Temporal trend of microsporidial keratoconjunctivitis and co
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Microsporidia are eukaryotic, obligate, spore-forming unicellular parasites. They have been known to infect invertebrates and have increasingly gained prominence in affecting humans over the past few decades. Microsporidia can cause a host of infections that includes myositis, diarrhea, bronchitis, and keratitis in both immune-compromised or immune-competent individuals. The infection with the microsporidial spores can occur via direct inoculation, inhalation, or ingestion. The ocular manifestations of microsporidial infection include keratoconjunctivitis or stromal keratitis. A strong correlation with environmental exposure to soil, sports activities, and water contamination in swimming pools has been described in the literature. The aim of this study was to describe the correlation between the temporal pattern of presentation of acute microsporidial keratoconjunctivitis (MKC) with meteorological parameters such as environmental temperature, rainfall, humidity, wind speed, and air pollution.

This cross-sectional hospital-based study included 182,789 patients presenting between January 2016 and December 2019 hailing from the district of Hyderabad. Patients with a clinical diagnosis of microsporidial keratoconjunctivitis in at least one eye with an acute onset of presentation were included as cases. Correlation analysis was performed with the local environmental temperature, rainfall, humidity, and windspeed (Telangana State Development and Planning Society) and air pollution (Central Pollution Control Board, Government of India).

Overall, 84 (0.05%) patients were diagnosed with acute onset microsporidial keratoconjunctivitis from the district of Hyderabad. The mean monthly prevalence in this cohort was 0.05% with peak prevalence in the months of July (0.08%), August (0.09%), September (0.12%), and October (0.08%). The environmental parameters of rainfall, humidity, windspeed were significantly positively correlated and the air pollution parameters such as ground-level ozone, particulate matter PM10, PM2.5, nitrogen dioxide, and carbon monoxide were significantly negatively correlated with the temporal pattern of microsporidial keratoconjunctivitis in the population.

Parasitic infections like microsporidial keratoconjunctivitis show a distinct temporal trend peaking during the monsoon season in the population. An increase in humidity, wind speed, and especially rainfall contributes to a higher prevalence of microsporidial keratoconjunctivitis cases during the year. An increase in ground-level ozone seems to be protective against infection.