PDF(Pubmed)
Abstract：
The cases illustrate Acanthamoeba coinfection with Pseudomonas aeruginosa or microsporidia in the cornea.
This case series aimed to alert clinicians toward considering Acanthamoeba coinfection in the cornea when unusual presentation such as perineuritis or epitheliitis was observed in clinical images. Increased suspicion of Acanthamoeba coinfection may facilitate early diagnosis and prompt management, eventually leading to good vision outcomes.
An 11-year-old boy wearing orthokeratology lens for myopia control complained of pain in the right eye for 1 week. A paracentral corneal ulcer with perineuritis was observed. Culture from corneal tissue revealed P. aeruginosa , and an in vivo confocal microscopic examination showed highly reflective and oval-shaped structures indicating Acanthamoeba coinfection. Corneal lesions gradually improved under 0.02% polyhexamethylene biguanidine, 0.1% propamidine isethionate, and 0.3% ciprofloxacin. At 1 year, the final best-corrected visual acuity was 20/25 with residual paracentral corneal opacity. Another 20-year-old man complained of pain in the right eye for 2 weeks. Multiple raised corneal lesions associated with epitheliitis were found. Moreover, 1% acid-fast staining showed oval-shaped spores, and microsporidia infection was inferred. In addition, polymerase chain reaction results obtained after subjecting the patient to corneal debridement revealed positivity for Acanthamoeba . Polyhexamethylene biguanidine (0.02%) and 0.5% moxifloxacin were prescribed, and the lesions subsided. At a 2-year follow-up, the final best-corrected visual acuity was 20/25.
Perineuritis in orthokeratology lens wearers and epitheliitis without any predisposing factor are unusual presentations of Acanthamoeba coinfection in the cornea. These corneal findings should arouse the suspicion of coinfection and enable the clinicians to conduct the appropriate workup and initiate adequate treatment. This case series demonstrated that early diagnosis and prompt treatment can improve visual prognosis.
This case series aimed to alert clinicians toward considering Acanthamoeba coinfection in the cornea when unusual presentation such as perineuritis or epitheliitis was observed in clinical images. Increased suspicion of Acanthamoeba coinfection may facilitate early diagnosis and prompt management, eventually leading to good vision outcomes.
An 11-year-old boy wearing orthokeratology lens for myopia control complained of pain in the right eye for 1 week. A paracentral corneal ulcer with perineuritis was observed. Culture from corneal tissue revealed P. aeruginosa , and an in vivo confocal microscopic examination showed highly reflective and oval-shaped structures indicating Acanthamoeba coinfection. Corneal lesions gradually improved under 0.02% polyhexamethylene biguanidine, 0.1% propamidine isethionate, and 0.3% ciprofloxacin. At 1 year, the final best-corrected visual acuity was 20/25 with residual paracentral corneal opacity. Another 20-year-old man complained of pain in the right eye for 2 weeks. Multiple raised corneal lesions associated with epitheliitis were found. Moreover, 1% acid-fast staining showed oval-shaped spores, and microsporidia infection was inferred. In addition, polymerase chain reaction results obtained after subjecting the patient to corneal debridement revealed positivity for Acanthamoeba . Polyhexamethylene biguanidine (0.02%) and 0.5% moxifloxacin were prescribed, and the lesions subsided. At a 2-year follow-up, the final best-corrected visual acuity was 20/25.
Perineuritis in orthokeratology lens wearers and epitheliitis without any predisposing factor are unusual presentations of Acanthamoeba coinfection in the cornea. These corneal findings should arouse the suspicion of coinfection and enable the clinicians to conduct the appropriate workup and initiate adequate treatment. This case series demonstrated that early diagnosis and prompt treatment can improve visual prognosis.
摘要：
这些病例说明了棘阿米巴与角膜中的铜绿假单胞菌或微孢子虫共同感染。
本病例系列旨在提醒临床医生，当在临床图像中观察到不寻常的表现，如神经周炎或上皮炎时，考虑角膜中的棘阿米巴共感染。对棘阿米巴合并感染的怀疑增加可能有助于早期诊断和及时治疗，最终导致良好的视力结果。
一名11岁男孩戴着角膜塑形镜控制近视，主诉右眼疼痛1周。观察到伴有神经周炎的中央角膜溃疡。从角膜组织培养显示铜绿假单胞菌，体内共聚焦显微镜检查显示高度反射和椭圆形结构，表明棘阿米巴共感染。角膜病变在0.02%聚六亚甲基双胍下逐渐好转，0.1%丙脒羟乙基磺酸盐，和0.3%环丙沙星。在1年,最终最佳矫正视力为20/25,并伴有角膜中央旁混浊.另一名20岁的男子抱怨右眼疼痛2周。发现与上皮炎相关的多个凸起的角膜病变。此外，1%耐酸染色显示卵形孢子，推断微孢子虫感染。此外,对患者进行角膜清创术后获得的聚合酶链反应结果显示棘阿米巴阳性。开出聚六亚甲基双胍（0.02％）和0.5％莫西沙星，病变消退了.在2年的随访中，最终最佳矫正视力为20/25.
角膜塑形镜佩戴者的神经膜炎和无任何诱发因素的上皮炎是角膜中棘阿米巴共感染的罕见表现。这些角膜发现应引起合并感染的怀疑，并使临床医生能够进行适当的检查并开始适当的治疗。该病例系列表明，早期诊断和及时治疗可以改善视觉预后。
本病例系列旨在提醒临床医生，当在临床图像中观察到不寻常的表现，如神经周炎或上皮炎时，考虑角膜中的棘阿米巴共感染。对棘阿米巴合并感染的怀疑增加可能有助于早期诊断和及时治疗，最终导致良好的视力结果。
一名11岁男孩戴着角膜塑形镜控制近视，主诉右眼疼痛1周。观察到伴有神经周炎的中央角膜溃疡。从角膜组织培养显示铜绿假单胞菌，体内共聚焦显微镜检查显示高度反射和椭圆形结构，表明棘阿米巴共感染。角膜病变在0.02%聚六亚甲基双胍下逐渐好转，0.1%丙脒羟乙基磺酸盐，和0.3%环丙沙星。在1年,最终最佳矫正视力为20/25,并伴有角膜中央旁混浊.另一名20岁的男子抱怨右眼疼痛2周。发现与上皮炎相关的多个凸起的角膜病变。此外，1%耐酸染色显示卵形孢子，推断微孢子虫感染。此外,对患者进行角膜清创术后获得的聚合酶链反应结果显示棘阿米巴阳性。开出聚六亚甲基双胍（0.02％）和0.5％莫西沙星，病变消退了.在2年的随访中，最终最佳矫正视力为20/25.
角膜塑形镜佩戴者的神经膜炎和无任何诱发因素的上皮炎是角膜中棘阿米巴共感染的罕见表现。这些角膜发现应引起合并感染的怀疑，并使临床医生能够进行适当的检查并开始适当的治疗。该病例系列表明，早期诊断和及时治疗可以改善视觉预后。
