Microsporidial keratoconjunctivitis in a patient with AIDS.

Ultrastructural examination of two cases of stromal microsporidial keratitis

“…In early cases the eye was lost before diagnosis was made, or a penetrating keratoplasty failed (Ashton & Wirasinha 1973;Pinnolis et al, 1981). There have been isolated reports of response of cases of keratoconjunctivitis to topical brolene (Metcalfe et al, 1992;Theng et al, 2001) or oral itraconazole (Garcia, 2002), but the mainstay appears to be the use of topical fumagillin (70 ìg ml À1 ) (Rosberger et al, 1993;Diesenhouse et al, 1993) and oral albendazole (400 mg twice daily; a benzimidazole related to thiabendazole) (Gritz et al, 1997;Blanshard et al, 1992). Nevertheless, laboratory determination of the microsporidian species involved in human disease is important, as some species, such as Enterocytozoon bieneusi, are not eliminated by treatment with albendazole (Blanshard et al, 1992;Dieterich et al, 1994).…”

“…Early cases from the USA (Friedberg et al, 1990;Lowder et al, 1990;Orenstein et al, 1990;Yee et al, 1991;Cali et al, 1991b;Metcalfe et al, 1992;McCluskey et al, 1993); UK (Hollister et al, 1996) and Australia (Lafranchi- Tristem et al, 2001) identified the microsporidian species to the genus Encephalitozoon, and it was later recognized as a new species, Encephalitozoon hellem Schwartz et al, 1993;Hollister, 1993a). Other species involved include Encephalitozoon (Septata) intestinalis (Lowder et al, 1996), possibly Encephalitozoon cuniculi (Aarons et al, 1994, Hollister et al 1993b and T. hominis (Field et al, 1996).…”

“…The most common human symptoms are enteric and associated with HIV infection (Lowder & Wilson, 1995). Ocular manifestations are typically a keratoconjunctivitis, found mainly in immunocompromised hosts (Friedberg et al, 1990;Lowder et al, 1990;Orenstein et al, 1990;Yee et al, 1991;Cali et al, 1991a;Metcalfe et al, 1992;McCluskey et al, 1993). By contrast, stromal keratitis has only been described in six cases and appears to be restricted to immunocompetent hosts.…”

Outbreak of microsporidial keratoconjunctivitis with rugby sport due to soil exposure

“…It was first described in 1990, when three patients with acquired immunodeficiency syndrome presented with bilateral superficial epithelial keratitis. 5 Two distinct clinical entities have emerged over the years: multifocal and superficial punctate epithelial keratopathy in immunocompromised patients such as AIDS, [6][7][8][9][10][11] and deep stromal corneal infection in immunocompetent patients. [12][13][14][15] Patients may develop other complications such as uveitis, corneal neovascularisation, necrosis, and perforation.…”

Infections in AIDS

“…2) [36], but E. intestinalis, E. cuniculi and Trachipleistophora hominis have also been reported. These infections cause a bilateral punctate keratopathy (keratoconjunctivitis) [37]. E. hellem has also been reported from the lungs [38], which may be the source of some ocular infections by reverse passage from this respiratory site of infection [39].…”