Padzik Marcin, Szaflik Jacek P., Baltaza Wanda, Perkowski Konrad, Dybicz Monika, Chomicz Lidia
Department of Medical Biology, Medical University of Warsaw, ul. Nowogrodzka 73, 02-018 Warsaw, Poland
Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, ul. Sierakowskiego 13, 03-709 Warsaw, Poland
Ann Parasitol. 2017;63(4):341-346. doi: 10.17420/ap6304.121.
Amphizoic amoebae belonging to the genus Acanthamoeba are known as etiological agents of sight-threatening Acanthamoeba keratitis. The leading risk factor for the development of this serious human disease is contact lens wearing which popularity increases worldwide, also in Poland. The disease with active epithelial inflammations, corneal ulcers, including loss of the visual acuity is a serious medical problem as an emerging threat for the public health related to improper contact lens hygiene. The treatment of the amoebic keratitis is difficult, often unsuccessful due to delayed proper diagnosis. The clinical picture of the disease, often with severe course is nonspecific, similar to that occurring in viral, fungal or bacterial keratitis, thus clinical symptoms alone are not sufficient to identify the causative agent of the amoebic infection. Early diagnosis is decisive for the suitable therapeutic management and the treatment efficacy. In our studies, several complicated, difficult to treat Acanthamoeba keratitis incidences pertaining Polish patients using contact lenses have been retrospectively analyzed in terms of the usefulness of non-invasive methods of in vivo confocal microscopy and in vitro culture techniques applied for diagnosis. Hyper-reflective double-walled spherical Acanthamoeba cysts, with a more reflective outer wall were detected in the epithelium and anterior layers of the corneal stroma. In vivo confocal microscopy, if available, may be a valuable, sensitive tool for diagnosis in late identified severe infections mainly with strong viability strains, however confoscan may offer limited value at lowintensity amoebic infections. The microscopic visualization of amoebae in slides prepared directly from corneal scraping and laboratory examinations of specimens from in vitro cultivated corneal isolates allow to confirm or verify results of in vivo examinations, furthermore to identify directly the pathogens and to clarify previous misdiagnoses.
属于棘阿米巴属的兼性阿米巴被认为是威胁视力的棘阿米巴角膜炎的病原体。这种严重人类疾病发生的主要危险因素是佩戴隐形眼镜，而隐形眼镜的普及在全球范围内都在增加，在波兰也是如此。这种伴有活跃上皮炎症、角膜溃疡，包括视力丧失的疾病是一个严重的医学问题，是与不当的隐形眼镜卫生相关的对公众健康的新威胁。阿米巴角膜炎的治疗很困难，由于诊断延误，往往不成功。这种疾病的临床表现通常病程严重，不具有特异性，类似于病毒、真菌或细菌性角膜炎，因此仅凭临床症状不足以确定阿米巴感染的病原体。早期诊断对于适当的治疗管理和治疗效果至关重要。在我们的研究中，回顾性分析了几例波兰隐形眼镜佩戴患者发生的复杂、难治的棘阿米巴角膜炎病例，以评估用于诊断的非侵入性体内共聚焦显微镜检查和体外培养技术的有效性。在角膜基质的上皮和前层中检测到了高反射性的双壁球形棘阿米巴囊肿，其外壁反射性更强。体内共聚焦显微镜检查（如果可用）可能是诊断晚期确诊的严重感染（主要是强活力菌株）的一种有价值、敏感的工具，然而，共聚焦扫描在低强度阿米巴感染时可能价值有限。直接从角膜刮片中制备的载玻片上对阿米巴进行显微镜观察以及对体外培养的角膜分离物标本进行实验室检查，不仅可以确认或验证体内检查的结果，还可以直接识别病原体并澄清先前的误诊。
