Wynter-Allison Zoe, Lorenzo Morales Jacob, Calder Donovan, Radlein Kraig, Ortega-Rivas Antonio, Lindo John F
Division of Ophthalmology and Department of Microbiology, The University of the West Indies, Kingston, Jamaica.
Am J Trop Med Hyg. 2005 Jul;73(1):92-4.
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.
我们报告了一例29岁的牙买加患者，其双眼出现剧痛、发红和肿胀。她是一名长期佩戴软性隐形眼镜的人，但未保持标准的镜片护理。她因可能的微生物/病毒性角膜炎接受了局部用环丙沙星滴眼液、局部用阿昔洛韦眼膏和局部用阿托品滴眼液治疗。治疗效果不佳，对她的角膜、隐形眼镜盒及两片镜片进行刮片检查，显微镜检查发现棘阿米巴，聚合酶链反应显示为多食棘阿米巴。她接受了每小时一次的0.02%洗必泰治疗、每4小时一次的环丙沙星治疗和每12小时一次的1%阿托品治疗，同时口服酮康唑200毫克，每日两次，病情有显著好转。然而，她随后角膜上皮再生缓慢，伴有严重瘢痕形成、血管化和晶状体皮质混浊，遂被转诊接受穿透性角膜移植术和白内障手术。这是牙买加报告的首例由棘阿米巴引起的严重角膜炎病例，表明这种新出现的病原体可能是热带地区严重角膜炎的病因。
