chlamydial & parasiticchlamydial & … and immunology/micro4_parasites...chlamydial &...

CHLAMYDIAL & PARASITICCHLAMYDIAL & PARASITIC EYE PATHOGENSDr. WILLIAM J. BENJAMIN

Eye Physiology & Ocular Prosthetics LaboratoryUniversity of Alabama at BirminghamUniversity of Alabama at Birmingham

School of Optometry

Presented at the UAB School of Optometry as Part ofOPT 121: MICROBIOLOGY and IMMUNOLOGY

N b 23 2009November 23, 2009

RICKETTSIAE & CHLAMYDIA

INTRACELLULAR PARASITESHAVE DNA AND RNA, UNLIKE VIRUSESREPLICATE INSIDE HOST CELLNOT VERY DEPENDENT ON HOST CELL

MACHINERYMACHINERYLESS VIRULENT THAN MOST CELL-LYSING

VIRUSESSUSCEPTIBLE TO MOST ANTIBACTERIALS DIFFERENCE IS LIKE “SPLITTING HAIRS”

VIRUS-LIKE BACTERIA OFVIRUS-LIKE BACTERIA OF SPECIAL SIGNIFICANCE

RICKETTSIAE: Generally Require a VectorTYPHUS, carried by several vectorsQ FEVER pasteurization of milkQ FEVER, pasteurization of milkROCKY MOUNT’N SPOTTED FEVER, tick

CHLAMYDIAChlamydia trachomatis: from humansChlamydia psittaci: from birds

TRACHOMA, AND NON-TRACHOMATOUS INCLUSION KERATOCONJUNCTIVITIS ACCOMPANIED BY GENITOURINARY TRACT INFECTION

MICROBIOLOGICAL DIAGNOSIS OF OCULAR

CHLAMYDIAL INFECTIONSCLINICAL PRESENTATIONOCULAR SURFACE CYTOLOGY

POLYMORPHIC RESPONSEPOLYMORPHIC RESPONSE PMNs, Lymphocytes, Monocytes Leber Cell in Trachoma:

Giant macrophages packedGiant macrophages packedwith phagocytized debris

Eosinophil (?)

MICROBIOLOGICAL DIAGNOSIS OF OCULAR

CHLAMYDIAL INFECTIONSSTAINS: GIEMSA, FLUORESENT ANTIBODY

INCLUSION BODIES: Cytoplasmic, visible with Light Microscopyvisible with Light Microscopy

TISSUE CULTURE: UNRELIABLE

TRANSMISSION OFTRANSMISSION OF CHLAMYDIA

URETHRAL EPITHELIUM OF MEN AND CERVICAL EPITHELIUM OF WOMEN

EYE INFECTION RARE W/O CONCURRENTEYE INFECTION RARE W/O CONCURRENT GENITAL INFECTION

ORAL ADMIN. OF ANTIBACTERIALS NECES-SARY: Tetracycline, Erythromycin

THE PING PONG FACTOR

CLASSIFICATION OF PARASITES THAT INFECT OR

INFEST THE HUMAN EYE

INTRACELLULAR PARASITESVirusesVirusesChlamydiaBartonella henselae (Parinaud’s OGS)

EXTRACELLULAR PARASITES

ENDOPARASITESENDOPARASITESECTOPARASITES

INTRACELLULAR PROTOZOAINTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Microsporidia: OVOID SPORE FORMERSTWO GROUPS for the EYE

Nosema sp.: Cornea Stroma UlcerEncephalitozoon sp.: Intractable

Infiltrative KeratoconjunctivitisInfiltrative Keratoconjunctivitis

INTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Microsporidia: pNO ANTECEDENT TRAUMAVECTOR UNKNOWNONLY IN THE IMMUNOCOMPROMISEDONLY IN THE IMMUNOCOMPROMISEDBROLENE, FUMAGILLIN INHIBIT, BUT IN-

FECTION RECURS AFTER CESSATION

Spores in Stroma: Acid-Fast Stain, 1000x

3 Spores in Macrophage: EM

INTRACELLULAR PROTOZOAINTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Leishmania sp.: LEISHMANIASISVECTOR: BITES OF SAND FLY, THEN

INGESTED BY PMNsINGESTED BY PMNsREPLICATION WITHIN PMNs, CAUSING

LESIONS OF MUCOUS MEMBRANES, SKIN AND VISCERAL ORGANSSKIN, AND VISCERAL ORGANS

INTRACELLULAR PROTOZOAINTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Leishmania sp.: LEISHMANIASISOCULAR EFFECTS: EDEMA, ULCERS,

SCARRING OF LIDS CONJ ANDSCARRING OF LIDS, CONJ., AND INTERSTITIAL KERATITIS

INTRACELLULAR PROTOZOAINTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Toxoplasma gondii: TOXOPLASMOSISFECAL TRANS. BY DOGS, CATS, ETC.LOCALIZED CHOROIDAL GRANULOMA

INTRACELLULAR PROTOZOAINTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Toxoplasma gondii: TOXOPLASMOSISFECAL TRANS. BY DOGS, CATS, ETC.LOCALIZED CHOROIDAL GRANULOMA

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Onchocerca volvulus: ONCHOCERCHIASISMICROFILARIAL NEMATODE (Worm)VECTOR: FEMALE BLACK FLY (Bites)VECTOR: FEMALE BLACK FLY (Bites)

Transfers microfilaria to humansMicrofilaria enter body thru bitesWolbachia sp. Bacteria are essent-Wolbachia sp. Bacteria are essent

ial symbionts of nematodes

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Onchocerca volvulus: ONCHOCERCHIASISMICROFILARIA JOURNEY TO EYE

via Ciliary Vessels, NervesFLY ALSO DEPOSITS ITS EGGS

NEAR RIVERS, LARVA GROWIN TROPICAL MOISTURE, i.e.,“RIVER BLINDNESS”“RIVER BLINDNESS”

CORNEAL REACTION TO DEADFILARIA AND WOHLBACHIABACTERIABACTERIAMild / Early: Opacities ReversibleSclerosing Keratitis (1): Irreversible Scars

SUSCEPTIBLE TO ANTIBACTERIALSSUSCEPTIBLE TO ANTIBACTERIALS

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

T h d i & i KERA’ISTrypanosoma rhodesiense & cruzi: KERA’ISAFR. & SO. AMER. SLEEPING SICKNESS

Acanthamoeba spAcanthamoeba sp.UBIQUITOUS; 15 DIFFERENT SPECIESFREE-LIVING: NOT REALLY PARASITE

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYEA th bAcanthamoeba sp.

BREATHING OFDUST, CONT-AM WATERAM. WATER

SWIMMING,HOT TUBS,,TAP WATER

CNS INFECTIONSvia NASO-via NASO-

PHARYNYX,as with Naegleria

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

A th bAcanthamoeba sp.TROPHOZOOITE& CYST FORMS

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Acanthamoeba sp.FEEDS ON BACTERIA, FUNGI, -ZOAHUMANS & ANIMALS HAVE IMMUNITYCULTURED FROM NASOPHARYNX OF

ASYMPTOMATIC ADULTSASYMPTOMATIC ADULTSLEGIONNAIRE’S DISEASE: AC, Humid.

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Acanthamoeba sp.SITES OF OCULAR INFECTION

Cornea, Orbit, Retina, Optic NerveINITIAL KERATITIS CAN BE Herpes-like

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Acanthamoeba sp.FACTORS IN INITIAL EYE INFECTION

Antecedent TraumaImmunocompromiseRepeated ExposureRepeated ExposureExposure to Virulent StrainInoculation of Immunoprivileged SiteInoculation of Immunoprivileged SiteWear of Soft Contact Lenses

HIGHER INCIDENCE FOLLOWING FLOODS and HURRICANES

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Acanthamoeba sp.DIAGNOSIS: CALCIFLUOR WHITE STAIN

Fluorescent Microscopy; Stain CystsFluorescent Microscopy; Stain Cysts

EXTRACELLULAR PROTOZOAEXTRACELLULAR PROTOZOA THAT INFECT THE HUMAN EYE

Acanthamoeba Sp.TREATMENT WITH MULTIPLE AGENTS

Brolene AntifungalsBrolene, AntifungalsNeomycin, Polymyxin B

TREATMENT IS PROLONGED / YEARENCYSTMENT IS A PROBLEMCORNEAL TRANSPLANT OFTEN REQ.TOO MANY ENUCLEATIONS

ENDOPARASITES THATENDOPARASITES THAT INFEST THE HUMAN EYE

THESE ARE A GROUP OF SOME 15+ PARA-SITES ASSOCIATED WITH THE GASTRO-INTESTINAL TRACTINTESTINAL TRACT

THEY ARE LARGER MULTICELLED ORGAN-ISMS, PERHAPS ON THE FRINGE OF BEING “MICRO”ORGANISMSBEING MICRO ORGANISMS

THEY SPREAD TO HUMANS BY:BITES OF FLIES, BUGS, MOSQUITOESBITES OF FLIES, BUGS, MOSQUITOESFECALLYINGESTION OF UNDERCOOKED FOOD

OR IMPURE WATER

ENDOPARASITES THATENDOPARASITES THAT INFEST THE HUMAN EYE

Loa Loa: LOIASISFILARIAL EYEWORMVECTOR: BITE OF MANGO FLYChrysops allows microfilaria into body

AROUND ORBIT & UNDER CONJUNCTIVAAROUND ORBIT & UNDER CONJUNCTIVA

ENDOPARASITES THATENDOPARASITES THAT INFEST THE HUMAN EYE

Thelazia Sp.EYEWORM OF DEER, RABBITHOOKWORM OF DOG, CATVECTOR TO MAN: BITE OF FLYDIRECT SKIN PENETRATION BY LARVADIRECT SKIN PENETRATION BY LARVA

ENDOPARASITES THATENDOPARASITES THAT INFEST THE HUMAN EYE

Toxocara canis & cati: TOXOCARIASISDOG & CAT NEMATODE (ROUNDWORMS)FECAL TRANSMISSION OF EGGS

TO HUMANS

ENDOPARASITES THATENDOPARASITES THAT INFEST THE HUMAN EYE

Toxocara canis & cati: TOXOCARIASISCHORIORETINITIS: Allergic Rxn to Worm

ENDOPARASITES THATENDOPARASITES THAT INFEST THE HUMAN EYE

Trichinella spiralis: TRICHINOSISLARVA ENCYST IN SKELETAL MUSCLEPIGS HORSE WALRUS BEARPIGS, HORSE, WALRUS, BEARVECTOR TO MAN:

INGESTION OF UNDERCOOKEDUNDERCOOKEDMEAT

EXTRA-OCULAR MUSCLESThe only striatedThe only striatedmuscles of the Eye

ECTOPARASITES THATECTOPARASITES THAT INFEST THE HUMAN EYE

Demodex folliculorum & brevisHAIR FOLLICLE & SABACEOUS GLANDNORMAL MITES OF LIDS NOSENORMAL MITES OF LIDS, NOSEMAY BE VECTORS FOR OTHER M.O.’sROLE IN BLEPHARITIS UNCLEARROLE IN BLEPHARITIS UNCLEAROVERGROWTH CALLED DEMODICOSIS

ECTOPARASITES THATECTOPARASITES THAT INFEST THE HUMAN EYE

TICKS: Can Attach to Lid or ConjunctivaBLOOD-SUCKING ARTHROPODSVECTORS FOR RICKETTSIAE, VIRUSESLYME DISEASE: SPIROCHETE

Borrelia burgdorferi & DEER TICKBorrelia burgdorferi & DEER TICK

Deer Tick

ECTOPARASITES THATECTOPARASITES THAT INFEST THE HUMAN EYE

Phthirus pubis: CRAB LOUSE & EGGSLOUSE & NITS IN PUBIC AREA, LASHESOCULAR EFFECTS:BlepharitisMadarosisMadarosisKeratitisInfection @ Bite Site

ECTOPARASITES THATECTOPARASITES THAT INFEST THE HUMAN EYE

Phthirus pubis: CRAB LOUSE & EGGSTRANSMITTED BY BED SHEETS, CLOTH-

ING TOWELS CLOSE CONTACTING, TOWELS, CLOSE CONTACT1 OF 3 LICE TO INFEST HUMANS:

Pediculus humanus corporisPediculus humanus corporisPediculus humanus capitus

ECTOPARASITES THATECTOPARASITES THAT INFEST THE HUMAN EYE

Sarcoptes scabeiUBIQUITOUS HUMAN SCABIES MITEMITES BURROW INTO SKIN OF EYELIDSPREAD BY BED SHEETS, CLOTHING,

TOWELS, CLOSE CONTACTTOWELS, CLOSE CONTACTINFESTATION CALLED SCABIES, OR

ACARIASIS

SUMMARY OF ANIMATESUMMARY OF ANIMATE VECTORS

ARTHROPODSFLEAS: Bubonic PlagueFLIES: African Sleeping SicknessLICEMITESMITESMOSQUITOES: MalariaTICKS: Tularemia, Lyme DiseaseTICKS: Tularemia, Lyme Disease

MAMMALSDOGS, CATS, ETC.HUMANS

SUMMARY OF INANIMATESUMMARY OF INANIMATE VECTORS

FOOD & WATERBODILY LIQUIDS: TEAR FLUID (?)FECESCONTAMINATED OBJECTS (FOMITES)