RESUMO
Some species of the Acanthamoeba genus cause keratitis, a very painful, most likely unilateral corneal infection , associated with eye and vision impairment. We here present a case of a 31-year-old female patient, a regular user of soft contact lenses without good practices of lens hygiene and handling. The patient attended medical consultation after two months of inflammation and pain in her right eye. After ophthalmological studies, and due to suspicion of a parasitic infection, a biopsy was performed and the sample submitted for bacteriological and parasitological analyses. Moreover, contact lens holders and lens cleaning solutions were studied. The samples yielded negative results for bacterial infection. However, cultivation of all samples showed the presence of amoeboid parasites. Isolated amoebae were morphologically and molecularly classified as members of the Acanthamoeba genus. This is the first case of keratitis caused by Acanthamoeba in Bahía Blanca, Buenos Aires Province, where the parasite was identified by specific and sensitive molecular techniques.
Assuntos
Ceratite por Acanthamoeba/diagnóstico , Acanthamoeba/isolamento & purificação , Acanthamoeba/classificação , Acanthamoeba/genética , Ceratite por Acanthamoeba/epidemiologia , Ceratite por Acanthamoeba/parasitologia , Adulto , Argentina/epidemiologia , Biópsia , Soluções para Lentes de Contato , Lentes de Contato Hidrofílicas/parasitologia , DNA de Protozoário/isolamento & purificação , Contaminação de Medicamentos , Contaminação de Equipamentos , Feminino , Humanos , Reação em Cadeia da Polimerase , Sensibilidade e EspecificidadeRESUMO
We report the case of a 29-year-old Jamaican patient who presented with severe pain, redness, and swelling of both eyes. She was a regular soft contact lens wearer who did not maintain standard lens care. She was treated for a possible microbial/viral keratitis using topical ciprofloxacin drops, topical acyclovir ointment, and topical atropine drops. The response was inadequate, and scrapings from her cornea, contact lens cases, and both lenses revealed Acanthamoeba on microscopy, which was shown to be Acanthamoeba polyphaga using polymerase chain reaction. She was treated using chlorhexidine 0.02% hourly, ciprofloxacin every 4 hours, and atropine 1% every 12 hours, along with oral ketoconazole 200 mg twice daily with a dramatic response. However, she subsequently suffered slow corneal epithelial regrowth with severe scarring, vascularization, and cortical lens opacification and was referred for penetrating keratoplasty and cataract surgery. This is the first case of severe keratitis caused by Acanthamoeba to be reported from Jamaica and demonstrates that this emerging pathogen can be a cause of severe keratitis in the tropics.
Assuntos
Acanthamoeba , Amebíase/diagnóstico , Lentes de Contato Hidrofílicas/parasitologia , Ceratite/parasitologia , Acanthamoeba/genética , Acanthamoeba/isolamento & purificação , Adulto , Animais , DNA de Protozoário/genética , Feminino , Humanos , Jamaica , Reação em Cadeia da PolimeraseRESUMO
Se presenta el caso de una un paciente de 36 años, cuyo motivo de consulta fue visión borrosa y dolor ocular severo de 5 semanas de evolución, en ojo izquierdo. La paciente tenia como hábito el uso de lentes de contacto blandas con higiene inadecuada. Fue sometida a exámenes bacteriológicos y virológicos con resultados negativos. Para el presente estudio se extrajo material obtenido a través de una biopsia de córnea. Se realizó observación microscópica en fresco y con colorantes permanentes. Por medio de cultivos xénicos, se obtuvo trofozoitos y quistes de Acanthamoeba spp: Las colonias fueron observadas con microscopía óptica en fresco y con contraste de fases. Por MET (microscopía electrónica de transmisión) se analizó la ultraestructura de la ameba.