Transcript Document

Case report
Reporter:I2吳孟峰
Date:94.12.26
History
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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
normal saline
no previous eye problems
Physical examination:corneal ulcer
Thinking process
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severe eye pain
trauma,chemical substence,foreign body,contact
lence coneral ulcer or abrasion,
Subconjunctival hemorrhage
Allergic conjunctivitis
Keratitis
Endophthalmitis
Meibomianitis
Herpes simplex virus
Thinking process
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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
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infection was suspectedDue to severe
eye paincorneal biopsyamebic
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
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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 fowleritrophozoites
Acanthamoeba spp. trophozoites or cyst
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How does the laboratory
culture this parasite?
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Naegleria fowleriaspiration of
CSF37℃,4-5hrs
Acanthamoeba spp.CSF or brain tissue
corneal biopsy
Which cytological techniques for
the diagnosis of this infection?
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Naegleria fowleri37℃,4-5hrsFlagellate
Acanthamoeba spp.trophozoites or cyst
risk factor
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Swimming
Immunocompromise(ex:AIDS)
weakness
clean lense without sterilizing
Diagnosis
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Acanthamoeba spp. Infected corneal ulcer
was highly suspected
Complication
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Granulomatous amebic encephalitis(GAE)
Mental state change,
headache
seizure
neck stiff
Nausea and vomiting
Loss of vision
Treatment
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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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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