Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, India.
Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, India.
Am J Ophthalmol. 2019 May;201:31-36. doi: 10.1016/j.ajo.2019.01.024. Epub 2019 Feb 2.
To ascertain the incidence of Acanthamoeba keratitis and the coexistence of Acanthamoeba and fungi in microbial keratitis.
Prospective cross-sectional study.
Patients presenting with stromal keratitis were additionally tested for Acanthamoeba irrespective of the clinical diagnosis. Culture positivity was the gold standard.
Of the 401 cases included in the study, 40 were positive for Acanthamoeba (10%); of these 40, 16 were positive for both Acanthamoeba and fungi (4.5% of the study group was Acanthamoeba and fungal keratitis positive); 5 were positive for Acanthamoeba and bacteria; and 2 had triple infection with Acanthamoeba, fungi, and bacteria. Ring infiltrates and stromal edema are frequently associated with Acanthamoeba keratitis, as well as in Acanthamoeba coinfections. Ring infiltrates in particular were more frequently seen in the Acanthamoeba and fungal keratitis group (8/16) and they were often yellowish with hyphate edges (vs ring infiltrates only, which are seen in the patients with Acanthamoeba alone). Only 2 patients were contact lens wearers: however, they presented with history of trauma.
Acanthamoeba coinfections are much more frequent and are not restricted to contact lens users. Anticipating coinfections is necessary for establishing a diagnosis as well as for appropriate and timely therapeutic interventions.
确定棘阿米巴角膜炎的发病率以及微生物角膜炎中棘阿米巴与真菌的共存情况。
前瞻性横断面研究。
无论临床诊断如何，出现基质性角膜炎的患者均需额外检测棘阿米巴。培养阳性是金标准。
在纳入研究的 401 例患者中，有 40 例（10%）棘阿米巴阳性；其中，16 例（4.5%的研究组）棘阿米巴和真菌均阳性（棘阿米巴和真菌性角膜炎阳性）；5 例棘阿米巴和细菌阳性；2 例三重感染，有棘阿米巴、真菌和细菌。棘阿米巴角膜炎以及棘阿米巴合并感染常伴有环状浸润和基质水肿。特别是环状浸润在棘阿米巴和真菌性角膜炎组更为常见（8/16），并且通常呈黄色，边缘有菌丝（与仅棘阿米巴的患者中所见的单纯环状浸润不同）。仅 2 名患者是隐形眼镜佩戴者：然而，他们都有创伤史。
棘阿米巴合并感染更为常见，并且不限于隐形眼镜使用者。为了做出诊断以及进行适当和及时的治疗干预，需要预测合并感染的情况。
