مرور نظام مند مطالعات گزارش‌ موردی و سری های موردی میکروسپوریدیوز چشمی در انسان

نوع مقاله : مروری

نویسندگان
علی تقی پور 1
امیر عبدلی 2
حسن جعفری 1
سعید بهادری 3
مهدی ترحمی 4
امیرحسین نصیری پور 1
1 گروه انگل شناسی و قارچ شناسی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.
2 گروه انگل شناسی پزشکی، دانشکده علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران.
3 گروه انگل شناسی و قارچ شناسی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی البرز، کرج، ایران.
4 کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی جهرم، جهرم، ایران
10.22034/pjms.2026.2085668.1276
چکیده
مقدمه: میکروسپوریدیا، یک ارگانیسم فرصت طلب نادر و اغلب اشتباه گرفته شده از عفونت‌های قرنیه، حدود 0.4% از موارد کراتیت میکروبی را در برخی جمعیت‌ها تشکیل می‌دهد. هدف از مطالعه حاضر، تجزیه و تحلیل سیستماتیک گزارش‌های موردی و سری‌های موردی میکروسپوریدیوز چشمی انسان برای اولین بار می باشد.
روش‌کار: این مرور سیستماتیک با استفاده از موارد گزارش‌دهی ترجیحی برای بررسی‌های سیستماتیک (PRISMA) انجام شد. اصطلاحات تعریف‌شده به عنوان کلمات کلیدی MESH از سال ۲۰۱۷ تا پایان سال ۲۰۲۳ در پایگاه های داده های علمی PubMed/MEDLINE، Embase، Web of Science و Cochrane Library جستجو شدند. گزارش‌های موردی و سری‌های موردی به زبان انگلیسی یا چکیده انگلیسی مربوط به میکروسپوریدیوز چشمی انسان در مطالعه گنجانده شدند.
یافته ها: در نهایت، 28 مطالعه شامل 426 شرکت‌کننده مورد بررسی نظام مند قرار گرفتند. عوامل خطر متعددی از جمله مواجهه با آب و خاک آلوده، استفاده از کورتیکواستروئیدها و بیماری‌های زمینه‌ای (مانند دیابت یا پیوند کلیه) شناسایی شدند. علائم اصلی شامل قرمزی، تاری دید و ترس از نور همراه با یافته‌های پاتولوژیک متفاوتی در قرنیه بودند. همچنین، پیامدهای درمانی متنوع بودند؛ از بهبودی کامل با درمان دارویی تا نیاز به کراتوپلاستی نافذ (پیوند قرنیه) در موارد مقاوم نیز مشاهده گردید.
نتیجه‌گیری: این بررسی نشان داد که میکروسپوریدیوز چشمی با طیف گسترده‌ای از تظاهرات بالینی و نتایج درمانی همراه است. بنابراین، مدیریت موفقیت‌آمیز این عفونت، مستلزم ارزیابی دقیق عوامل خطر بیمار و تنظیم برنامه درمانی اختصاصی از درمان دارویی تا مداخله جراحی است تا از عود جلوگیری و بهترین پیامد بینایی حاصل شود.
کلیدواژه‌ها
میکروسپوریدیا
میکروسپوریدیای چشمی
کراتوکونژونکتیویت
کراتیت
مرور نظام مند

عنوان مقاله English

Systematic Review of Case Reports and Case Series Studies of Ocular Microsporidiosis in Humans

نویسندگان English

Ali Taghipour 1
Amir Abdoli 2
Hassan Jafari 1
Saeed Bahadory 3
Mahdi Tarahhomi 4
Amirhossein Nasiripour 1
1 Department of Medical Parasitology and Mycology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
2 Department of Medical Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
3 Department of Medical Parasitology and Mycology, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran
4 Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
چکیده English

Introduction: Microsporidia, a rare opportunistic organism often misidentified in corneal infections, constitutes approximately 0.4% of microbial keratitis cases in certain populations. The aim of the present study is to conduct a systematic analysis of case reports and case series of ocular microsporidiosis in humans for the first time.
Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Defined terms as Medical Subject Headings (MeSH) keywords were searched from 2017 to the end of 2023 in the scientific databases PubMed/MEDLINE, Embase, Web of Science and Cochrane Library. Case reports and case series in English or English abstracts related to ocular microsporidiosis in humans were included in the study.
Results: Finally, 28 studies including 426 participants were systematically reviewed. Several risk factors were identified, such as exposure to contaminated water and soil, corticosteroid use, and underlying diseases (e.g., diabetes or kidney transplantation). The main clinical features included redness, blurred vision, and photophobia, accompanied by varying pathological findings in the cornea. Also, treatment outcomes were diverse, ranging from full recovery with medication to the need for penetrating keratoplasty (corneal transplantation) in resistant cases were also observed.
Conclusion
This review demonstrated that ocular microsporidiosis is associated with a broad spectrum of clinical manifestations and treatment outcomes. Therefore, successful management of this infection necessitates a meticulous assessment of the patient’s risk factors and the customization of a specific treatment plan, ranging from pharmacotherapy to surgical intervention, to prevent recurrence and achieve the best visual outcome.

کلیدواژه‌ها English

Microsporidia
ocular microsporidiosis
keratoconjunctivitis
keratitis
systematic review
References
1. Sridhar U, Rahman A, Neelam S, Btra J. Ocular
microsporidiosis—our experience in a tertiary care
centre in North India. Open J Ophthalmol. 2015.
5(03): 130-8.
2. Thomas G, The Host-Pathogen Interface:
Characterising Putative Secreted Proteins of the
Honeybee Pathogen Nosema Ceranae
(Microsporidia). University of Exeter (United
Kingdom). 2016.
3. Moshirfar M, Somani SN, Shmunes KM, Espandar
L, Gokhale NS, Ronquillo YC, et al. A narrative
review of microsporidial infections of the cornea.
Ophthalmol Ther. 2020. 9(2): 265-78.
4. Alabduljabbar M, Sirajuddin F, Maktabi A,
AlShabeeb R. A Rare Microsporidial Infection in
Lamellar Corneal Tissue, following Transepithelial
Photorefractive Keratectomy. Case Rep Ophthalmol.
2023;14(1):127-33.
5. Kwok AK, Tong JM, Tang BS, Poon RW, Li WW,
Yuen KY. Outbreak of microsporidial
keratoconjunctivitis with rugby sport due to soil
exposure. Eye (Lond). 2013 ;27(6):747-54.
6. Seatamanoch N, Kongdachalert S, Sunantaraporn S,
Siriyasatien P, Brownell N. Microsporidia, a Highly
Adaptive Organism and Its Host Expansion to
Humans. Front Cell Infect Microbiol.
2022;12:924007.
7. aju S, Tilahun Y, Ayalew M, Fikrie N, Schneider J,
Kempen JH. Diagnosis and treatment of
microsporidial keratoconjunctivitis: literature review
and case series. J Ophthalmic Inflamm Infect.
2011;1(3):105-10.
8. Centers for Disease Control (CDC). Microsporidian
keratoconjunctivitis in patients with AIDS. MMWR
Morb Mortal Wkly Rep. 1990 Mar 23;39(11):188-9.
9. Spena R, Bovone C, Ciarmatori N, Pellegrini M, Yu
AC, Zauli G, Busin M. Microsporidial Stromal
Keratitis in Post-Keratoplasty Eyes. J Clin Med. 2023
May 27;12(11):3706.
10. Singh P, Tripathy K. Microsporidial Keratitis. 2024
Mar 7. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2026.
11. Joseph J, Vemuganti GK, Sharma S. Microsporidia:
emerging ocular pathogens. Indian J Med Microbiol.
2005;23(2):80-91.
12. Sabhapandit S, Murthy SI, Garg P, Korwar V,
Vemuganti GK, Sharma S. Microsporidial Stromal
Keratitis: Clinical Features, Unique Diagnostic
Criteria, and Treatment Outcomes in a Large Case
Series. Cornea. 2016;35(12):1569-74.
13. Khurana S, Agrawal SK, Megha K, Dwivedi S, Jain
N, Gupta A. Demographic and clinical profile of
microspodial keratitis in North India: an
underreported entity. J Parasit Dis. 2019;43(4):601-6.
14. Sharma S, Das S, Joseph J, Vemuganti GK, Murthy
S. Microsporidial keratitis: need for increased
awareness. Surv Ophthalmol. 2011;56(1):1-22.
15. Wang WY, Chu HS, Lin PC, Lee TF, Kuo KT, Hsueh
PR, Hu FR, Wang IJ. Outbreak of Microsporidial
Keratoconjunctivitis Associated With Water
Contamination in Swimming Pools in Taiwan. Am J
Ophthalmol. 2018;194:101-9.
16. Reddy AK, Balne PK, Garg P, Krishnaiah S. Is
microsporidial keratitis a seasonal infection in India?
Clin Microbiol Infect. 2011;17(7):1114-6.
17. Thanathanee O, Athikulwongse R, Anutarapongpan
O, Laummaunwai P, Maleewong W, Intapan PM, et al.
Clinical Features, Risk Factors, and Treatments of
Microsporidial Epithelial Keratitis. Semin
Ophthalmol. 2016;31(3):266-70.
18. Liu HY, Hopping GC, Vaidyanathan U, Ronquillo
YC, Hoopes PC, Moshirfar M. Polymerase Chain
Reaction and Its Application in the Diagnosis of
Infectious Keratitis. Med Hypothesis Discov Innov
Ophthalmol. 2019;8(3):152-5.
19. Das S, Sharma S, Sahu SK, Nayak SS, Kar S.
Diagnosis, clinical features and treatment outcome of
microsporidial keratoconjunctivitis. Br J Ophthalmol.
2012;96(6):793-5.
20. Ueno S, Eguchi,H, Hotta F, Fukuda M, Kimura M,
Yagita K, et al. Microsporidial keratitis retrospectively
diagnosed by ultrastructural study of formalin-fixed
paraffin-embedded corneal tissue: a case report. Ann
Clin Microbiol Antimicrob. 2019. 18(1):17.
21. Leroy J, Cornu M, Deleplancque AS, Bart A,
Loridant S, Fréalle E, et al. Case Report: Ocular
Microsporidiosis: Case in a Patient Returning from
India and Review of the Literature. Am J Trop Med
Hyg. 2018 Jul;99(1):90-3.
22. Franssen FF, Lumeij JT, van Knapen F.
Susceptibility of Encephalitozoon cuniculi to several
drugs in vitro. Antimicrob Agents Chemother.
1995;39(6):1265-8.
23. Thanathanee O, Laohapitakvorn S, Anutarapongpan
O, Suwan-Apichon O, Bhoomibunchoo C. Anterior
Segment Optical Coherence Tomography Images in
Microsporidial Keratoconjunctivitis. Cornea.
2019;38(8):943-7.
24. Sridhar MS, Sharma S. Microsporidial
keratoconjunctivitis in a HIV-seronegative patient
treated with debridement and oral itraconazole. Am J
Ophthalmol. 2003;136(4):745-6.
25. Garg P. Microsporidia infection of the cornea--a
unique and challenging disease. Cornea. 2013;32:33-
8.
26. Sangit VA, Murthy SI, Garg P. Microsporidial
stromal keratitis successfully treated with medical
therapy: a case report. Cornea. 2011;30(11):1264-6.
27. Ramatchandirane B, A MK, Marimuthu Y,
Nicodemus DS, Yarra MC. Successful Treatment of
Microsporidial Keratoconjunctivitis (MKC) With a
Combination of Topical Voriconazole 1% and
Gatifloxacin 0.5%: A Large Case Series of 29 Patients.
Cureus. 2023;15(11):e49247.
28. Fan NW, Lin PY, Chen TL, Chen CP, Lee SM.
Treatment of microsporidial keratoconjunctivitis with
repeated corneal swabbing. Am J Ophthalmol.
2012;154(6):927-933.e1.
29. Uematsu M, Mohamed YH, Kusano M, Inoue D,
Harada K, Tang D, et al. Microsporidial
keratoconjunctivitis - first outbreak in Japan. BMC
Infect Dis. 2023;23(1):752.
30. Watson AL, Matic M, Robertson T, Stewart AGA.
Microsporidial myositis, keratitis and hypercalcaemia
in a cystic fibrosis lung transplant recipient. BMJ Case
Rep. 2022;15(7):e250643.
31. Chou TY, Bansal J, Seidman R, Rahman A,
Montalto D. Bilateral microsporidial
keratoconjunctivitis in a clinically healthy female
receiving intravitreal steroid injections: Associations and potential risk factors. Am J Ophthalmol Case Rep.
2022;27:101659.
32. Malik S, Ishaq M, Nayyar S, Humayun S.
Microsporidial Keratitis - First Case Series of a Rare
Pathogen in the Wake of Flood Disasters of 2022 in
Pakistan. J Coll Physicians Surg Pak.
2022;32(12):165-7.
33. Roy A, Chaurasia S, Ramappa M, Joseph J, Mishra
DK. Clinical profile of keratitis treated within
3 months of acute COVID-19 illness at a tertiary care
eye centre. Int Ophthalmol. 2022;42(10):3027-35.
34. Raghavan A, Raja DR, Venkatapathy N, Rammohan
R. A case of stromal microsporidiosis: medical
strategies employed for successful resolution. BMJ
Case Rep. 2022;15(2):e246233.
35. Donovan CP, Margo CE, Espana EM. Stromal
microsporidial keratitis successfully treated with
medical therapy. Am J Ophthalmol Case Rep.
2021;23:101178.
36. Huang AS, Cho JS, Bertram BA. Microsporidial
Keratitis Related to Water Exposure: A Case Series.
Cureus. 2021;13(6):e15760.
37. Sharma S, Madduri B, Mohan N, Fernandes M.
Successful medical management of bilateral
microsporidial stromal keratitis: A case report and
review of literature. Indian J Ophthalmol-Case
Reports, 2021. 1(4):651-3.
38. Chandran K, Tendolkar S, Kalra P, Murthy SI. Rare
presentation of sequential epithelial microsporidiosis
and endotheliitis. BMJ Case Rep.
2021;14(4):e237490.
39. Yeh TC, Kuo YS, Wang LC, Tai TY, Lin PY.
Chlorhexidine in the treatment of microsporidial
stromal keratitis and the effect of host immunity: A
case series and literature review. J Chin Med Assoc.
2022;85(4):532-6.
40. Dutta A, Das S, Priyadarshini SR. Stromal
microsporidiosis: a differential for disciform keratitis.
BMJ Case Rep. 2020;13(9):e237396.
41. Farooqui JH, Acharya M, Gandhi A, Mathur U.
Acute stromal keratitis in clinics - are we missing
microsporidia? GMS Ophthalmol Cases.
2020;10:Doc01.
42. Mohanty A, Mitra S, Das S, Priyadarshini S, Sahu
SK. Clinical Profile of Bilateral Microsporidial
Keratoconjunctivitis in Healthy Individuals-A Case
Series With Long-term Follow-up. Cornea.
2020;39(7):902-8.
43. Donthineni PR, Murthy SI, Joseph J, Garg P,
Acharya M, Sangwan V. Microsporidial stromal
keratitis: an uncommon etiology of bilateral
simultaneous corneal infection. Asian J Ophthalmol:
2020;17 (3):311-7.
44. Kaur A, Sahu SK, Mitra S, Das S. Microsporidial
stromal keratitis in an immunocompromised patient:
Successful management with medical therapy. Indian
J Ophthalmol. 2020;68(11):2552-4.
45. Balamurugan R, Gupta PC, Sharma SP, Rana N,
Ram J. Microsporidial Keratoconjunctivitis. J
Ophthalmic Vis Res. 2020;15(2):259-60.
46. Agarwal P, Coc IR, Navon SE. Importance of
clinical signs leading to the diagnosis in a case of
microbiological smear negative ocular
microsporidiosis. BMJ Case Rep.
2019;12(2):e228407.
47. Grillo LM, Epstein IJ, Donnenfeld ED, Perry HD.
Late-Onset microsporidial keratitis in femtosecond
astigmatic keratotomy after laser-Assisted
phacoemulsification. Cornea. 2018;37(11):1471-
1473.
48. Leroy J, Cornu M, Deleplancque AS, Bart A,
Loridant S, Fréalle E, et al. Case Report: Ocular
Microsporidiosis: Case in a patient returning from
India and review of the literature. Am J Trop Med
Hyg. 2018;99(1):90-3.
49. Pariyakanok L, Satitpitakul V, Laksanaphuk P,
Ratanawongphaibul K, Putaporntip C, Jongwutiwes S.
Stromal Keratitis with Endophthalmitis Caused by
Vittaforma Corneae in an Immunocompetent Patient:
A Case Report. Ocul Immunol Inflamm.
2019;27(5):826-8.
50. Sridhar MS, Shaik B. Anterior segment optical
coherence tomography of microsporidial
keratoconjunctivitis. Indian J Ophthalmol.
2018;66(5):691-2.
51. Dhakal R, Ramappa M, Sharma S. Punctate
epithelial keratoconjunctivitis: A microsporidial
infestation. Indian J Ophthalmol. 2018
Sep;66(9):1327-28.
52. Mittal R, Balne PK, Sahu S, Das S, Sharma S.
Coexistence of herpes simplex virus infection in
microsporidial stromal keratitis associated with
granulomatous inflammation. Indian J Ophthalmol.
2017 Apr;65(4):276-281.
مجله علوم پزشکی پارس
دوره 23، شماره 4
زمستان 1404
صفحه 6-20