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[Bilateral microsporidial keratitis in an HIV-positive patient with AIDS stage infection]
Introduction:
Microsporidia are spore-forming, obligate intracellular protozoa. Humans seem to be infected only by 4 genera of microsporidia. Microsporidial keratoconjunctivitis in immunodeficient patients has a characteristic appearance.
Case Report:
34 year old woman with AIDS complained of bilateral blurred vision. The visual acuity was 0.6 on both eyes. She had a mild conjunctivitis and disseminate, not very prominent intraepithelial corneal opacities. She was treated with propamidine isethionate 0.1% 5 times daily and artificial tears under presumptive diagnosis of microsporidial keratoconjunctivitis. We discontinued this treatment because of no improvement. Within 6 months the visual acuity decreased to 0.05. A conjunctival smear was positive for microsporidia. Local Fumagillin-eye-drops 0.07 mg/ml 7 times daily were given. Within 2 weeks an impressively improvement was seen. Because of an persisting diarrhea 400 mg Albendazol twice daily was added orally without success.
Discussion:
The biomicroscopically changes of microsporidial keratoconjunctivitis are characteristical and lead to the clinical diagnosis. Fumagillin is in vitro and clinically a potent antimicrosporidian agent with an extremely broad therapeutic range.
Insights
Fumagillin eye drops effectively treated microsporidial keratoconjunctivitis in an AIDS patient when other treatments failed. This highlights Fumagillin
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Microsporidia are obligate intracellular protozoa causing infections, particularly in immunocompromised individuals.
- Microsporidial keratoconjunctivitis presents distinct clinical features in patients with weakened immune systems.
Observation:
- A 34-year-old woman with AIDS experienced blurred vision and corneal opacities, diagnosed as microsporidial keratoconjunctivitis.
- Initial treatment with propamidine isethionate showed no improvement, leading to vision deterioration.
Findings:
- Conjunctival smear confirmed microsporidia infection.
- Topical Fumagillin eye drops resulted in significant visual improvement within two weeks.
- Oral Albendazole was ineffective for persistent diarrhea.
Implications:
- Biomicroscopic examination is crucial for diagnosing microsporidial keratoconjunctivitis.
- Fumagillin demonstrates potent in vitro and clinical efficacy against microsporidia.
- Fumagillin offers a broad therapeutic range for treating microsporidial infections.