Case report Reporter:I2 吳孟峰 Date:

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:corneal ulcer

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

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 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

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

How does the laboratory culture this parasite? 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? Naegleria fowleri  37 ℃,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