1887

Abstract

Two cases with chronic stromal keratitis are described in immunocompetent hosts where the diagnosis was originally thought to be herpetic or adenoviral disease. Light microscopy and ultrastructural examination of corneal tissue by electron microscopy were performed following penetrating keratoplasty (case 1) and corneal biopsy (case 2). Specimens from both cases were analysed for viral identification by PCR. Two different species of Microsporidia were identified. Case 1 represents the fourth reported case of corneal stromal where the spores measured 3.3 × 1.4 μm, arranged in characteristic linear groups of about four to eight. Each spore contained a diplokaryotic nucleus and a single row of ten polar tube coils. By contrast, case 2 is the first reported case of stromal keratitis caused by . In this case, spores measured 4 × 2.4 μm, located typically within packets. In this species, the polar tube was arranged as a single row of about 10–13 profiles. Viral DNA could not be amplified by PCR. In conclusion, microsporidial stromal keratitis should be considered in culture-negative cases refractory to medical therapy. As microbiological culture techniques are unsuccessful, diagnosis may only be established following histopathological and ultrastructural examination of corneal tissue.

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2004-08-01
2024-03-28
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References

  1. Aarons E. J., Woodrow D., Hollister W. S., Canning E. U., Francis N., Gazzard B. G. 1994; Reversible renal failure caused by a microsporidian infection. AIDS 8:1119–1121 [CrossRef]
    [Google Scholar]
  2. Ashton N., Wirasinha P. A. 1973; Encephalitozoonosis (nosematosis) of the cornea. Br J Ophthalmol 57:669–674 [CrossRef]
    [Google Scholar]
  3. Blanshard C., Ellis D. S., Tovey D. G., Dowell S., Gazzard B. G. 1992; Treatment of intestinal microsporidiosis with albendazole in patients with AIDS. AIDS 6:311–313 [CrossRef]
    [Google Scholar]
  4. Bouladoux N., Biligui S., Desportes-Livage I. 2003; A new monoclonal antibody enzyme-linked immunosorbent assay to measure in vitro multiplication of Encephalitozoon intestinalis . J Microbiol Methods 53:377–385 [CrossRef]
    [Google Scholar]
  5. Cali A., Meisler D. M., Rutherford I., Lowder C. Y., McMahon J. T., Longworth D. L., Bryan R. T. 1991a; Corneal microsporidiosis in a patient with AIDS. Am J Trop Med Hyg 44:463–468
    [Google Scholar]
  6. Cali A., Meisler D. M., Lowder C. Y. 7 other authors 1991b; Corneal microsporidioses: characterization and identification. J Protozool 38:215S–217S
    [Google Scholar]
  7. Cali A., Takvorian P. M., Lewin S., Rendel M., Sian C. S., Wittner M., Tanowitz H. B., Keohane E., Weiss L. M. 1998; Brachiola vesicularum , n.g., n. sp., a new microsporidium associated with AIDS and myositis. J Eukaryot Microbiol 45:240–251 [CrossRef]
    [Google Scholar]
  8. Canning E. U. 1993; Microsporidia. In Parasitic protozoa , 2nd edn. vol6 pp 299–370 Edited by Kreier J. P., Baker J. R. San Diego, CA: Academic Press;
    [Google Scholar]
  9. Canning E. U., Lom J. 1986 The Microsporidia of Vertebrates pp 1–289 London: Academic Press;
    [Google Scholar]
  10. Canning E. U., Curry A., Vavra J., Bonshek R. E. 1998; Some ultrastructural data on Microsporidium ceylonensis , a cause of corneal microsporidiosis. Parasite 5:247–254 [CrossRef]
    [Google Scholar]
  11. Cheney S. A., LaFranchi-Tristem N. J., Canning E. U. 2000; Phylogenetic relationships of Pleistophora -like microsporidia based on small subunit ribosomal DNA sequences and implications for the source of Trachipleistophora hominis infections. J Eukaryot Microbiol 47:280–287 [CrossRef]
    [Google Scholar]
  12. Curry A. 1999; Human microsporidial infection and possible animal sources. Curr Opin Infect Dis 12:473–480 [CrossRef]
    [Google Scholar]
  13. Curry A., Canning E. U. 1993; Human microsporidiosis. J Infect 27:229–236 [CrossRef]
    [Google Scholar]
  14. Davis R. M., Font R. L., Keisler M. S., Shadduck J. A. 1990; Corneal microsporidiosis: a case report including ultrastructural observations. Ophthalmology 97:953–957 [CrossRef]
    [Google Scholar]
  15. Deplazes P., Mathis A., van Saanen M., Iten A., Keller R., Tanner I., Glauser M. P., Weber R., Canning E. U. 1998; Dual microsporidial infection due to Vittaforma corneae and Encephalitozoon hellem in a patient with AIDS. Clin Infect Dis 27:1521–1524 [CrossRef]
    [Google Scholar]
  16. Didier E. S., Didier P. J., Friedberg D. N. other authors 1991; Isolation and characterization of a new microsporidian, Encephalitozoon hellem (n.sp.), from three AIDS patients with keratoconjunctivitis. J Infect Dis 163:617–621 [CrossRef]
    [Google Scholar]
  17. Diesenhouse M. C., Wilson L. A., Corrent G. F., Visvesvara G. S., Grossniklaus H. E., Bryan R. T. 1993; Treatment of microsporidial keratoconjunctivitis with topical fumagillin. Am J Ophthalmol 115:293–298 [CrossRef]
    [Google Scholar]
  18. Dieterich D. T., Lew E. A., Kotler D. P., Poles M. A., Orenstein J. M. 1994; Treatment with albendazole for intestinal diseases due to Enterocytozoon bieneusi in patients with AIDS. J Infect Dis 169:178–183 [CrossRef]
    [Google Scholar]
  19. Dowd S. E., Gerba C. P., Pepper I. L. 1998; Confirmation of the human-pathogenic microsporidia Enterocytozoon bieneusi , Encephalitozoon intestinalis and Vittaforma corneae in water. Appl Environ Microbiol 64:3332–3335
    [Google Scholar]
  20. Field A. S., Marriott D. J., Milliken S. T., Brew B. J., Canning E. U., Kench J. G., Darveniza P., Harkness J. L. 1996; Myositis associated with a newly described microsporidian, Trachipleistophora hominis , in a patient with AIDS. J Clin Microbiol 34:2803–2811
    [Google Scholar]
  21. Font R. L., Samaha A. N., Keener M. J., Chevez-Barrios P., Goosey J. D. 2000; Corneal microsporidiosis: report of case, including electron microscopic observations. Ophthalmology 107:1769–1775 [CrossRef]
    [Google Scholar]
  22. Font R. L., Su G. W., Matoba A. Y. 2003; Microsporidial stromal keratitis. Arch Ophthalmol 121:1045–1047 [CrossRef]
    [Google Scholar]
  23. Franzen C., Muller A. 1999; Molecular techniques for detection, species differentiation, and phylogenetic analysis of microsporidia. Clin Microbiol Rev 12:243–285
    [Google Scholar]
  24. Friedberg D. N., Stenson S. M., Orenstein J. M., Tierno P. M., Charles N. C. 1990; Microsporidian keratoconjunctivitis in acquired immunodeficiency syndrome. Arch Ophthalmol 108:504–508 [CrossRef]
    [Google Scholar]
  25. Garcia L. S. 2002; Laboratory identification of the microsporidia. J Clin Microbiol 40:1892–1901 [CrossRef]
    [Google Scholar]
  26. Gritz D. C., Holsclaw D. S., Neger R. E., Whitcher J. P. Jr, Margolis T. P. 1997; Ocular and sinus microsporidial infection cured with systemic albendazole. Am J Ophthalmol 124:241–243 [CrossRef]
    [Google Scholar]
  27. Hollister W. S., Canning E. U., Colbourn N. I., Curry A., Lacey C. J. 1993a; Characterization of Encephalitozoon hellem (Microspora) isolated from the nasal mucosa of a patient with AIDS. Parasitology 107:351–358 [CrossRef]
    [Google Scholar]
  28. Hollister W. S., Canning E. U., Colbourn N. I. 1993b; A species of Encephalitozoon isolated from an AIDS patient: criteria for species differentiation. Folia Parasitol (Praha 40:293–295
    [Google Scholar]
  29. Hollister W. S., Canning E. U., Weidner E., Field A. S., Kench J., Marriott D. J. 1996; Development and ultrastructure of Trachipleistophora hominis n.g., n. sp. after in vitro isolation from an AIDS patient and inoculation into athymic mice. Parasitology 112:143–154 [CrossRef]
    [Google Scholar]
  30. Keeling P. J., Fast N. M. 2002; Microsporidia: biology and evolution of highly reduced intracellular parasites. Annu Rev Microbiol 56:93–116 [CrossRef]
    [Google Scholar]
  31. Lafranchi-Tristem N. J., Curry A., Cheney S. A., Canning E. U. 2001; Growth of Trachipleistophora hominis (Microsporidia: Pleistophoridae ) in C2,C12 mouse myoblast cells and response to treatment with albendazole. Folia Parasitol (Praha) 48:192–200 [CrossRef]
    [Google Scholar]
  32. Lowder C. Y., Meisler D. M., McMahon J. T., Longworth D. L., Rutherford I. 1990; Microsporidia infection of the cornea in a man seropositive for human immunodeficiency virus. Am J Ophthalmol 109:242–244 [CrossRef]
    [Google Scholar]
  33. Lowder C. Y., Wilson L. 1995; Microsporidiosis. In Ocular Infection and Immunology pp 1072–1079 Edited by Pepose J. S., Holldan G. N., Wilhelmus K. R. St Louis, MO: Mosby-Year Book Inc;
    [Google Scholar]
  34. Lowder C. Y., McMahon J. T., Meisler D. M., Dodds E. M., Calabrese L. H., Didier E. S., Cali A. 1996; Microsporidial keratoconjunctivitis caused by Septata intestinalis in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 121:715–717 [CrossRef]
    [Google Scholar]
  35. McCluskey P. J., Goonan P. V., Marriott D. J., Field A. S. 1993; Microsporidial keratoconjunctivitis in AIDS. Eye 7:80–83 [CrossRef]
    [Google Scholar]
  36. Metcalfe T. W., Doran R. M., Rowlands P. L., Curry A., Lacey C. J. 1992; Microsporidial keratoconjunctivitis in a patient with AIDS. Br J Ophthalmol 76:177–178 [CrossRef]
    [Google Scholar]
  37. Mietz H., Franzen C., Hoppe T., Bartz-Schmidt K. U. 2002; Microsporidia-induced sclerouveitis with retinal detachment. Arch Ophthalmol 120:864–865
    [Google Scholar]
  38. Moon S. J., Mann P. M., Matoba A. Y. 2003; Microsporidial keratoconjunctivitis in a healthy patient with a history of LASIK surgery. Cornea 22:271–272 [CrossRef]
    [Google Scholar]
  39. Orenstein J. M., Seedor J., Friedberg D. N. & 12 other authors; 1990; Microsporidian keratoconjunctivitis in patients with AIDS. MMWR (Morbid Mortal Wkly Rep) 39:188–189
    [Google Scholar]
  40. Pinnolis M., Egbert P. R., Font R. L., Winter F. C. 1981; Nosematosis of the cornea: case report, including electron microscopic studies. Arch Ophthalmol 99:1044–1047 [CrossRef]
    [Google Scholar]
  41. Rosberger D. F., Serdarevic O. N., Erlandson R. A., Bryan R. T., Schwartz D. A., Visvesvara G. S., Keenan P. C. 1993; Successful treatment of microsporidial keratoconjunctivitis with topical fumagillin in a patient with AIDS. Cornea 12:261–265 [CrossRef]
    [Google Scholar]
  42. Schwartz D. A., Visvesvara G. S., Diesenhouse M. C. other authors 1993; Pathologic features and immunofluorescent antibody demonstration of ocular microsporidiosis ( Encephalitozoon hellem ) in seven patients with acquired immunodeficiency syndrome. Am J Ophthalmol 115:285–292 [CrossRef]
    [Google Scholar]
  43. Shadduck J. A., Meccoli R. A., Davis R., Font R. L. 1990; Isolation of a microsporidian from a human patient. J Infect Dis 162:773–776 [CrossRef]
    [Google Scholar]
  44. Silveira H., Canning E. U. 1995a; In vitro cultivation of the human microsporidium Vittaforma corneae : development and effect of albendazole. Folia Parasitol (Praha) 42:241–250
    [Google Scholar]
  45. Silveria H., Canning E. U. 1995b; Vittaforma corneae n.comb. for the human microsporidium Nosema corneum Shadduck, Meccoli, Davis & Font, 1990, based on its ultrastructure in the liver of experimentally infected athymic mice. J Eukaryot Microbiol 42:158–165 [CrossRef]
    [Google Scholar]
  46. Silveira H., Canning E. U., Shadduck J. A. 1993; Experimental infection of athymic mice with the human microsporidian Nosema corneum . Parasitology 107:489–496 [CrossRef]
    [Google Scholar]
  47. Silverstein B. E., Cunningham E. T. Jr, Margolis T. P., Cevallos V., Wong I. G. 1997; Microsporidia keratoconjunctivitis in a patient without human immunodeficiency virus infection. Am J Ophthalmol 124:395–396 [CrossRef]
    [Google Scholar]
  48. Theng J., Chan C., Ling M. L., Tan D. 2001; Microsporidia keratoconjunctivitis in a healthy contact lens wearer without human immunodeficiency virus infection. Ophthalmology 108:976–978 [CrossRef]
    [Google Scholar]
  49. Trammer T., Dombrowski F., Doehring M., Maier W. A., Seitz H. M. 1997; Opportunistic properties of Nosema algerae (Microspora), a mosquito parasite, in immunocompromised mice. J Eukaryot Microbiol 44:258–262 [CrossRef]
    [Google Scholar]
  50. Trammer T., Chioralia G., Maier W. A., Seitz H. M. 1999; In vitro replication of Nosema algerae (Microsporidia), a parasite of anopheline mosquitoes, in human cells above 36 °C. J Eukaryot Microbiol 46:464–468 [CrossRef]
    [Google Scholar]
  51. Visvesvara G. S. 2002; In vitro cultivation of microsporidia of clinical importance. Clin Microbiol Rev 15:401–413 [CrossRef]
    [Google Scholar]
  52. Visvesvara G. S., Belloso M., Moura H. & 8 other authors; 1999; Isolation of Nosema algerae from the cornea of an immunocompetent patient. J Eukaryot Microbiol 46:10S– 10S [CrossRef]
    [Google Scholar]
  53. Wolk D. M., Schneider S. K., Wengenack N. L., Sloan L. M., Rosenblatt J. E. 2002; Real-time PCR method for detection of Encephalitozoon intestinalis from stool specimens. J Clin Microbiol 40:3922–3928 [CrossRef]
    [Google Scholar]
  54. Yee R. W., Tio F. O., Martinez J. A., Held K. S., Shadduck J. A., Didier E. S. 1991; Resolution of microsporidial epithelial keratopathy in a patient with AIDS. Ophthalmology 98:196–201 [CrossRef]
    [Google Scholar]
  55. Yoken J., Forbes B., Maguire A. M., Prenner J. L., Carpentieri D. 2002; Microsporidial endophthalmitis in a patient with acute myelogenous leukaemia. Retina 22:123–125 [CrossRef]
    [Google Scholar]
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