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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
少戴隱形眼鏡清潔消毒眼鏡要落實不戴隱形眼鏡去游泳按時遵循指示配戴及清潔消毒鏡片