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Ophthalmic microsporidiosis: the Manchester experience
Author(s) -
BONSHEK R,
CURRY A,
IRION L
Publication year - 2009
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2009.4355.x
Subject(s) - microsporidiosis , microsporidia , medicine , encephalitozoon cuniculi , conjunctiva , dermatology , biology , virology , pathology , microbiology and biotechnology , spore
Abstract Purpose We report cases of ocular and adnexal microsporidiosis diagnosed in Manchester, UK, and review the literature. Methods The archives of the National Specialist Ophthalmic Pathology (NSOPS) Manchester Laboratory and Health Protection Agency Laboratory (HPA)at Manchester Royal Infirmary were reviewed for cases of microsporidiosis between 1990 and 2009. Results 8 cases of ocular and adnexal microsporidiosis were identified. Organisms were Encephalitozoon hellem, Encephalitozoon sp., Vittaforma corneae, Trachipleistophora hominis, Nosema sp. with infection of ocular surface, cornea, nasolacrimal apparatus and nasal sinuses, and eyelid; a historical case of Microsporidium ceylonensis keratitis, first reported by Norman Ashton in 1973 was also reviewed. Ages ranged from 11 years (Ashton’s case) to 50 years. One case was from an HIV +ve patient, the others were immunocompetent. At least 4 infections were contracted whilst the patient was outside the UK. Conclusion Microsporidia, minute obligate intracellular parasites related to fungi, infect via a polar tube housed within a highly resistant spore. Microsporidial infection in HIV/AIDS, usually entereic, is the most reported. Antiretroviral treatment has lowered the incidence of enteric microsporidiosis and ocular infection is increasingly prevalent and often not HIV‐related. In our cases the majority were immunocompetent individuals. LM can be diagnostic if characteristic refractile ZN‐positive spores are seen, but LM does not permit speciation, which usually requires EM. Diligent searching for organisms may be necessary as distribution may be focal. Insufficient data exist for PCR‐based diagnosis of most microsporidial species.Sources and mechanisms of microsporidial infection remain speculative.