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Treatment of microsporidial keratoconjunctivitis with topical fumagillin
M C Diesenhouse1, L A Wilson, G F Corrent
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Abstract:
Encephalitozoon hellem is a newly described cause of microsporidial keratoconjunctivitis, occurring chiefly in patients with significantly diminished CD4+ T-lymphocyte levels. This disorder is symptomatically disabling and generally recalcitrant to topical antimicrobial therapy. Two homosexual men with E. hellem keratoconjunctivitis diagnosed by Gram stain, transmission electron microscopy, and specific indirect immunofluorescent assay were treated with topical fumagillin (Fumidil B). Both patients had marked symptomatic improvement with reduction of clinical findings. Symptoms and signs recurred with temporary discontinuation of the drug. Both patients, however, remained symptom-free on maintenance levels of topical fumagillin with no evidence of toxic side effects.
Insights
Encephalitozoon hellem (E. hellem) causes severe eye infections in immunocompromised patients. Topical fumagillin effectively treated E. hellem keratoconjunctivitis, with symptoms returning upon drug discontinuation.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Encephalitozoon hellem (E. hellem) is an emerging pathogen causing keratoconjunctivitis.
- This opportunistic infection primarily affects individuals with compromised CD4+ T-lymphocyte counts.
- Current treatments for E. hellem infections are often ineffective.
Observation:
- Two homosexual men presented with E. hellem keratoconjunctivitis.
- Diagnosis was confirmed via Gram stain, transmission electron microscopy, and immunofluorescence assay.
- Patients experienced disabling symptoms unresponsive to standard antimicrobial therapies.
Findings:
- Treatment with topical fumagillin (Fumidil B) led to significant symptomatic and clinical improvement in both patients.
- Discontinuation of topical fumagillin resulted in symptom recurrence.
- Maintenance therapy with topical fumagillin controlled the infection without reported toxic side effects.
Implications:
- Topical fumagillin represents a promising therapeutic option for E. hellem-induced keratoconjunctivitis.
- This finding is particularly relevant for managing ocular infections in immunocompromised populations.
- Further research into fumagillin's efficacy and long-term use in E. hellem infections is warranted.