Microsporidium Stromal Keratitis: In Vivo Confocal Findings

Sagoo, Mandeep S.; Hau, Scott; Irion, Luciane; Curry, Alan; Bonshek, Richard; Tuft, Stephen

doi:10.1097/ico.0b013e31806c7a3c

Cited by 37 publications

(28 citation statements)

References 33 publications

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“…They may be seen within keratocytes and histiocytes, or align along the stromal lamellae, with varying degrees of inflammation and stromal necrosis depending on the host immune status. 12,14 The modified trichrome and Ziehl-Neelsen stains best show the characteristic waistband and polar periodic acid-Schiff staining granule in mature spores-which are diagnostic for microsporidia. Recently, Gram chromotrope staining has been proposed to be useful.…”

Section: Discussionmentioning

confidence: 99%

“…Topical fumagillin and oral albendazole, usually effective in early epithelial disease, have been used in the majority of cases of deeper stromal involvement, often with a poor response. [5][6][7][8][9][10][11][12][13] Presumed poor penetration into deep stroma and suggestions that fumagillin is parasitistatic rather parasiticidal means that long periods of medication are required, with discontinuation often leading to recurrence. 9 Invariably, surgical intervention may be required and of the 13 published cases of stromal keratitis, 10 ultimately required therapeutic PK.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 13 reported cases in the literature, medical treatment results have often been variable, with 10 cases eventually requiring penetrating keratoplasty (PK). [5][6][7][8][9][10][11][12][13] We present a case of microsporidial stromal keratitis in an immunocompetent patient who was successfully treated with intensive medical therapy, followed by deep anterior lamellar keratoplasty (DALK).…”

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confidence: 99%

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Deep Anterior Lamellar Keratoplasty to Treat Microsporidial Stromal Keratitis

Ang

Mantoo²,

Tan³

2009

Cornea

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Deep Anterior Lamellar Keratoplasty to Treat Microsporidial Stromal Keratitis

Ang

Mantoo²,

Tan³

2009

Cornea

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“…Immune restoration following highly active antiretroviral therapy (HAART) is also necessary for the resolution or remission of microsporidial disease occurring as a result of HIV infection (224,393). Given the close relationship between the microsporidia and fungi, it is not surprising that certain antifungal compounds (particularly some benzimidazoles) exhibit good antimicrosporidial activity (164,233,489,491,532,617). As such, the future discovery of novel antifungal compounds may also have implications for future antimicrosporidial therapy.…”

Section: Nonenteric Microsporidiamentioning

confidence: 99%

Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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SUMMARY There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.

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“…Microsporidial spores are visualized as high contrast intraepithelial or intrastromal bright dots aligned along keratocytes. It is also an important tool for monitoring the treatment response [34]. …”

Section: Confocal Microscopymentioning

confidence: 99%

Microsporidial Keratitis

Bhosale¹,

Ganesan²

2015

J Bacteriol Parasitol

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Hundreds of genera and thousands of species of obligate intracellular spore forming eukaryotes constitute the phylum Microspora. Currently these organisms are known to cause infections in the immunocompromised individuals in whom they exhibit diverse clinical manifestations including pulmonary, ocular, intestinal, muscular and renal disease. Ocular microsporidiosis can present as an isolated entity or as a part of systemic infection. Infection is acquired by traumatic inoculation or by contact with contaminated soil or water. Clinically this infection can present as stromal keratitis, scleritis, keratoconjuntivitis and endophthalmitis. Seven genera have been found to be associated with human ocular infections. Infections by these pathogenic organisms involve unique pathogenic mechanism-injection of the sporoplasm in the host cell via polar tube. Protean clinical manifestations and resemblance to herpetic keratitis poses as a challenge in clinical diagnosis of this condition. Diagnosis therefore mainly depends on morphological demonstration of these organisms. Electron microscopy is the 'gold standard' diagnostic method to detect microsporidial spores. Molecular methods like PCR, real time PCR are sensitive tests and aids in identification till the species level. Drugs like albendazole and fumagillin are widely used to treat microsporidial keratitis. Penetrating keratoplasty is useful in treating medically non responding cases.

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Microsporidium Stromal Keratitis: In Vivo Confocal Findings

Abstract: The in vivo confocal microscopy appearance of microsporidial keratitis corresponds to the histologic features from biopsy material. Treatment response may be monitored by using this technique, although definitive diagnosis requires corneal biopsy.

Cited by 37 publications

References 33 publications

Deep Anterior Lamellar Keratoplasty to Treat Microsporidial Stromal Keratitis

Deep Anterior Lamellar Keratoplasty to Treat Microsporidial Stromal Keratitis

Importance of Nonenteric Protozoan Infections in Immunocompromised People

Microsporidial Keratitis

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