Microsporodial Keratoconjunctivitis First Case Series In Japan

to report the first case series of microsporidial keratoconjunctivitis (MKC) in Japan in healthy football players in same team along one month.

Descriptive noncomparative case series report/Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan.

Five patients with unilateral keratoconjunctivitis initially treated by general ophthalmologists were referred to the Cornea clinic in our department. All patients were evaluated with Cornea specialists by comprehensive ophthalmic examination including history taking, symptoms analysis, best corrected visual acuity measurements (BCVA), slit lamp biomicroscopy, AS-OCT and IVCM. All patients had unilateral central or diffuse multifocal, coarse epithelial punctate lesions stained with fluorescein. All patients had diffuse conjunctival inflammation  papillae.  All our patients were football players related to the same team exposing to the same soil/muddy water which may harbor the spores.

All patients were subjected to corneal epithelial scraping and specimens were sent to department of Clinical Pathology for staining and polymerase chain reaction (PCR) analysis. Treatment includes Voriconazole eye drops every 2 hours, Fluorometholone 0.1% and Levofloxacin eye drops 4 times/day. Follow up of all cases until full recovery were done with complete ophthalmic evaluation. 

In the AS-OCT, the lesions appear as hyperreflective spots mainly in the epithelial layers, slightly raised above the surface and pinpoints ovoid spores can be seen with IVCM. All cases with the use of pan microsporidial PCR have been reported positive.

Complete corneal epithelial healing with no residual opacity had occurred in all cases within few weeks after initiation of treatment with regain of their BCVA.

There has been a growing awareness of MKC in recent years largely because of the increasing number of infections in healthy, immunocompetent individuals. A multifocal, coarse, punctate unilateral keratitis associated with mild conjunctivitis appears to be the characteristic manifestation of this disease. Exposure to contaminated water/ soil, in addition to inadequate sanitary facilities, is a potential source of infection.