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Desafíos en el manejo de la queratoconjuntivitis microsporidial: infección recurrente y contaminación ambiental
Aakash Sharma1, Smruti Rekha Priyadarshini2, Srikant Kumar Sahu1
1Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India.
BMJ case reports
|August 31, 2025
Resumen
La infección microsporidial de la córnea causada por el agua contaminada condujo a la pérdida de la visión en un varón joven. Evitar la fuente de agua contaminada resolvió las lesiones oculares y los síntomas.
Área de la Ciencia:
- Oftalmología
- Enfermedades infecciosas
- Microbiología
Sus antecedentes:
- La queratoconjuntivitis vernal (VKC) es una enfermedad ocular alérgica común en niños y adultos jóvenes.
- Los que responden a los esteroides son personas cuya presión intraocular aumenta en respuesta al uso de corticosteroides.
- Las microsporidias son parásitos intracelulares oportunistas que pueden causar diversas infecciones, incluidas las infecciones oculares.
Objetivo del estudio:
- Para reportar un caso de queratoconjuntivitis microsporidial en un paciente con respuesta a esteroides.
- Identificar la fuente de la infección microsporidial y su papel en la recurrencia de la enfermedad.
- Evaluar los resultados del tratamiento de la queratoconjuntivitis microsporidial.
Principales métodos:
- Examen clínico que incluya la biomicroscopia con lámpara de hendidura y el raspado de la córnea para la identificación microscópica de las microsporidias.
- Análisis PCR convencional del agua de pozo para la detección de microsporidios.
- Tratamiento con gotas para los ojos lubricantes, corticosteroides tópicos (loteprednol) y evitar el agua contaminada.
Principales resultados:
- El raspado corneal reveló esporas microsporidianas, lo que condujo a un diagnóstico de queratoconjuntivitis microsporidiana.
- El análisis de PCR del agua de pozo confirmó la presencia de microsporidia, implicándola como la fuente de infección.
- El tratamiento con loteprednol y la evitación del agua contaminada dio lugar a la resolución de las lesiones y síntomas de la córnea.
Conclusiones:
- Las fuentes de agua contaminadas pueden ser un reservorio importante para las microsporidias, lo que lleva a infecciones oculares.
- La queratoconjuntivitis microsporidial puede ser recurrente, especialmente en personas con factores predisponentes como la respuesta a los esteroides.
- El diagnóstico rápido, el tratamiento adecuado y la eliminación de la fuente de infección son cruciales para el manejo de la queratoconjuntivitis microsporidial.
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