Mycobacterium fortuitum Endocarditis Associated with Cardiac Surgery, Serbia

This outbreak provided an opportunity to study the incubation period of V. corneae keratoconjunctivitis in otherwise healthy persons. Time from soil exposure to development of ocular symptoms of microsporidial keratitis has been reported to be 2–21 days (median 14 days) (2) and 5–14 days (mean 6.8 days) (3). The incubation period during this outbreak was 5–31 days (median 15 days). An investigation by the Singapore Ministry of Health of this outbreak revealed that microsporidial spores are probably ubiquitous in soil in Singapore (4). All interviewed rugby players from Hong Kong were exposed to soil or muddy water in Singapore before the outbreak, but we could not demonstrate the dose– response relationship because of the long incubation period and difficulty quantifying exposure to soil and muddy water. This was an uncommon microsporidial keratoconjunctivitis outbreak. Advice about hygiene should be given to athletes who are exposed to dirt and mud on playing fields to minimize their risk for infection. Instructions should be given for safe and thorough washing of eyes, especially after dirt/mud exposures on waterlogged playing fields. Clinicians and public health professionals must consider microsporidial keratoconjunctivitis as a differential diagnosis for conditions of field athletes who exhibit eye redness accompanied by eye pain, discharge, swelling, or itchiness after exposure to soil or mud.