Clinical and microbiological profile of microsporidial keratoconjunctivitis in southern India.
OBJECTIVE
To report the clinical and microbiological profile of microsporidial keratoconjunctivitis in immunocompetent individuals in southern India.


METHODS
Retrospective noncomparative case series.


METHODS
Nineteen cases of microsporidial keratoconjunctivitis diagnosed between January 2002 and December 2004 were studied.


METHODS
All medical and laboratory records of patients with infectious keratitis during the study period were reviewed. In all cases, after relevant history recording and slit-lamp examination, corneal/conjunctival scrapings were collected. Multiple scrapings were taken from the lesions and examined by fluorescence or light microscopy after staining with potassium hydroxide and calcofluor white (KOH + CFW), Gram's stain, Kinyoun's, and Giemsa stain. In some cases, the serum was tested for human immunodeficiency virus antibody by enzyme-linked immunosorbent assay.


METHODS
Clinical course, demographic features, predisposing factors, microbiological profile, treatment, and final outcome.


RESULTS
Of 4822 cases of suspected microbial keratitis seen during the period, 19 (0.4%) were identified as microbiologically proven microsporidial keratitis. All patients were apparently healthy; 8 had a history of ocular trauma, and 3 mentioned bathing in unclean river water. All but 2 had unilateral involvement. The mean age of the patients was 38.4+/-13.7 years (range, 23-73). The duration of symptoms ranged from 1 day to 2 years, with 11 of 19 (58%) presenting within a week of onset of symptoms. Slit-lamp examination revealed multifocal, coarse, punctate, raised epithelial lesions in all patients. A mild to moderate nonpurulent conjunctivitis was present in all cases, with papillary and/or follicular reaction in 14. Corneal/conjunctival scrapings demonstrated microsporidial spores by KOH + CFW in 16 of 17 cases tested, whereas the diagnosis was made by Giemsa stain in 2 cases and by Gram's stain in one. Kinyoun's (1% acid fast) stain was confirmatory in all cases. In all patients, treatment was started after debridement and included oral and/or topical antimicrobial agents. At last follow-up, 15 of 19 achieved a visual acuity of 20/20.


CONCLUSIONS
Microsporidial keratoconjunctivitis should be considered in the differential diagnosis of atypical punctate epithelial keratitis associated with conjunctivitis and can be diagnosed by routine microbiological methods. The disease can occur in healthy individuals, and the outcome of treatment is often satisfactory.
Joseph
Joveeta
J
Jhaveri Microbiology Center, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Hyderabad, India.
Sridhar
Mittanamalli S
MS
Murthy
Somasheila
S
Sharma
Savitri
S
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000382:microbiology; D003646:Debridement; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007637:Keratoconjunctivitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D016814:Microsporidia / Q000302:isolation & purification*; D016881:Microsporidiosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity
D000935:Antifungal Agents