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Case report

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 normal saline no previous eye problems

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Case report

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  1. Case report Reporter:I2吳孟峰 Date:94.12.26

  2. 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 normal saline • no previous eye problems • Physical examination:cornealulcer

  3. Thinking process • severe eye pain • trauma,chemical substence,foreign body,contact lenceconeral ulcer or abrasion, • Subconjunctival hemorrhage • Allergic conjunctivitis • Keratitis • Endophthalmitis • Meibomianitis • Herpes simplex virus

  4. Thinking process • loss of vision • Cataract • Glaucoma • Macular Degeneration • Central serous chorioretinopathy • Diabetic retinopathy • Melanoma and other tumor

  5. 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

  6. 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

  7. Amebic infected to persons • Entamoeba: Entamoeba histolytica, Entamoeba hartmanni, Entamoeba coli, Entamoeba gingivalis Entamoeba polecki

  8. Amebic infected to persons Other intestinal amebae Iodamoeba butschlii Endolimax nana The opportunistic amebae Naegleria fowleri Acanthamoeba spp.

  9. 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

  10. Why difficult to diagnose microscopically? • Opportunistic amebae: Naegleria fowleritrophozoites Acanthamoeba spp. trophozoites or cyst

  11. How does the laboratory culture this parasite? • Naegleria fowleriaspiration of • CSF37℃,4-5hrs • Acanthamoeba spp.CSF or brain tissue • corneal biopsy

  12. Which cytological techniques for the diagnosis of this infection? • Naegleria fowleri37℃,4-5hrsFlagellate • Acanthamoeba spp.trophozoites or cyst

  13. risk factor • Swimming • Immunocompromise(ex:AIDS) • weakness • clean lense without sterilizing

  14. Diagnosis • Acanthamoeba spp. Infected corneal ulcer was highly suspected

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

  16. 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

  17. 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

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