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Stromal Keratitis


Presentation

  • 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.[ncbi.nlm.nih.gov]
Pathologist
  • Microsporidia is a very small organism and unless the pathologist has the organism in the differential diagnosis it may pass undiagnosed.[cureus.com]
  • […] culture-negative samples and difficulty in differentiating Microsporidia from necrotic debris in routine stains explain the challenges and the need for an increased awareness in timely diagnoses of this infection by the ophthalmologist, microbiologist, and ocular pathologist[ijo.in]
Prisoner of War
  • The physician Hans Reiter as a prisoner of war in Nuremberg: a contextual review of his interrogation (1945–1947). Semin Arthritis Rheum . 2003;32:208–230. doi:10.1053/sarh.2003.49995 [CrossRef] Hannu T. Reactive arthritis.[healio.com]
Aspiration
  • Culture of the joint aspirate grew no organism and pediatric rheumatology made a diagnosis of reactive arthritis.[healio.com]
  • Diagnosis of microsporidiosis currently depends on morphological demonstration of the organisms in one or more readily obtainable specimens such as stool, duodenal aspirates, urine, sputum, nasal discharge, bronchoalveolar lavage fluid, conjunctival smears[bmcophthalmol.biomedcentral.com]
Oligoarthritis
  • Non-validated classification criteria exist. 6 Clinically, a monoarthritis or oligoarthritis follows enteric or genitourinary infection by 2 to 4 weeks (range: 1 day to 6 weeks). 6,7 It is not necessary to have the full triad of arthritis, non-gonococcal[healio.com]

Workup

  • Three of these patients were subjected to a complete microbiologic workup, but the lesions were all sterile. The lesions healed with conservative treatment of patching and, in some cases, a soft contact lens.[ncbi.nlm.nih.gov]
Borrelia Burgdorferi
  • A positive Borrelia burgdorferi antibody enzyme immunoassay and Western blot analysis (9 of 10 reactive immunoglobulin G bands and 1 of 3 immunoglobulin M bands) confirmed the diagnosis.[ncbi.nlm.nih.gov]
HLA-B27
  • We describe a 15-year-old HLA-B27–positive boy with infectious gastroenteritis complicated by polyarthritis and a severe painful keratitis.[healio.com]

Treatment

  • In the remaining 2 cases, stromal scarring that was present before cyclosporin A treatment prevented vision increase.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: These results indicate that human cytotoxic T cells show a difference in numbers and natural killer cell activity that may affect the prognosis of recurrent herpetic stromal keratitis.[ncbi.nlm.nih.gov]
  • Prognosis: One of the hallmarks of herpes simplex virus (HSV) infection is the establishment of a lifelong latent infection accompanied by periods of recurrent disease.[missionforvisionusa.org]
  • Long-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome. Ophthalmology . 2003;110:1764–1769. doi:10.1016/S0161-6420(03)00620-1 [CrossRef] Cass E.[healio.com]
  • Prognosis Prognosis for interstitial keratitis is good if recognized and treated early before significant corneal scarring has occurred.[eyewiki.aao.org]
  • Microsporidial stromal keratitis has a poor prognosis and a high rate of medical therapy failure requiring PKP in most reported cases in literature.[cureus.com]

Etiology

  • Four patients presented with unilateral, small, persisting deep stromal infiltrates, of uncertain etiology, in the cornea, which were not responding to conventional antimicrobial treatment and required penetrating keratoplasty in three.[ncbi.nlm.nih.gov]
  • […] of infectious interstitial keratitis, such as other viruses (Varicella zoster virus, Epstein-Barr virus), bacteria (syphilis, lyme), fungus, and Acanthamoeba, as well as immune-mediated etiologies, including sarcoidosis and Cogan syndrome.[eyewiki.aao.org]
  • Etiology: Herpes simplex vius has been isolated from corneas in some cases of chronic stromal keratitis by culture, electron microscopy, PCR and immunohistochemistry.[missionforvisionusa.org]
  • Classical resemblance of clinical and morphological findings of cases of Group A, with viral keratitis, intrigued the authors to investigate for associated viral etiology.[ijo.in]

Epidemiology

  • We also discuss relevant epidemiologic issues regarding HSV epithelial and stromal disease. Copyright 2012 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • The epidemiology of HSV endotheliitis is less clear at least in part because many publications include disciform HSV endotheliitis as a form of HSK.[eyewiki.aao.org]
  • Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen[books.google.de]
  • Epidemiology: Most frequent cause of corneal blindness in the United States Most common source of infectious blindness in the Western world.[coreem.net]
  • Infection and Disease Epidemiology, p 139-169. In Stephens R (ed), Chlamydia . ASM Press, Washington, DC. doi: 10.1128/9781555818203.ch6[asmscience.org]
Sex distribution
Age distribution

Pathophysiology

  • Intraocular pressure may be elevated secondary to trabeculitis. [14] Pathophysiology The pathophysiology of HSK is complex and remains incompletely understood.[eyewiki.aao.org]
  • […] bacterial infections ( TB, Leprosy and Lyme disease ) and parasitic infections ( Acanthamoeba, Onchocerciasis or river blindness, Leishmaniasis, Trypanosoma cruzi or Chagas disease, Trypanosoma brucei or African sleeping sickness and microsporidia) [2] Pathophysiology[en.wikipedia.org]
  • Approximately 2 million people worldwide have impaired vision from herpetic eye disease ( Farooq 2012 ) Pathophysiology: Primary infection: occurs most commonly in the mucocutaneous or ocular distribution of the trigeminal nerve, and can present as a[coreem.net]
  • Viral replication within the stroma probably isn’t taking place, and viral proteins haven’t been isolated in eyes with experimental HSK. 2 This intuitively makes sense when we consider viral pathophysiology: viruses are obligate intracellular pathogens[reviewofcontactlenses.com]

Prevention

  • A benefit was seen for preventing both epithelial keratitis (rate ratio, 0.62; 95% confidence interval, 0.39-0.97) and stromal keratitis (rate ratio, 0. 57; 95% confidence interval, 0.36-0.89).[ncbi.nlm.nih.gov]

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