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Norman FF, González-López JJ, Gayoso-Cantero D, Vicente-Antolin M, Corbacho-Loarte MD, López-Vélez R, González-Sanz M. Ocular infections in international travelers. Travel Med Infect Dis 2025; 63:102789. [PMID: 39603311 DOI: 10.1016/j.tmaid.2024.102789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 11/20/2024] [Accepted: 11/24/2024] [Indexed: 11/29/2024]
Abstract
INTRODUCTION Ophthalmological conditions in international travelers may be associated with low mortality but high morbidity. Eye involvement in travelers is less frequently reported than febrile, gastrointestinal and respiratory infections, but data probably represent a degree of under-notification. METHODS an extensive narrative review of the main viral, bacterial, fungal and parasitic infections affecting the eye in travelers was performed. MAIN FINDINGS Common respiratory tract viral infections may cause ocular complications in travelers, human influenza viruses have been associated with conjunctivitis and emerging avian influenza subtypes may also affect the eye. Vector-borne viral infections may affect travelers, usually with systemic symptoms, but eye disease may be the first presenting feature. A spectrum of manifestations have been described with dengue, chikungunya and Zika infections, including conjunctivitis, anterior uveitis, posterior uveitis with chorioretinitis and macular involvement. Staphylococcus spp, Streptococcus spp, and Pseudomonas spp (especially associated with use of contact lenses) are common causes of keratitis, however, resistance patterns to antimicrobials might vary depending on area of travel. Less frequent infections, such as Burkholderia pseudomallei, associated with environmental exposure, and Bartonella spp. may rarely present with ophthalmological involvement in travelers. Fungal ocular infections, especially after ocular trauma caused by plants and contact lens use, should be considered in patients with stromal keratitis not improving with antibiotic eye drops. Parasitic eye infections tend to occur in tropical areas, but some, such as acanthamoebic keratitis or Toxoplasma spp retinitis, are found worldwide. Increasing exposure to animals, undercooked food consumption or poor hygiene during international travels might be leading to the emergence of certain parasitic eye diseases. CONCLUSIONS Clinical features, with identification of risk factors and geographical region of exposure, can assist in the definitive diagnosis of imported ophthalmological infections. Management of imported eye infections requires a multi-disciplinary approach involving ophthalmologists, travel medicine/infectious diseases physicians and other specialists.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBERINFEC, Madrid, Spain; Universidad de Alcalá, Madrid, Spain.
| | | | - Diego Gayoso-Cantero
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
| | | | - Maria-Dolores Corbacho-Loarte
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
| | - Marta González-Sanz
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
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Wei J, Fei Z, Pan G, Weiss LM, Zhou Z. Current Therapy and Therapeutic Targets for Microsporidiosis. Front Microbiol 2022; 13:835390. [PMID: 35356517 PMCID: PMC8959712 DOI: 10.3389/fmicb.2022.835390] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Microsporidia are obligate intracellular, spore-forming parasitic fungi which are grouped with the Cryptomycota. They are both opportunistic pathogens in humans and emerging veterinary pathogens. In humans, they cause chronic diarrhea in immune-compromised patients and infection is associated with increased mortality. Besides their role in pébrine in sericulture, which was described in 1865, the prevalence and severity of microsporidiosis in beekeeping and aquaculture has increased markedly in recent decades. Therapy for these pathogens in medicine, veterinary, and agriculture has become a recent focus of attention. Currently, there are only a few commercially available antimicrosporidial drugs. New therapeutic agents are needed for these infections and this is an active area of investigation. In this article we provide a comprehensive summary of the current as well as several promising new agents for the treatment of microsporidiosis including: albendazole, fumagillin, nikkomycin, orlistat, synthetic polyamines, and quinolones. Therapeutic targets which could be utilized for the design of new drugs are also discussed including: tubulin, type 2 methionine aminopeptidase, polyamines, chitin synthases, topoisomerase IV, triosephosphate isomerase, and lipase. We also summarize reports on the utility of complementary and alternative medicine strategies including herbal extracts, propolis, and probiotics. This review should help facilitate drug development for combating microsporidiosis.
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Affiliation(s)
- Junhong Wei
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
| | - Zhihui Fei
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
| | - Guoqing Pan
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Zeyang Zhou
- State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
- Chongqing Key Laboratory of Microsporidia Infection and Control, Southwest University, Chongqing, China
- Key Laboratory for Sericulture Functional Genomics Biotechnology of Agricultural Ministry, Southwest University, Chongqing, China
- College of Life Sciences, Chongqing Normal University, Chongqing, China
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes in opportunistic ocular infections (OOIs) in the era of modern combination antiretroviral therapy (cART), in the setting of HIV-infected patients. RECENT FINDINGS Improvements in modern cART has led to a progressive decline in the incidence of OOIs and mortality among patients with AIDS. Not only has there been a decreasing incidence of cytomegalovirus (CMV) retinitis, but there also has been a decline in progression of such retinitis when it does occur in AIDS patients, since the introduction of cART. Nevertheless, CMV retinitis remains the major cause of vision loss in AIDS patients. Although the incidence of CMV retinitis has declined overall, the incidence of ocular syphilis has increased during the cART era. Moreover, the impact of having HIV plays a role with respect to multidrug-resistant (MDR) tuberculosis and has resulted in a high prevalence of presumed ocular tuberculosis in HIV/MDR-TB co-infected patients. Although immune reconstitution uveitis (IRU) has been an important cause of visual deficits in developed countries, OOIs remain an important cause of blindness in the developing world. SUMMARY Reconstituting the immune system with effective cART while increasing accessibility of screening examinations is key to the success of blindness prevent in HIV-infected individuals, particularly in developing countries.
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Chen JS, Hsu TK, Hsu BM, Huang TY, Huang YL, Shaio MF, Ji DD. Surveillance of Vittaforma corneae in hot springs by a small-volume procedure. WATER RESEARCH 2017; 118:208-216. [PMID: 28432932 DOI: 10.1016/j.watres.2017.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/21/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
Vittaforma corneae is an obligate intracellular fungus and can cause human ocular microsporidiosis. Although accumulating reports of V. corneae causing keratoconjunctivitis in both healthy and immunocompromised persons have been published, little is known about the organism's occurrence in aquatic environments. Limitations in detection sensitivity have meant a large sampling volume is required to detect the pathogen up to now, which is problematic. A recent study in Taiwan has shown that some individuals suffering from microsporidial keratitis (MK) were infected after exposure to the pathogen at a hot spring. As a consequence of this, a survey and analysis of environmental V. corneae present in hot springs became an urgent need. In this study, sixty water samples from six hot spring recreation areas around Taiwan were analyzed. One liter of water from each sample site was filtered to harvest the fungi. The positive samples were detected using a modified nested PCR approach followed by sequencing using specific SSU rRNA gene primer pairs for V. corneae. In total fifteen V. corneae-like isolates were identified (25.0% of sites). Among them, six isolates, which were collected from recreational areas B, C and D, were highly similar to known V. corneae keratitis strains from Taiwan and other countries. Furthermore, five isolates, which were collected from recreation areas A, C, E and F, were very similar to Vittaforma-like diarrhea strains isolated in Portugal. Cold spring water tubs and public foot bath pools had the highest detection rate (50%), suggesting that hot springs might be contaminated via untreated water sources. Comparing the detection rate across different regions of Taiwan, Taitung, which is in the east of the island, gave the highest positive rate (37.5%). Statistical analysis showed that outdoor/soil exposure and a high heterotrophic plate count (HPC) were risk factors for the occurrence of V. corneae. Our findings provide empirical evidence supporting the need for proper control and regulations at hot spring recreational waters in order to avoid health risks from this pathogen. Finally, we have developed a small volume procedure for detecting V. corneae in water samples and this has proved to be very useful.
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Affiliation(s)
- Jung-Sheng Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tsui-Kang Hsu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Bing-Mu Hsu
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Minhsiung Township, Chiayi County, 62102, Taiwan, ROC.
| | - Tung-Yi Huang
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Minhsiung Township, Chiayi County, 62102, Taiwan, ROC
| | - Yu-Li Huang
- Department of Safety Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Men-Fang Shaio
- Department of Tropical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan, ROC
| | - Dar-Der Ji
- Department of Tropical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan, ROC.
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Thanathanee O, Athikulwongse R, Anutarapongpan O, Laummaunwai P, Maleewong W, Intapan PM, Suwan-Apichon O. Clinical Features, Risk Factors, and Treatments of Microsporidial Epithelial Keratitis. Semin Ophthalmol 2014; 31:266-70. [PMID: 25495852 DOI: 10.3109/08820538.2014.962161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To report the clinical manifestations, risk factors, and treatments of microsporidial epithelial keratitis in Thailand. METHODS Twenty eyes of 19 patients were diagnosed and the clinical presentations, risk factors, and management were analyzed. RESULTS Of 19 patients, six patients (32%) had no apparent risk factors. Predisposing factors included soil exposure (6/19, 32%), water contamination (6/19, 32%), and eye liner (1/19, 4%). Twelve cases (63%) were detected in the rainy season. All cases presented with disseminated, punctated, elevated, epithelial keratitis. Corneal scrapings with Gram-chromotrope staining were positive in all patients. Moxifloxacin 0.5% eye drops were given and all 16 patients experienced complete resolution. Three recurrent cases were resolved with only topical moxifloxacin without corneal scraping or swabbing. CONCLUSIONS Predisposing factors were not found in some patients; thus, corneal scraping with staining should be considered in cases having a high index of suspicion. The incidence is increased during the rainy season; therefore, clinicians should have more awareness during these times. Debridement with topical moxifloxacin eye drops, without any systemic medication, may be an effective treatment. Corneal scraping or swabbing may not be required in recurrences.
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Affiliation(s)
- Onsiri Thanathanee
- a Department of Ophthalmology , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
| | - Raweewan Athikulwongse
- a Department of Ophthalmology , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
| | - Orapin Anutarapongpan
- a Department of Ophthalmology , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
| | - Porntip Laummaunwai
- b Department of Parasitology , Khon Kaen University , Khon Kaen , Thailand , and.,c Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University , Khon Kaen , Thailand
| | - Wanchai Maleewong
- b Department of Parasitology , Khon Kaen University , Khon Kaen , Thailand , and.,c Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University , Khon Kaen , Thailand
| | - Pewpan Maleewong Intapan
- b Department of Parasitology , Khon Kaen University , Khon Kaen , Thailand , and.,c Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University , Khon Kaen , Thailand
| | - Olan Suwan-Apichon
- a Department of Ophthalmology , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
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Tan J, Lee P, Lai Y, Hishamuddin P, Tay J, Tan AL, Chan KS, Lin R, Tan D, Cutter J, Goh KT. Microsporidial keratoconjunctivitis after rugby tournament, Singapore. Emerg Infect Dis 2014; 19:1484-6. [PMID: 23965938 DOI: 10.3201/eid1909,121464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated an outbreak of 47 probable and 6 confirmed cases of microsporidial keratoconjunctivitis involving participants of an international rugby tournament in Singapore in April 2012.The mode of transmission was eye contact with soil. Vittaforma corneae was identified in 4 of 6 corneal scrapings and in 1 of 12 soil water samples.
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Tan J, Lee P, Lai Y, Hishamuddin P, Tay J, Tan AL, Chan KS, Lin R, Tan D, Cutter J, Goh KT. Microsporidial keratoconjunctivitis after rugby tournament, Singapore. Emerg Infect Dis 2014. [PMID: 23965938 PMCID: PMC3810903 DOI: 10.3201/eid1909.121464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We investigated an outbreak of 47 probable and 6 confirmed cases of microsporidial keratoconjunctivitis involving participants of an international rugby tournament in Singapore in April 2012.The mode of transmission was eye contact with soil. Vittaforma corneae was identified in 4 of 6 corneal scrapings and in 1 of 12 soil water samples.
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