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Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation
BACKGROUND: Microsporidial stromal keratitis poses several diagnostic challenges. Patients may present with corneal ulceration, marked stromal thinning, or even as a quite corneal scar. The presentation of microsporidial stromal keratitis commonly mimics viral keratitis. Microbiology scrapings are u...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452578/ https://www.ncbi.nlm.nih.gov/pubmed/28513490 http://dx.doi.org/10.4103/ijo.IJO_761_15 |
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author | Mittal, Ruchi Balne, Praveen K Sahu, Srikant Das, Sujata Sharma, Savitri |
author_facet | Mittal, Ruchi Balne, Praveen K Sahu, Srikant Das, Sujata Sharma, Savitri |
author_sort | Mittal, Ruchi |
collection | PubMed |
description | BACKGROUND: Microsporidial stromal keratitis poses several diagnostic challenges. Patients may present with corneal ulceration, marked stromal thinning, or even as a quite corneal scar. The presentation of microsporidial stromal keratitis commonly mimics viral keratitis. Microbiology scrapings are usually helpful; however, scraping and culture-negative cases pose a significant diagnostic dilemma. Histopathological examination is diagnostic but shows varying degree of inflammation, predominantly composed of polymorphonuclear leukocytes. Granulomatous inflammation, in microsporidial stromal keratitis, is never well described, and the authors in this article aim to describe the presence of granulomatous inflammation in microsporidial stromal keratitis, in patients with associated herpes simplex virus (HSV) keratitis. METHODS: This was a retrospective and observational study conducted at a tertiary eye care center. RESULTS: Of 263 patients who underwent therapeutic penetrating keratoplasty for infectious keratitis, during 2011–2013, seven patients were diagnosed as microsporidial stromal keratitis. Microsporidial spores could be demonstrated on microbiological scrapings in 5/7 (71%) of cases, but identified on histopathological examination and also confirmed on polymerase chain reaction (PCR) for microsporidium in 100% of cases. There was evidence of diffuse stromal necrosis with markedly severe degree of polymorphonuclear leukocytic infiltrates, with granulomatous inflammation in 42% of cases. Interestingly, these were positive for HSV-1 DNA on PCR. Review of medical records revealed much severe clinical presentations in patients with granulomatous inflammation, in comparison to cases without granulomatous inflammation. CONCLUSIONS: The authors hereby recommend that severe clinical presentation in patients with microsporidial stromal keratitis, markedly dense polymorphonuclear leukocytic infiltrates or the presence of granulomatous inflammation on the histopathological examination, should be investigated further for the presence of HSV-1 DNA for better patient management and good visual outcome. |
format | Online Article Text |
id | pubmed-5452578 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-54525782017-06-05 Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation Mittal, Ruchi Balne, Praveen K Sahu, Srikant Das, Sujata Sharma, Savitri Indian J Ophthalmol Original Article BACKGROUND: Microsporidial stromal keratitis poses several diagnostic challenges. Patients may present with corneal ulceration, marked stromal thinning, or even as a quite corneal scar. The presentation of microsporidial stromal keratitis commonly mimics viral keratitis. Microbiology scrapings are usually helpful; however, scraping and culture-negative cases pose a significant diagnostic dilemma. Histopathological examination is diagnostic but shows varying degree of inflammation, predominantly composed of polymorphonuclear leukocytes. Granulomatous inflammation, in microsporidial stromal keratitis, is never well described, and the authors in this article aim to describe the presence of granulomatous inflammation in microsporidial stromal keratitis, in patients with associated herpes simplex virus (HSV) keratitis. METHODS: This was a retrospective and observational study conducted at a tertiary eye care center. RESULTS: Of 263 patients who underwent therapeutic penetrating keratoplasty for infectious keratitis, during 2011–2013, seven patients were diagnosed as microsporidial stromal keratitis. Microsporidial spores could be demonstrated on microbiological scrapings in 5/7 (71%) of cases, but identified on histopathological examination and also confirmed on polymerase chain reaction (PCR) for microsporidium in 100% of cases. There was evidence of diffuse stromal necrosis with markedly severe degree of polymorphonuclear leukocytic infiltrates, with granulomatous inflammation in 42% of cases. Interestingly, these were positive for HSV-1 DNA on PCR. Review of medical records revealed much severe clinical presentations in patients with granulomatous inflammation, in comparison to cases without granulomatous inflammation. CONCLUSIONS: The authors hereby recommend that severe clinical presentation in patients with microsporidial stromal keratitis, markedly dense polymorphonuclear leukocytic infiltrates or the presence of granulomatous inflammation on the histopathological examination, should be investigated further for the presence of HSV-1 DNA for better patient management and good visual outcome. Medknow Publications & Media Pvt Ltd 2017-04 /pmc/articles/PMC5452578/ /pubmed/28513490 http://dx.doi.org/10.4103/ijo.IJO_761_15 Text en Copyright: © 2017 Indian Journal of Ophthalmology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Mittal, Ruchi Balne, Praveen K Sahu, Srikant Das, Sujata Sharma, Savitri Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
title | Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
title_full | Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
title_fullStr | Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
title_full_unstemmed | Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
title_short | Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
title_sort | coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452578/ https://www.ncbi.nlm.nih.gov/pubmed/28513490 http://dx.doi.org/10.4103/ijo.IJO_761_15 |
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