Is microsporidial keratitis an emerging cause of stromal keratitis? A case series study.
BACKGROUND
Microsporidial keratitis is a rare cause of stromal keratitis. We present a series of five cases of microsporidial keratitis from a single centre in southern India with microbiologic and histopathologic features.


METHODS
Patient charts of five cases of microsporidial stromal keratitis diagnosed between January 2002 and June 2004 were reviewed retrospectively for clinical data, microbiologic and histopathologic data. The presence of microsporidia was confirmed by special stains on corneal scrapings and/or corneal tissues, and electron microscopy. All patients were immunocompetent with a preceding history of trauma in three. Four patients presented with unilateral, small, persisting deep stromal infiltrates, of uncertain etiology, in the cornea, which were not responding to conventional antimicrobial treatment and required penetrating keratoplasty in three. Fifth case was unsuspected and underwent keratoplasty for post-traumatic scar. Three of five cases were diagnosed on corneal scrapings, prior to keratoplasty, while two were diagnosed only on histology. The microsporidia appeared as oval well defined bodies with dense staining at one pole. None of the patients showed recurrence following keratoplasty.


CONCLUSIONS
Microsporidia, though rare, should be suspected in chronic culture-negative stromal keratitis. Organisms could lie dormant without associated inflammation.
Vemuganti
Geeta K
GK
Ophthalmic Pathology Service, L.V. Prasad Eye Institute, Hyderabad, India. geeta@lvpei.org
Garg
Prashant
P
Sharma
Savitri
S
Joseph
Joveeta
J
Gopinathan
Usha
U
Singh
Shashi
S
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003319:Corneal Stroma / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D016814:Microsporidia / Q000302:isolation & purification*; D016881:Microsporidiosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies
D000935:Antifungal Agents