What is the role of infectious keratitis in the ocular manifestations of HIV infection?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Bacterial and fungal keratitides are not more frequent in HIV patients, but these infections tend to be more severe in the immunocompromised host. The most common etiology of fungal keratitis is Candida, especially in intravenous drug users. Other fungal organisms known to cause keratitis include Fusarium and Aspergillus species.

Immunosuppression predisposes HIV-positive patients to fungal infections. The filamentous fungi (eg, Fusarium or Aspergillus species) can also be  inoculated following trauma with organic matter

In some developing countries, fungal keratitis may be an indicator of HIV infection. In a study from Africa, 26 of 32 (81.2%) patients with fungal keratitis were found to be HIV positive; 60 of 180 (33%) of those with nonfungal keratitis were HIV positive. Fusarium solani was the most common organism, accounting for 75% of cases with fungal keratitis. [6]

Microsporidia are intracellular protozoa that have emerged as important opportunistic parasitic organisms in HIV-positive patients. Five species have been identified in patients who are HIV positive. Microsporidia are very difficult to culture, but can be seen readily within corneal or conjunctival epithelial cells with the use of Masson trichrome or Giemsa stain.

The organism can infect the cornea and conjunctiva. [7]  In immunocompetent patients, microsporidiosis may result in a necrotizing stromal keratitis, whereas HIV-positive patients tend to develop epithelial keratitis. [1]

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