Case report Reporter:I2 吳孟峰 Date:94.12.26. History A 29-year-old women :severe eye pain and a...

Case report

Reporter:I2吳孟峰Date:94.12.26

History

A 29-year-old women :severe eye pain and a recent loss of vision in her right eye over the past few weeks

Hx of contact lenses since the age of 20 She clean her lenses with tap water or norm

al saline no previous eye problems Physical examination:corneal ulcer

Thinking process

severe eye pain trauma,chemical substence,foreign body,contact l

ence coneral ulcer or abrasion, Subconjunctival hemorrhage Allergic conjunctivitis Keratitis Endophthalmitis Meibomianitis Herpes simplex virus

Thinking process

loss of vision Cataract Glaucoma Macular Degeneration Central serous chorioretinopathy Diabetic retinopathy Melanoma and other tumor

Thinking process

Corneal ulcer:

wear contact lense too long,or over night

Chemical burns

Tiny tears

foreign body,

infections (bacteria,virus,parasites),

Scratches with dirty hands or unclean contact lense

infection was suspectedDue to severe eye paincorneal biopsyamebic trophozoites

Histological preparations neutrophils and monocytes

Cultures negative of bacteria and viruses amebic parasite was found

Amebic infected to persons

Entamoeba:

Entamoeba histolytica,

Entamoeba hartmanni,

Entamoeba coli,

Entamoeba gingivalis

Entamoeba polecki

Amebic infected to persons

Other intestinal amebae

Iodamoeba butschlii

Endolimax nana

The opportunistic amebae

Naegleria fowleri

Acanthamoeba spp.

Amebic infected to persons

Acanthamoeba spp. A.astronyxis:CNS infection A.castellanii:eye and CNS A.culbertsoni:eye and CNS A.hatchetti:eye infected only A.palestinensis:CNS infection A.polyphaga:eye infected only A.rhysodes:eye and CNS

Why difficult to diagnose microscopically?

Opportunistic amebae:

Naegleria fowleritrophozoites

Acanthamoeba spp. trophozoites or cyst

How does the laboratory culture this parasite?

Naegleria fowleriaspiration of CSF37 ,4-5hrs℃ Acanthamoeba spp.CSF or brain tissue corneal biopsy

Which cytological techniques for the diagnosis of this infection?

Naegleria fowleri37 ,4-5hrs℃ Flagellate Acanthamoeba spp.trophozoites or cyst

risk factor

Swimming Immunocompromise(ex:AIDS) weakness clean lense without sterilizing

Diagnosis

Acanthamoeba spp. Infected corneal ulcer was highly suspected

Complication

Granulomatous amebic encephalitis(GAE) Mental state change, headache seizure neck stiff Nausea and vomiting Loss of vision

Treatment

Granulomatous amebic encephalitis(GAE):operation(excision)

Amebic related corneal ulcer:dibromopropamide oint or propamide isethionate eyedrops with neomycin eyedrops or itraconazole

Antibiotics:ketoconazole,penicillin or chloramphenicol or sulfamethazine

Prevention

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