Ocular Microsporidiosis—Our Experience in a Tertiary Care Centre in North India

Uma Sridhar¹, Amil Ausaf Ur Rahman², Jyoti Batra¹, Neelam Sapra³

¹Cornea Department, ICARE Eye Hospital, Noida, India.
²Training Centre, ICARE Eye Hospital, Noida, India.
³Microbiology Depatment, Shroff Charity Eye Hospital, New Delhi, India.

DOI: 10.4236/ojoph.2015.53020                

Abstract

Microsporidia are obligate intracellular protozoal parasites. They are eukaryotic and spore forming. Increasing interest in this parasite as a pathogen in the ocular tissues in recent times is due to increasing awareness of microsporidia as an ocular pathogen and better methods of identification of the organism. It also can cause intestinal, sinus, pulmonary, muscular and renal diseases, in both immunocompetent and immunosuppressed patients. Ocular microsporidiosis can occur in isolation or as a part of systemic infections. In earlier published literature, ocular involvement in immunocompetent individuals was more in the form of stromal keratitis and immunocompromised individuals were seen to have keratoconjunctivitis. However, later studies show that this pattern has many variations. Occurrence in rainy season with exposure to muddy water and history of minor trauma is now a known factor. Identification by light microscopy from scrapings with KOH, Gram, Giemsa staining is possible. Growth of the organisms, however, is possible only by cell culture. Species identification is done by polymerase chain reaction and by electron microscopy. Immunofluorescent staining techniques are also available in advanced laboratories for species differentiation of microsporidia. Till date, treatment of ocular microsporidia has not been standardized and varies from simple debridement to use of various antibiotics, antiseptics antifungals and antiviral agents.

Keywords

Microsporidia, Keratoconjunctivitis, Stromal Keratitis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Nageli, K.W. (1857) Uber die neue Krankheit der Seidenraupe und verwandte Organismen. Bot Z, 15, 760-761.
[2]	Nkinin, S.W., Asonganyi, T., Didier, E.S., et al. (2007) Microsporidian Infection is Prevalent in Healthy People in Cameroon. Journal Clinical Microbiology, 45, 2841-2846. http://dx.doi.org/10.1128/JCM.00328-07
[3]	Matsubayashi, H., Koike, T., Mikata, T. and Hagiwara, S. (1959) A Case of Encephatitozoon like Body Infection in Man. Archives of Pathology, 67, 181-187.
[4]	Ashton, N. and Wirashinha, P.A. (1973) Encephalitozoonosis (Nosematosis) of the Cornea. British Journal of Ophthalmology, 57, 669-674. http://dx.doi.org/10.1136/bjo.57.9.669
[5]	Cali, A., Meisler, D.M., Lowder, C.Y., et al. (1991) Corneal Microsporidiosis: Characterization and Identification. The Journal of Protozoology, 38, S215-S217.
[6]	Chan, C.M., Theng, J.T., Li, L., et al. (2003) Microsporidial Keratoconjunctivitis in Healthy Individuals: A Case Series. Ophthalmology, 110, 1420-1425. http://dx.doi.org/10.1016/S0161-6420(03)00448-2
[7]	Quek, D.T., Pan, J.C., Unny Krishnan, P. and Zhao, P.S. (2011) Teoh SCB Microsporidial Keratoconjunctivitis in the Tropics: A Case Series. The Open Ophthalmology Journal, 5, 42-47. http://dx.doi.org/10.2174/1874364101105010042
[8]	Mathis, A., Weber, R. and Deplazes, P. (2005) Zoonotic Potential of the Microsporidia. Clinical Microbiology Reviews, 18, 423-445. http://dx.doi.org/10.1128/CMR.18.3.423-445.2005
[9]	Didier, E.S., Stovall, M.E., Green, L.C., et al. (2004) Epidemiology of Microsporidiosis: Sources and Modes of Transmission. Veterinary Parasitology, 126, 145-166.
[10]	Calvo, M., Carazo, M., Arias, M.L., et al. (2004) Prevalence of Cyclospora sp., Cryptosporidium sp., Microsporidia and Fecal coliform Determination in Fresh Fruit and Vegetables Consumed in Costa Rica. Archivos Latinoamericanos de Nutrición, 54, 428-432.
[11]	Lee, J.H. (2008) Molecular Detection of Enterocytozoon bieneusi and Identification of a Potentially Human-Pathogenic Genotype in Milk. Applied and Environmental Microbiology, 74, 1664-1666. http://dx.doi.org/10.1128/AEM.02110-07
[12]	Sarfati, C., Bourgeois, A., Menotti, J., Liegeois, F., Moyou-Somo, R., Delaporte, E., et al. (2006) Prevalence of Intestinal Parasites Including Microsporidia in Human Immunodeficiency Virus-Infected Adults in Cameroon: A Cross-Sectional Study. The American Journal of Tropical Medicine and Hygiene, 74, 162-164.
[13]	Chacin-Bonilla, L., Panunzio, A.P., Monsalve-Castillo, F.M., Parra-Cepeda, I.E. and Martinez, R. (2006) Microsporidiosis in Venezuela: Prevalence of Intestinal Microsporidiosis and Its Contribution to Diarrhea in a Group of Human Immunodeficiency Virus-Infected Patients from Zulia State. The American Journal of Tropical Medicine and Hygiene, 74, 482-486.
[14]	Tan, J., Lee, P., Lai, Y., Hishamuddin, P., Tay, J., Tan, A.L., Chan, K.S., Lin, R., Tan, D., Cutter, J. and Goh, K.T. (2013) Microsporidial Keratoconjunctivitis after Rugby Tournament, Singapore. Emerging Infectious Diseases, 19, 1484-1486. www.cdc.gov/eid
[15]	Current, W.L. and Owen, R.L. (1989) Cryptosporidiosis and Microsporidiosis. In: Farthing, M.J.G. and Keusch, G.T., Eds., Enteric Infection. Mechanisms, Manifestations and Management, 11th Edition, Chapman and Hall, London, 203-207.
[16]	Bryan, R.T., Cali, A., Owen, R.L. and Spencer, H.C. (1991) Microsporidia: Opportunistic Pathogens in Patients with AIDS. In: Sun, T., Ed., Progress in Clinical Parasitology, Vol. 2, Field and Wood Medical Publishers, New York, 1-26.
[17]	Lowder, C.Y. (1993) Ocular Microsporidiosis. International Ophthalmology Clinics, 33, 145-151. http://dx.doi.org/10.1097/00004397-199303310-00012
[18]	Sharma, S., Das, S., Joseph, J., Vemuganti, G.K. and Murthy, S. (2011) Microsporidial Keratitis: Need for Increased Awareness. Survey of Ophthalmology, 56, 1-22.
[19]	Sprague, V. and Va′vra, J. (1977) Systematics of the Microsporidia. In: Bulla Jr., L.A. and Cheng, T.C., Eds., Comparative Pathobiology, Vol. 2. Plenum Press, New York, 1-510.
[20]	Weber, R., Bryan, R.T., Schwartz, D.A. and Owen, R.L. (1994) Human Microsporidial Infections. Clinical Microbiology Reviews, 7, 426-461.
[21]	Franzen, C. (2008) Microsporidia: A Review of 150 Years of Research. The Open Parasitology Journal, 2, 1-34. http://dx.doi.org/10.2174/1874421400802010001
[22]	Kotler, D.P. and Orenstein, J.M. (1998) Clinical Syndromes Associated with Microsporidiosis. Advances in Parasitology, 40, 321-349. http://dx.doi.org/10.1016/S0065-308X(08)60126-8
[23]	Costa, S.F. and Weiss, L.M. (2000) Drug Treatment of Microsporidiosis. Drug Resistance Updates, 3, 384-399. http://dx.doi.org/10.1054/drup.2000.0174
[24]	Didier, E.S., Didier, P.J., Friedberg, S.M., Stenson, D.N., Orenstein, J.M., Vee, R.W., et al. (1991) Isolation and Characterization of a New Human Microsporidian, Encephalitozoon hellem (n. sp.), from Three AIDS Patients with Keratoconjunctivitis. The Journal of Infectious Diseases, 163, 617-621. http://dx.doi.org/10.1093/infdis/163.3.617
[25]	Grossnikiaus, H.E., Diesenhouse, M.C., Wilson, L.A., Corrent, G.F., Visvesvara, G.S. and Bryan, R.T. (1993) Treatment of Microsporidial Keratoconjunctivitis with Topical Fumagillin. American Journal of Ophthalmology, 115, 293-298. http://dx.doi.org/10.1016/S0002-9394(14)73578-0
[26]	Friedberg, D.N., Stenson, S.M., Orenstein, J.M., Tierno, P.M. and Charles, N.C. (1990) Microsporidial Keratoconjunctivitis in Acquired Immunodeficiency Syndrome. Archives of Ophthalmology, 108, 504-508. http://dx.doi.org/10.1001/archopht.1990.01070060052047
[27]	Joseph, J., Sridhar, M.S., Murthy, S. and Sharma, S. (2006) Clinical and Microbiological Profile of Microsporidial Keratoconjunctivitis in Southern India. Ophthalmology, 113, 531-537. http://dx.doi.org/10.1016/j.ophtha.2005.10.062
[28]	Moon, S.J., Mann, P.M. and Matoba, A.Y. (2003) Microsporidial Keratoconjunctivitis in a Healthy Patient with a History of LASIK Surgery. Cornea, 22, 271-272. http://dx.doi.org/10.1097/00003226-200304000-00020
[29]	Sridhar, M.S. and Sharma, S. (2003) Microsporidial Keratoconjunctivitis in a HIV-Seronegative Patient Treated with Debridement and Oral Itraconazole. American Journal of Ophthalmology, 136, 745-746. http://dx.doi.org/10.1016/S0002-9394(03)00391-X
[30]	Loh, R.S., Chan, C.M., Ti, S.E., Lim, L., Chan, K.S. and Tan, D.T.H. (2009) Emerging Prevalence of Microsporidial Keratitis in Singapore: Epidemiology, Clinical Features, and Management. Ophthalmology, 116, 2348-2353. http://dx.doi.org/10.1016/j.ophtha.2009.05.004
[31]	Kakrania, R., Joseph, J., Vaddavalli, P.K., Gangopadhyay, N. and Sharma, S. (2005) Microsporidia Keratoconjunctivitis in a Corneal Graft. Eye, 20, 1314-1315. http://dx.doi.org/10.1038/sj.eye.6702178
[32]	Das, S., Sharma, S., Sahu, S.K., Nayak, S.S. and Kar, S. (2008) New Antimicrobial Spectrum of Epidemic Keratoconjunctivitis: Clinical and Laboratory Aspects of an Outbreak. British Journal of Ophthalmology, 92, 861-862.
[33]	Font, R.L., Samaha, A.N., Keener, M.J., Chevez-Barrios, P. and Goosey, J.D. (2000) Corneal Microsporidiosis. Report of Case, Including Electron Microscopic Observations. Ophthalmology, 107, 1769-1775. http://dx.doi.org/10.1016/S0161-6420(00)00285-2
[34]	Fogla, R., Padmanabhan, P., Therese, K.L., Biswas, J. and Madhavan, H.N. (2005) Chronic Microsporidial Stromal Keratitis in an Immunocompetent, Noncontact Lens Wearer. Indian Journal of Ophthalmology, 53, 123-125. http://dx.doi.org/10.4103/0301-4738.16177
[35]	Mietz, H., Franzen, C., Hoppe, T. and Bartz-Schmidt, K.U. (2002) Microsporidia-Induced Sclerouveitis with Retinal Detachment. Archives of Ophthalmology, 120, 864-865.
[36]	Yoken, J., Forbes, B., Maguire, A.M., Prenner, J.L. and Carpentieri, D. (2002) Microsporidial Endophthalmitis in a Patient with Acute Myelogenous Leukemia. Retina, 22, 123-125. http://dx.doi.org/10.1097/00006982-200202000-00028
[37]	Shah, G.K., Pfister, D., Probst, L.E., Ferrieri, P. and Holland, E. (1996) Diagnosis of Microsporidial Keratitis by Confocal Microscopy and the Chromatrope Stain. American Journal of Ophthalmology, 121, 89-91. http://dx.doi.org/10.1016/S0002-9394(14)70538-0
[38]	Sagoo, M.S., Mehta, J.S., Hau, S., Irion, L.D., Curry, A. and Bonshek, R.E. (2007) Microsporidium Stromal Keratitis: In Vivo Confocal Findings. Cornea, 26, 870-873. http://dx.doi.org/10.1097/ICO.0b013e31806c7a3c