微孢子虫感染导致角膜穿孔1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.258

摘要/Abstract

摘要： 目的探讨微孢子虫感染性角膜穿孔的诊疗方法,临床特点、诊断依据和研究进展。方法回顾性分析1例微孢子虫感染导致角膜穿孔患者的临床资料并复习相关文献进行总结。结果微孢子虫感染性角膜溃疡穿孔是罕见的眼部感染性疾病,传染途径暂不明确,可能与患者不洁手卫生史有关。角膜组织病检及荧光增白剂染色、宏基因组检测可确诊。在病程早期及时进行宏基因组检测对于尽早明确病原体类型、及时治疗用药具有关键性的指导作用。结论近年来,微孢子虫感染引起角膜疾病的病例越来越多,临床医生在诊断结膜炎相关的非典型点状上皮性角膜炎的过程中,应考虑微孢子虫感染的角膜结膜炎,避免发展为角膜穿孔,严重危及视力。

关键词: 角膜溃疡, 微孢子虫, Vittaforma corneae, 角膜移植, 宏基因组测序

Abstract: Objective To investigate the diagnosis, treatment, clinical features, diagnostic principles, and research progress of corneal perforations caused by Microsporidia infection. Methods We retrospectively analyzed the clinical data of a patient with corneal perforation caused by Microsporidia infection and reviewed relevant literature. Results Microsporidial infection of corneal ulcer perforation is a rare infectious ocular disease. The transmission route is unclear but could be related to unclean hand hygiene. The diagnosis can be confirmed through corneal tissue examination, fluorescent whitening agent staining, and metagenomic detection. Early metagenomic detection during the disease course is crucial for the early identification of pathogen types and timely medication prescriptions. Conclusion In recent years, increased cases of Microsporidium keratoconjunctivitis have occurred in healthy individuals. Clinicians should consider Microsporidium keratoconjunctivitis in diagnosing conjunctivitis-related atypical punctate epithelial keratitis to avoid corneal perforation, which seriously endangers vision.

Key words: Corneal ulcer, Microsporidium, Vittaforma corneae, Cornea transplantation, Metagenomics Next-Generation Sequencing

中图分类号:

R770.4

王玲,黎明,应方微,王玉,温文,姚晓明. 微孢子虫感染导致角膜穿孔1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 95-99.

WANG Ling, LI Ming, YING Fangwei, WANG Yu, WEN Wen, YAO Xiaoming. Corneal perforation caused by microsporidia infection: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(5): 95-99.

参考文献

[1] Ryan ET, Hill DR, Solomon T, et al. Acknowledgments[M] //Hunter's Tropical Medicine and Emerging Infectious Diseases. Amsterdam: Elsevier, 2020: vi. doi:10.1016/b978-0-323-55512-8.00224-6
[2] Han B, Pan GQ, Weiss LM. Microsporidiosis in humans[J]. Clin Microbiol Rev, 2021, 34(4): e0001020. doi:10.1128/CMR.00010-20
[3] Sak B, Kvá cM, Ku cerová Z, et al. Latent microsporidial infection in immunocompetent individuals - a longitudinal study[J]. PLoS Negl Trop Dis, 2011, 5(5): e1162. doi:10.1371/journal.pntd.0001162
[4] Didier ES, Stovall ME, Green LC, et al. Epidemiology of microsporidiosis: sources and modes of transmission[J]. Vet Parasitol, 2004, 126(1/2): 145-166. doi:10.1016/j.vetpar.2004.09.006
[5] 张斌, 李威, 何伟. 大气泡法辅助深板层角膜移植治疗圆锥角膜的临床观察[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 92-94. doi:10.6040/j.issn.1673-3770.0.2020.095 ZHANG Bin, LI Wei, HE Wei. Big bubble assisted deep lamellar keratoplasty surgery for keratoconus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 92-94. doi:10.6040/j.issn.1673-3770.0.2020.095
[6] James TY, Pelin A, Bonen LD, et al. Shared signatures of parasitism and phylogenomics unite Cryptomycota and microsporidia[J]. Curr Biol, 2013, 23(16): 1548-1553. doi:10.1016/j.cub.2013.06.057
[7] Weber R, Deplazes P, Schwartz D. Diagnosis and clinical aspects of human microsporidiosis[J]. Contrib Microbiol, 2000, 6: 166-192. doi:10.1159/000060360
[8] Manual of clinical microbiology[M]. 12th Edition. American Society for Microbiology Press, 2011
[9] 许隆祺. 图说寄生虫学与寄生虫病[M]. 北京: 北京科学技术出版社, 2016
[10] Didier ES. Microsporidiosis: an emerging and opportunistic infection in humans and animals[J]. Acta Trop, 2005, 94(1): 61-76. doi:10.1016/j.actatropica.2005.01.010
[11] 莫碧莹, 包佳玲, 周泽扬. 人类微孢子虫检测方法研究进展[J]. 微生物学报, 2021, 61(5): 1031-1043. doi:10.13343/j.cnki.wsxb.20200290 MO Biying, BAO Jialing, ZHOU Zeyang. Research progress in detection methods of human microsporidia[J]. Acta Microbiologica Sinica, 2021, 61(5): 1031-1043. doi:10.13343/j.cnki.wsxb.20200290
[12] 黄敏君, 黄松如. 眼部微孢子虫病研究进展[J]. 传染病信息, 2010, 23(5): 314-318. doi:10.3969/j.issn.1007-8134.2010.05.021 HUANG Minjun, HUANG Songru. Research progress of ocular microsporidiosis[J]. Infectious Disease Information, 2010, 23(5): 314-318. doi:10.3969/j.issn.1007-8134.2010.05.021
[13] 戴媛媛, 马筱玲. 宏基因组二代测序技术在临床病原学诊断中的应用[J]. 临床检验杂志, 2021, 39(1): 1-5. doi:10.13602/j.cnki.jcls.2021.01.01 DAI Yuanyuan, MA Xiaoling. Application of metagenome second-generation sequencing technology in clinical etiological diagnosis[J]. Chinese Journal of Clinical Laboratory Science, 2021, 39(1): 1-5. doi:10.13602/j.cnki.jcls.2021.01.01
[14] Blauwkamp TA, Thair S, Rosen MJ, et al. Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease[J]. Nat Microbiol, 2019, 4(4): 663-674. doi:10.1038/s41564-018-0349-6
[15] Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection[J]. Annu Rev Pathol, 2019, 14: 319-338. doi:10.1146/annurev-pathmechdis-012418-012751
[16] 宏基因组分析和诊断技术在急危重症感染应用专家共识组. 宏基因组分析和诊断技术在急危重症感染应用的专家共识[J]. 中华急诊医学杂志, 2019, 28(2): 151-155. doi:10.3760/cma.j.issn.1671-0282.2019.02.005
[17] Hibbett DS, Binder M, Bischoff JF, et al. A higher-level phylogenetic classification of the Fungi[J]. Mycol Res, 2007, 111(Pt 5): 509-547. doi:10.1016/j.mycres.2007.03.004
[18] Adl SM, Bass D, Lane CE, et al. Revisions to the classification, nomenclature, and diversity of eukaryotes[J]. J Eukaryot Microbiol, 2019, 66(1): 4-119. doi:10.1111/jeu.12691
[19] Huang AS, Cho JS, Bertram BA. Microsporidial keratitis related to water exposure: a case series[J]. Cureus, 2021, 13(6): e15760. doi:10.7759/cureus.15760
[20] Alabduljabbar M, Sirajuddin F, Maktabi A, et al. A rare microsporidial infection in lamellar corneal tissue, following transepithelial photorefractive keratectomy[J]. Case Rep Ophthalmol, 2023, 14(1): 127-133. doi:10.1159/000528894
[21] Arnalich-Montiel F, de-Arriba-Palomero P, de Dompablo E, et al. Vittaforma Corneae keratoconjunctivitis: an emerging pathology among travelers returning from Southeast Asia[J]. Arch Soc Esp Oftalmol, 2020, 95(11): 569-572. doi:10.1016/j.oftal.2020.04.017
[22] Dobo?瘙塂i AA, Bel LV, Pa?瘙塂tiu AI, et al. A review of Encephalitozoon cuniculi in domestic rabbits(Oryctolagus cuniculus)-biology, clinical signs, diagnostic techniques, treatment, and prevention[J]. Pathogens, 2022, 11(12): 1486. doi:10.3390/pathogens11121486
[23] Malik S, Ishaq M, Nayyar S, et al. Microsporidial keratitis- first case series of a rare pathogen in the wake of flood disasters of 2022 in Pakistan[J]. J Coll Physicians Surg Pak, 2022, 32(12): SS165-SS167. doi:10.29271/jcpsp.2022.Supp0.SS165
[24] Sarabeev V, Ovcharenko M, Jarosiewicz A, et al. Database on eukaryotic symbionts of native and invasive gammarids(Crustacea, Amphipoda)in the Baltic region of Poland with information on water parameters for sampling sites[J]. Data Brief, 2023, 49: 109308. doi:10.1016/j.dib.2023.109308
[25] Akossi RF, Delbac F, El Alaoui H, et al. The intracellular parasite Anncaliia algerae induces a massive miRNA down-regulation in human cells[J]. Noncoding RNA Res, 2023, 8(3): 363-375. doi:10.1016/j.ncrna.2023.05.003
[26] Carella F, De Vico G. Pathology, epidemiology, and phylogeny of mussel egg disease due to the microsporidian Steinhausia mytilovum(Field, 1924)in the Mediterranean mussel(Mytilus galloprovincialis)[J]. J Invertebr Pathol, 2023, 198: 107927. doi:10.1016/j.jip.2023.107927
[27] Mohanty A, Sahu SK, Sharma S, et al. Past, present, and prospects in microsporidial keratoconjunctivitis- A review[J]. Ocul Surf, 2023, 28: 364-377. doi:10.1016/j.jtos.2021.08.008

相关文章 15

[1]	张斌,李威,何伟. 大气泡法辅助深板层角膜移植治疗圆锥角膜的临床观察[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 92-94.
[2]	郝文培, 翟华蕾, 孙晓彤, 张雅妮, 朱艳辉, 孔倩倩, 程钧, 张婷. 角膜再移植原因与植片失活的危险因素分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 134-140.
[3]	王娟,赵敏,徐梅,张琪,周善璧. 外伤致穿透性角膜移植伤口裂开八例并文献复习[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 95-98.
[4]	赵军, 刘景, 王大江, 陈国玲, 王琪, 张晗. Foxp3基因转染的Teff细胞抗高危角膜移植排斥的作用[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 44-48.
[5]	王群1，白华2，田磊2，王丽强2，黄一飞2 . 软性一体式PHEMA人工角膜植入碱烧伤兔角膜的电镜观察[J]. 山东大学耳鼻喉眼学报, 2014, 28(3): 59-62.
[6]	崔长霞1，朱伟2，张春晓3，李志伟3. 核黄素／UVA诱导的角膜交联术治疗真菌性角膜溃疡[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 68-70.
[7]	刘志谦. 结膜瓣遮盖术治疗难治性角膜溃疡27例[J]. 山东大学耳鼻喉眼学报, 2011, 25(3): 78-79.
[8]	靳雷崔建萍. 共焦显微镜在角膜溃疡病原学诊断中的临床应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(6): 549-550.
[9]	王相如,蒋华,张霞,王晓莉 . 穿透角膜移植术各屈光变量及其相互关系[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 373-375 .
[10]	张华,王旭,韩旭光,张玉光,徐湘辉 . 穿透性角膜移植术中前房积脓的处理[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 165-166 .
[11]	蒋华,张霞,高洪瑞,魏捷,路振莉,王光洁 . 角膜弹性半球定律指导下的穿透角膜移植屈光控制[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 159-161 .
[12]	温莹,王兴荣,毕宏生,张建华 . 那他霉素滴眼液辅助角膜移植治疗顽固真菌性角膜溃疡[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 23-24 .
[13]	陶祥臣,李新,王振,牟国营 . 硬性透气性角膜接触镜用于穿透性角膜移植术后屈光重建探讨[J]. 山东大学耳鼻喉眼学报, 2007, 21(5): 468-470 .
[14]	张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84-87 .
[15]	张玉光,韩旭光,张华,王旭,徐湘辉 . 改良穿透性角膜移植术治疗真菌性角膜炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 94-95 .

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed