exposures were documented in 10 patients. All patients self-reported that they had no acquired immunodeficiency. In all cases, patients had complete resolution of active symptoms after receiving treatment with 1-2% topical voriconazole, with an approximate average primary treatment duration of 40.1 ± 17.1 days (median: 40 days, range: 14-70 days). None of the patients reported any clinically significant adverse effects from therapy. There have been increasing reports about this emerging infectious pathogen, particularly in Asia. However, there is limited data in the literature on the etiology, pathogenesis, and treatment of microsporidia-caused ophthalmic diseases. In this case series, we highlight the strong correlation of our patients' condition with specific types of water exposure in the USA as well as the complete resolution of active disease in all our patients as a result of monotherapy with topical voriconazole.
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Affiliation(s)
- Andy S Huang
- Ophthalmology, Augusta University Medical College of Georgia, Augusta, USA
| | - James S Cho
- Anesthesiology, Massachusetts General Hospital, Boston, USA.,Ophthalmology, Augusta University Medical College of Georgia, Augusta, USA
| | - Bradley A Bertram
- Ophthalmology, Eye Physicians and Surgeons of Augusta, PC, Augusta, USA
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Mohanty A, Mitra S, Mallick A, Barik MR, Das S, Priyadarshini S, Sahu SK. Sequelae of microsporidial keratoconjunctivitis and its management. Indian J Ophthalmol 2021; 69:1537-1543. [PMID: 34011737 PMCID: PMC8302272 DOI: 10.4103/ijo.ijo_1971_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To characterize the sequelae of microsporidia keratoconjunctivitis (MKC) and outline its management. Methods: Retrospective analysis of microbiologically proven MKC returned with persistent disease between January 2015 and December 2019 was done. Demographics, clinical features, management, and outcome were analyzed. Results: Sixteen patients (21 eyes) of 332 treated for MKC returned with the persisting disease. The mean age of 11 males (68.7%), and 5 females was 35.1 ± 12.2 years. Three-quarter of them did not have a known predisposing risk factor and one-quarter of them were referred for chronic conjunctivitis. Past medications included topical antivirals (n = 8) and topical corticosteroid (n = 6). Three predominant presentations were persistent (>3 weeks) superficial punctate keratitis (SPKs, n = 7), sub-epithelial infiltrates (SEIs, n = 13), and uveitis (n = 2). The lesions recurred in eight eyes (SPK and SEI 4 each) after a disease-free interval of 60.4 ± 40.6 days; there were 13 episodes of recurrence. Topical low potent corticosteroids (loteprednol/fluorometholone), and tacrolimus ointment 0.03% were used in 17 (80.9%) and 8 (38%) eyes, respectively, for a mean duration of 44.8 ± 31.6 and 226.8 ± 180.5 days, respectively. At follow-up, 172.3 ± 183.6 days, visual recovery was statistically significant in persistent eyes (BCVA 0.07 ± 0.07 logMAR; P < 0.00001) but, not in recurrent eyes (BCVA 0.16 ± 0.08 logMAR; P = 0.07). Five of 21 eyes were left with residual significant scar. Conclusion: The sequelae of microsporidial keratoconjunctivitis are not uncommon. Topical 0.03% tacrolimus ointment appeared to be an effective corticosteroid-sparing agent for the treatment of SEIs and prevention of recurrence.
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Affiliation(s)
- Amrita Mohanty
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sanchita Mitra
- Ocular Microbiology Service, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Aparajita Mallick
- Ocular Microbiology Service, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Manas Ranjan Barik
- Ocular Microbiology Service, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sujata Das
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Smrutirekha Priyadarshini
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
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Das AV, Basu S. Temporal trend of microsporidial keratoconjunctivitis and correlation with environmental and air pollution factors in India. Indian J Ophthalmol 2021; 69:1089-1094. [PMID: 33913839 PMCID: PMC8186659 DOI: 10.4103/ijo.ijo_1942_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: The aim of this study was to describe the correlation between the temporal pattern of presentation of acute microsporidial keratoconjunctivitis (MKC) with meteorological parameters such as environmental temperature, rainfall, humidity, windspeed, and air pollution. Methods: This cross-sectional hospital-based study included 182,789 patients presenting between January 2016 and December 2019 hailing from the district of Hyderabad. Patients with a clinical diagnosis of MKC in at least one eye with an acute onset (≤1 week) of presentation were included as cases. Correlation analysis was performed with the local environmental temperature, rainfall, humidity, and windspeed (Telangana State Development and Planning Society) and air pollution (Central Pollution Control Board, Government of India). Results: Overall, 84 (0.05%) patients were diagnosed with acute onset MKC from the district of Hyderabad. The mean monthly prevalence in this cohort was 0.05% with peak prevalence in the months of July (0.08%), August (0.09%), September (0.12%), and October (0.08%). The environmental parameters of rainfall (r2 = 0.87/P = < 0.0001), humidity (r2 = 0.78/P = 0.0001), windspeed (r2 = 0.38/P = 0.0321) were significantly positively correlated and the air pollution parameters such as ground level ozone (r2 = 0.89/P = < 0.0001), particulate matter PM10 (r2 = 0.65/P = 0.0013), PM2.5 (r2 = 0.50/P = 0.0095), nitrogen dioxide (r2 = 0.53/P = 0.0071), and carbon monoxide (r2 = 0.69/P = 0.0008) were significantly negatively correlated with the temporal pattern of MKC in the population. Conclusion: Parasitic infections like MKC show a distinct temporal trend peaking during the monsoon season in the population. An increase in humidity, wind speed, and especially rainfall contributes to a higher prevalence of MKC cases during the year. An increase in ground-level ozone seems to be protective against infection.
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Affiliation(s)
- Anthony Vipin Das
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- The Cornea Institute; Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
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Vittaforma Corneae keratoconjunctivitis: An emerging pathology among travelers returning from Southeast Asia. ACTA ACUST UNITED AC 2020; 95:569-572. [PMID: 32660763 DOI: 10.1016/j.oftal.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Abstract
Microsporidium keratoconjunctivitis is an very rare disease. It is related to outbreaks in Asia due to exposure to contaminated water or soil. Microsporidium keratoconjunctivitis is a a self-limited disease, but it could have long term courses. We present the case of a 29 year old woman who started with pain, redness and blurred vision after a holiday in Singapore and did not respond to conjunctivitis treatment. PCR sequencing and PAS staining of corneal epithelial biopsy identified Vittaforma corneae as the causative organism. Treatment was initiated with corneal debridement, oral albendazol, and intensive topical voriconazole, levofloxacin and propamidine, but the conjunctival and corneal disease was only resolved 5 months later with the introduction of topical steroids to treat her severe limbitis. Suspicion of Microsporidium keratoconjunctivitis should be raised amongst ophthalmologists in unilateral keratitis with mild conjunctivitis in travelers from Asia.
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Khurana S, Sharma M. Parasitic keratitis - An under-reported entity. Trop Parasitol 2020; 10:12-17. [PMID: 32775286 PMCID: PMC7365502 DOI: 10.4103/tp.tp_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 11/04/2022] Open
Abstract
Parasitic keratitis (PK) is unique entity among parasitic infections where corneal involvement could result from direct inoculation of the parasite via exogenous environment or spread via endogenous neighboring organs or as a result of immune-mediated damage secondary to a systemic parasitic infection. Most cases of PK are caused by Acanthamoeba spp. and Microsporidia spp. though few other parasitic agents can also lead to corneal involvement. Mimicking as other infectious and non-infectious causes of keratitis, PK often escapes detection. This review summarizes the predominant causes of PK along with the epidemiological, clinical and microbiological details of each. Though several gaps exist in our understanding of the prevalence of PK, the one thing for sure is that PK is on the rise. With advanced diagnostic modalities and enough literature on optimal management of cases of PK, it is now imperative that a strong clinical suspicion of PK is kept when examining a case of corneal pathology and adequate investigations are ordered.
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Affiliation(s)
- Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Balamurugan R, Gupta PC, Sharma SP, Rana N, Ram J. Microsporidial Keratoconjunctivitis. J Ophthalmic Vis Res 2020; 15:259-260. [PMID: 32308963 PMCID: PMC7151509 DOI: 10.18502/jovr.v15i2.6746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/05/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- R Balamurugan
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surya Prakash Sharma
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeti Rana
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Microsporidia are a rare and commonly misdiagnosed cause of corneal infection, accounting for approximately 0.4% of cases of microbial keratitis in some populations. Ocular microsporidiosis most often presents as either microsporidial keratoconjunctivitis (MKC) or microsporidial stromal keratitis (MSK). Though these two clinical entities exhibit similar symptomology, they are distinguished from one another by the time course for disease progression, findings on slit-lamp examination, and response to medical therapy. This review summarizes the current literature on the etiology and clinical presentation of microsporidial infections of the cornea and highlights ongoing developments in available diagnostic modalities and treatment regimens.
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Liu HY, Chu HS, Wang IJ, Chen WL, Hu FR. Microbial Keratitis in Taiwan: A 20-Year Update. Am J Ophthalmol 2019; 205:74-81. [PMID: 30951687 DOI: 10.1016/j.ajo.2019.03.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/17/2019] [Accepted: 03/23/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the demographics, risk factors, microbiology, and resistance pattern at a tertiary hospital and to detect the shifting trend over 2 decades. DESIGN A retrospective observational case series. METHODS We reviewed all records of patients with microbial keratitis (MK) that were hospitalized in National Taiwan University Hospital between 2007 and 2016. Demographics, predisposing factors, pathogens, and clinical courses were compared to our previous study conducted from 1992 to 2001. Antibiotic susceptibility was compared with those conducted from 1994 to 2005. RESULTS The percentage of patients 60 years and older in the MK population was increasing (P = 2.1E-21). The proportion of trauma-related MK declined while MK related to chronic ocular or systemic disorders rose. The prevalence of nontuberculous mycobacteria (NTM) showed a decreasing trend (P = .0032), whereas Microsporidia has been increasingly detected. The 2 most common bacterial isolates were Pseudomonas aeruginosa (35.2%) and Staphylococcus species (13.2%). Management of these infection did not differ in common pathogens between the 2 decades. The susceptibility of Staphylococcus species to oxacillin reduced significantly (P = .002) and there was an increase in methicillin-resistant Staphylococcus aureus keratitis. CONCLUSIONS Contact lens wear remained the most common predisposing factor, with Pseudomonas species as the major pathogen. However, chronic disorder-related MK was on the rise along with an increasing trend of oxacillin resistance in Staphylococcus species. We found a decreasing trend in NTM keratitis while Microsporidia keratitis was considered as an emerging ocular disease. Though gram-negative isolates remained susceptible to all antibiotics tested, antibiotic resistance was more common in gram-positive isolates.
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Affiliation(s)
- Hsin-Yu Liu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Sang Chu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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Ueno S, Eguchi H, Hotta F, Fukuda M, Kimura M, Yagita K, Suzuki T, Kusaka S. Microsporidial keratitis retrospectively diagnosed by ultrastructural study of formalin-fixed paraffin-embedded corneal tissue: a case report. Ann Clin Microbiol Antimicrob 2019; 18:17. [PMID: 31182106 PMCID: PMC6558824 DOI: 10.1186/s12941-019-0316-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/06/2019] [Indexed: 01/07/2023] Open
Abstract
Background The utility of formalin-fixed paraffin-embedded (FFPE) corneal tissue specimens for retrospective diagnosis of microsporidial keratitis was evaluated by transmission electron microscopy (TEM) analysis and the possible second case of microsporidial keratitis after Descemet stripping automated endothelial keratoplasty (DSAEK) was described. Case presentation A 68-year-old man presented with multiple crystalline opacities in the corneal stroma that progressed extremely slowly after DSAEK. Fungiflora Y staining of corneal scrapings from the affected regions revealed an oval microorganism. Topical voriconazole administration was ineffective and penetrating keratoplasty was performed. Histological and molecular analyses were carried out on the excised cornea. Ziehl–Neelsen staining revealed an acid-fast, oval organism that was visible by ultraviolet illumination after Fungiflora Y and Uvitex 2B staining, whereas periodic acid-Schiff and Grocott’s staining did not yield any significant findings. Microsporidium was detected by TEM of FFPE tissue. Nosema or Vittaforma sp. was suspected as the causative microorganism by PCR of FFPE tissue and by the fact that those species are known to cause eye infection. The corneal graft has maintained transparency at 1 year and half postoperatively. Conclusions This is the first known case of microsporidial keratitis diagnosed retrospectively by molecular and ultrastructural study of FFPE tissue, and the possible second case of microsporidial keratitis after DSAEK. Microsporidial keratitis should be considered when corneal opacity refractory to conventionally known therapy would occur after DSAEK. Our findings suggest that more microsporidial keratitis cases than have been reported to date can be identified by TEM or PCR examination of FFPE corneal specimens.
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Affiliation(s)
- Satoru Ueno
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroshi Eguchi
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Fumika Hotta
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masahiko Fukuda
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masatomo Kimura
- Department of Pathology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kenji Yagita
- Department of Parasitology, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku, Tokyo, 162-8640, Japan
| | - Takashi Suzuki
- Department of Ophthalmology, Toho University Medical Center, 6-11-1, Ohmorinishi, Ota, Tokyo, 143-8541, Japan
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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Abstract
The purpose of this article is to provide a review of existing literature describing complications with contemporary contact lenses and their management. It is envisioned that this will serve as a useful summary of noninfectious and infectious complications associated with contact lens wear.
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes in opportunistic ocular infections (OOIs) in the era of modern combination antiretroviral therapy (cART), in the setting of HIV-infected patients. RECENT FINDINGS Improvements in modern cART has led to a progressive decline in the incidence of OOIs and mortality among patients with AIDS. Not only has there been a decreasing incidence of cytomegalovirus (CMV) retinitis, but there also has been a decline in progression of such retinitis when it does occur in AIDS patients, since the introduction of cART. Nevertheless, CMV retinitis remains the major cause of vision loss in AIDS patients. Although the incidence of CMV retinitis has declined overall, the incidence of ocular syphilis has increased during the cART era. Moreover, the impact of having HIV plays a role with respect to multidrug-resistant (MDR) tuberculosis and has resulted in a high prevalence of presumed ocular tuberculosis in HIV/MDR-TB co-infected patients. Although immune reconstitution uveitis (IRU) has been an important cause of visual deficits in developed countries, OOIs remain an important cause of blindness in the developing world. SUMMARY Reconstituting the immune system with effective cART while increasing accessibility of screening examinations is key to the success of blindness prevent in HIV-infected individuals, particularly in developing countries.
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Wang WY, Chu HS, Lin PC, Lee TF, Kuo KT, Hsueh PR, Hu FR, Wang IJ. Outbreak of Microsporidial Keratoconjunctivitis Associated With Water Contamination in Swimming Pools in Taiwan. Am J Ophthalmol 2018; 194:101-109. [PMID: 30055152 DOI: 10.1016/j.ajo.2018.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To report an outbreak of microsporidial keratoconjunctivitis resulting from a swimming pool in Taiwan. DESIGN Retrospective case series. METHODS The records of 13 teenagers (15 eyes) contracting microsporidial keratoconjunctivitis after swimming in a local swimming pool were reviewed. Corneal scrapings were collected in all eyes at a tertiary referred hospital in June 2017. Gram stain, modified Kinyoun acid-fast stain, polymerase chain reaction (PCR), and gene analysis of the microsporidian 16S ribosomal RNA (rRNA) were examined in all 15 cases. RESULTS Symptoms occurred 1-12 days after the water contact. At presentation, all eyes showed nonpurulent conjunctivitis and small, plaque-like epithelial lesions peripherally (n = 6), centrally (n = 3), both peripherally and centrally (n = 5), or centrally with superficial punctate keratopathy (n = 1). During the follow-up period, 10 eyes developed central superficial punctate keratopathy (n = 6) or subepithelial haze or infiltrates, which were distributed centrally (n = 2) or peripherally (n = 3), following development of plaque-like epithelial lesions. The results of Gram stain and modified Kinyoun's acid-fast stain were confirmatory in 10 cases (67%). All 15 cases yielded positive PCR results and were all identified to be Vittaforma corneae. All followed-up eyes healed without sequelae using topical levofloxacin and betamethasone eye drops. CONCLUSIONS Microsporidial keratoconjunctivitis can develop from contact with swimming pool water. The clinical course initially manifested as rapidly resolving conjunctivitis and peripheral plaque-like epithelial lesions, followed by paracentral or central plaque-like epithelial lesions, which evolved into subepithelial haze or infiltrates.
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Affiliation(s)
- Wen-Yi Wang
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiao-Sang Chu
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Chun Lin
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tai-Fen Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Ting Kuo
- Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.
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Leroy J, Cornu M, Deleplancque AS, Bart A, Loridant S, Fréalle E, Dutoit E, Gaillot O, van Gool T, Puisieux F, Labalette P, Sendid B. Case Report: Ocular Microsporidiosis: Case in a Patient Returning from India and Review of the Literature. Am J Trop Med Hyg 2018; 99:90-93. [PMID: 29692301 DOI: 10.4269/ajtmh.18-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Microsporidia are protists close to the kingdom of fungi that may cause eye infections. Most cases are reported in Asia and affect both immunocompromised and immunocompetent patients. Here, we report a rare case of microsporidial keratoconjunctivitis in an immunocompetent French patient 3 weeks after returning from India. In our patient, Weber trichrome staining of conjunctival scrapings revealed rounded elements approximately 1-3 μm in size. Conventional polymerase chain reaction analysis by ribosomal RNA subunit sequencing showed 100% identity with Vittaforma corneae. Treatment by corneal debridement combined with fluoroquinolone eye drops allowed complete resolution of the lesions. Although rare, ocular microsporidiosis should be investigated in a patient who is native to Asia or has returned from an endemic area and presents with keratoconjunctivitis of undetermined etiology.
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Affiliation(s)
- Jordan Leroy
- Institut National de la Santé et de la Recherche Médicale, Unité 995-Lille Inflammation Research International Center, Fungal Associated Invasive & Inflammatory Diseases, Lille, France.,Service de Parasitologie-Mycologie, Lille University Hospital, Lille, France
| | - Marjorie Cornu
- Institut National de la Santé et de la Recherche Médicale, Unité 995-Lille Inflammation Research International Center, Fungal Associated Invasive & Inflammatory Diseases, Lille, France.,Service de Parasitologie-Mycologie, Lille University Hospital, Lille, France
| | | | - Aldert Bart
- Department of Medical Microbiology, Section Parasitology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Séverine Loridant
- Institut National de la Santé et de la Recherche Médicale, Unité 995-Lille Inflammation Research International Center, Fungal Associated Invasive & Inflammatory Diseases, Lille, France.,Service de Parasitologie-Mycologie, Lille University Hospital, Lille, France
| | - Emilie Fréalle
- Service de Parasitologie-Mycologie, Lille University Hospital, Lille, France
| | - Emmanuel Dutoit
- Service de Parasitologie-Mycologie, Lille University Hospital, Lille, France
| | - Olivier Gaillot
- Service de Bactériologie, Lille University Hospital, Lille, France
| | - Tom van Gool
- Department of Medical Microbiology, Section Parasitology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Pierre Labalette
- Service d'Ophtalmologie, Lille University Hospital, Lille, France
| | - Boualem Sendid
- Institut National de la Santé et de la Recherche Médicale, Unité 995-Lille Inflammation Research International Center, Fungal Associated Invasive & Inflammatory Diseases, Lille, France.,Service de Parasitologie-Mycologie, Lille University Hospital, Lille, France
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Huang FC, Hsieh HY, Chang TC, Su SL, Tseng SL, Lai YH, Kuo MT. A DNA dot hybridization model for molecular diagnosis of parasitic keratitis. Mol Vis 2017; 23:614-623. [PMID: 28867932 PMCID: PMC5568909 DOI: pmid/28867932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/22/2017] [Indexed: 02/08/2023] Open
Abstract
Purpose Developing a DNA dot hybridization model for diagnosing parasitic keratitis. Methods Newly designed oligonucleotide probes for detecting Acanthamoeba and microsporidia were tested with target reference strains of Acanthamoeba (n = 20) and microsporidia (n = 3), and non-target microorganisms, including bacteria (n = 20) and fungi (n = 20). These probes, which had passed the preliminary tests, were then assembled as a parasite dot hybridization (PDH) model for assessing 33 clinical samples from patients with clinically suspected Acanthamoeba and microsporidia keratitis, including eight positives for Acanthamoeba, 13 positives for microsporidia, and 12 negatives for both pathogens. Results Two probes for detecting Acanthamoeba and two for detecting microsporidia passed the tests using target and non-target strains and then were assembled in the PDH model. For clinical samples, one Acanthamoeba-positive sample (proved with pathology) was falsely negative according to the PDH assay. The sensitivity and specificity of the PDH assay for diagnosing Acanthamoeba keratitis were 87.5% and 100%, respectively, while the sensitivity and specificity for diagnosing microsporidia keratitis were 100%. The infectious agent of all clinical samples of microsporidia keratitis was identified as Vittaforma corneae with DNA sequencing, while those of Acanthamoeba keratitis were caused by four species of Acanthamoeba, with Acanthamoeba castellanii found in four samples (50%, 4/8). Conclusions The PDH model has the potential to be a molecular assay for diagnosing Acanthamoeba and microsporidia keratitis. However, a prospective clinical study might be needed before the model is adopted in routine clinical practice.
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Affiliation(s)
- Fu-Chin Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yi Hsieh
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung C Chang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Li Su
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shin-Ling Tseng
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Hsuan Lai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chen JS, Hsu TK, Hsu BM, Huang TY, Huang YL, Shaio MF, Ji DD. Surveillance of Vittaforma corneae in hot springs by a small-volume procedure. WATER RESEARCH 2017; 118:208-216. [PMID: 28432932 DOI: 10.1016/j.watres.2017.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/21/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
Vittaforma corneae is an obligate intracellular fungus and can cause human ocular microsporidiosis. Although accumulating reports of V. corneae causing keratoconjunctivitis in both healthy and immunocompromised persons have been published, little is known about the organism's occurrence in aquatic environments. Limitations in detection sensitivity have meant a large sampling volume is required to detect the pathogen up to now, which is problematic. A recent study in Taiwan has shown that some individuals suffering from microsporidial keratitis (MK) were infected after exposure to the pathogen at a hot spring. As a consequence of this, a survey and analysis of environmental V. corneae present in hot springs became an urgent need. In this study, sixty water samples from six hot spring recreation areas around Taiwan were analyzed. One liter of water from each sample site was filtered to harvest the fungi. The positive samples were detected using a modified nested PCR approach followed by sequencing using specific SSU rRNA gene primer pairs for V. corneae. In total fifteen V. corneae-like isolates were identified (25.0% of sites). Among them, six isolates, which were collected from recreational areas B, C and D, were highly similar to known V. corneae keratitis strains from Taiwan and other countries. Furthermore, five isolates, which were collected from recreation areas A, C, E and F, were very similar to Vittaforma-like diarrhea strains isolated in Portugal. Cold spring water tubs and public foot bath pools had the highest detection rate (50%), suggesting that hot springs might be contaminated via untreated water sources. Comparing the detection rate across different regions of Taiwan, Taitung, which is in the east of the island, gave the highest positive rate (37.5%). Statistical analysis showed that outdoor/soil exposure and a high heterotrophic plate count (HPC) were risk factors for the occurrence of V. corneae. Our findings provide empirical evidence supporting the need for proper control and regulations at hot spring recreational waters in order to avoid health risks from this pathogen. Finally, we have developed a small volume procedure for detecting V. corneae in water samples and this has proved to be very useful.
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Affiliation(s)
- Jung-Sheng Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tsui-Kang Hsu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Bing-Mu Hsu
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Minhsiung Township, Chiayi County, 62102, Taiwan, ROC.
| | - Tung-Yi Huang
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Minhsiung Township, Chiayi County, 62102, Taiwan, ROC
| | - Yu-Li Huang
- Department of Safety Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Men-Fang Shaio
- Department of Tropical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan, ROC
| | - Dar-Der Ji
- Department of Tropical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan, ROC.
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Gulias Cañizo R, Hernandez Ayuso Y, Rios y Valles D, Sanchez Huerta V, Rodríguez Reyes AA. Microsporidiosis corneal. Reporte de casos y revisión de la literatura. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2015.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Das S, Wallang BS, Sharma S, Bhadange YV, Balne PK, Sahu SK. The efficacy of corneal debridement in the treatment of microsporidial keratoconjunctivitis: a prospective randomized clinical trial. Am J Ophthalmol 2014; 157:1151-5. [PMID: 24589573 DOI: 10.1016/j.ajo.2014.02.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the efficacy of corneal debridement in the treatment of clinically diagnosed cases of microsporidial keratoconjunctivitis. DESIGN Prospective, double-masked randomized clinical trial. METHODS Patients with clinical features such as multifocal, coarse, raised, punctate, round to oval epithelial lesions in the cornea in slit-lamp examination with mild to moderate conjunctival congestion, suggestive of microsporidial superficial keratoconjunctivitis, were included in the prospective study. All patients were randomized into 2 groups. Group 1 patients underwent debridement with the help of a sterile #15 blade on a Bard-Parker handle, whereas only conjunctival swabs were taken from Group 2 patients. All patients were treated with ocular lubricants. RESULTS One hundred and twenty patients with clinical features suggestive of microsporidial superficial keratoconjunctivitis were included in the study. The mean age was 34.3 ± 13.6 years (Group 1) and 35.8 ± 16.2 years (Group 2) (P = .59). The mean duration of symptoms was 6.8 ± 3.9 days (Group 1) and 7.2 ± 4.6 days (Group 2) (P = .61). Baseline characteristics showed no difference between the 2 groups. The primary outcome was the time from the presentation to complete resolution (ie, absence of corneal lesions) of the clinical signs and symptoms. The secondary outcomes were final visual acuity and residual corneal side effects and/or scarring, if any. The mean resolution time of the corneal lesions was 5.7 ± 4.0 days (Group 1) and 5.9 ± 3.9 days (Group 2) (P = .83). There was no significant difference in final visual outcome in the 2 groups. No serious side effects were observed. CONCLUSION Debridement does not have any significant advantage in terms of resolution of the corneal lesions and final visual outcome in cases of microsporidial keratoconjunctivitis.
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Affiliation(s)
- Sujata Das
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India.
| | - Batriti S Wallang
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Savitri Sharma
- Ocular Microbiology Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Yogesh V Bhadange
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Praveen K Balne
- Ocular Microbiology Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
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Wong SSY, Fung KSC, Chau S, Poon RWS, Wong SCY, Yuen KY. Molecular diagnosis in clinical parasitology: When and why? Exp Biol Med (Maywood) 2014; 239:1443-60. [DOI: 10.1177/1535370214523880] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Microscopic detection and morphological identification of parasites from clinical specimens are the gold standards for the laboratory diagnosis of parasitic infections. The limitations of such diagnostic assays include insufficient sensitivity and operator dependence. Immunoassays for parasitic antigens are not available for most parasitic infections and have not significantly improved the sensitivity of laboratory detection. Advances in molecular detection by nucleic acid amplification may improve the detection in asymptomatic infections with low parasitic burden. Rapidly accumulating genomic data on parasites allow the design of polymerase chain reaction (PCR) primers directed towards multi-copy gene targets, such as the ribosomal and mitochondrial genes, which further improve the sensitivity. Parasitic cell or its free circulating parasitic DNA can be shed from parasites into blood and excreta which may allow its detection without the whole parasite being present within the portion of clinical sample used for DNA extraction. Multiplex nucleic acid amplification technology allows the simultaneous detection of many parasitic species within a single clinical specimen. In addition to improved sensitivity, nucleic acid amplification with sequencing can help to differentiate different parasitic species at different stages with similar morphology, detect and speciate parasites from fixed histopathological sections and identify anti-parasitic drug resistance. The use of consensus primer and PCR sequencing may even help to identify novel parasitic species. The key limitation of molecular detection is the technological expertise and expense which are usually lacking in the field setting at highly endemic areas. However, such tests can be useful for screening important parasitic infections in asymptomatic patients, donors or recipients coming from endemic areas in the settings of transfusion service or tertiary institutions with transplantation service. Such tests can also be used for monitoring these recipients or highly immunosuppressed patients, so that early preemptive treatment can be given for reactivated parasitic infections while the parasitic burden is still low.
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Affiliation(s)
- Samson SY Wong
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kitty SC Fung
- Department of Pathology, United Christian Hospital, Kwun Tong of New Kowloon, Hong Kong
| | - Sandy Chau
- Department of Pathology, United Christian Hospital, Kwun Tong of New Kowloon, Hong Kong
| | - Rosana WS Poon
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Sally CY Wong
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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