Case Report: The Use of In Vivo Confocal Microscopy for Diagnosis and Monitoring in a Rare Case of Ancaliia algerae Microsporidial Keratitis in New South Wales, Australia

Kathryn M. Sutton Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia;

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Matthew R. Watts Centre for Infectious Diseases and Microbiology Public Health, Westmead, Australia;
Institute for Clinical Pathology and Medical Research—New South Wales Health Pathology, Westmead, Australia;
University of Sydney, Sydney, Australia;

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Daniel D. Athavale Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia;

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Noni Lewis Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia;

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Constantinos Petsoglou University of Sydney, Sydney, Australia;
Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia;

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Bernard J. Hudson University of Sydney, Sydney, Australia;
Department of Clinical Microbiology and Infectious Diseases, Royal North Shore Hospital, Sydney, Australia

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Suran L. Fernando Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia;
University of Sydney, Sydney, Australia;

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ABSTRACT.

We describe the successful management of Ancaliia Algerae microsporidial keratitis in an immunosuppressed 54-year-old woman with refractory linear IgA disease. The case highlights the challenges in diagnosis and management of this infection in immunocompromised individuals and emphasizes the usefulness of in vivo confocal microscopy as a novel, noninvasive tool to aid in the diagnosis and monitoring of microsporidial keratitis. We also discuss the possible mode of acquisition of this rare infection.

Author Notes

Authors’ addresses: Kathryn M. Sutton, Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia, E-mail: kathryn.sutton@health.nsw.gov.au. Matthew R. Watts, Centre for Infectious Diseases and Microbiology Public Health, Westmead, Australia, Institute for Clinical Pathology and Medical Research—New South Wales Health Pathology, Westmead, Australia, and University of Sydney, Sydney, Australia, E-mail: matthew.watts@health.nsw.gov.au. Dnyaneshwar D. Athavale, Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia, E-mail: daniel_athavale@hotmail.com. Noni Lewis, Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia, E-mail: noni.lewis@health.nsw.gov.au. Constantinos Petsoglou, University of Sydney, Sydney, Australia, and Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia, E-mail: constantinos.petsoglou@health.nsw.gov.au. Bernard J. Hudson, University of Sydney, Sydney, Australia, and Department of Clinical Microbiology and Infectious Diseases, Royal North Shore Hospital, Sydney, Australia, E-mail: bernard.hudson@health.nsw.gov.au. Suran L. Fernando, Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia, and University of Sydney, Sydney, Australia, E-mail: suran.fernando@health.nsw.gov.au.

Address correspondence to Kathryn M. Sutton, Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney 2065, Australia. E-mail: kathryn.sutton@health.nsw.gov.au
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