To describe the clinical and epidemiological characteristics of patients with severe infectious keratitis in Asunción, Paraguay between April 2009 and September 2011. All patients with the clinical diagnosis of severe keratitis (ulcer ≥2 mm in size and/or central location) were included. Empiric treatment consisted of topical antibiotics and antimycotics; in cases of advanced keratitis, fortified antibiotics were used. After microbiological analysis, treatment was changed if indicated. In total 48 patients (62.5 % males, 25 % farmers) were included in the analysis. A central ulcer was found in 81.3 % (n = 39). The median delay between onset of symptoms and time of first presentation at our institution was 7 days (range 1-30 days). Fungal keratitis was diagnosed in 64.5 % (n = 31) of patients, of which Fusarium sp. (n = 17) was the most common. Twenty-one patients (43.8 %) reported previous trauma to the eye. The globe could be preserved in all cases. While topical therapy only was sufficient in most patients, a conjunctival flap was necessary in six patients suffering from fungal keratitis. The high rate of fungal keratitis in this series is remarkable, and microbiological analysis provided valuable information for the appropriate treatment. In this setting, one has to be highly suspicious of fungal causes of infectious keratitis.
We present a case in which epithelial downgrowth developed after uneventful clear corneal phacoemulsification. The diagnosis of epithelial downgrowth was confirmed by clinical features and anterior segment optical coherence tomography (OCT), high-frequency ultrasound (US), and confocal microscopy. Intracameral 5-fluorouracil (5-FU) was administered 3 times to control epithelial growth. Sixteen months after the last intervention, the epithelial layer did not appear to have increased. Although 5-FU seemed to be effective in preventing epithelial growth, we cannot be sure epithelial cell growth will not progress over time. Corneal melting is a potential complication of this treatment. Anterior segment OCT and high-frequency US were helpful tools in the diagnosis of epithelial downgrowth after clear corneal phacoemulsification.
La queratitis amebiana que con frecuencia se presenta en usuarios de lentes de contacto cursa con mucho dolor y comprometen la visión. La sintomatología es inespecífica y el diagnóstico se apoya en estudios laboratoriales basados en métodos de cultivo y moleculares para identificación específica de Acanthamoeba. Presentación de los casos. Se presentan tres casos de queratitis amebiana en usuarios de lentes de contacto, dos mujeres y un varón con cuadros que varían de lesiones leves a neoplasia, todos usuarios de lentes de contacto y con antecedentes de exposición al agua ya sea en la ducha o por almacenamiento de lentes de contacto con agua de canilla. La lesión se caracteriza por presentar infiltrados multifocales, epiteliopatía, pseudodendritas centrales y peurineritis redial. Los métodos microbiológicos detectaron al parásito en cultivo en una muestra, mientras que el método molecular fue positivo en dos casos. El tratamiento se basó en isetionato de propamidina (Brolene), polihexametilbiguanida 0,02% y clorhexidina 0,02%, inhibidores de la síntesis de ADN y la formación de la pared celular. La evolución de los cuadros fue de total recuperación en dos casos, mientras que en el tercer caso la queratitis fue una infección agregada de una neoplasia que precisó de métodos quirúrgicos para tratamiento. Conclusiones. Las queratitis amebianas pueden simular cuadros infecciosos de carácter viral herpético o micótico, y por su baja frecuencia y difícil confirmación por falta de métodos laboratoriales apropiados, no se considera a la Acanthamoeba como agente etiológico, y en consecuencia hay retraso en el diagnóstico y tratamiento.Palabras clave: queratitis por Acanthamoeba; lentes de contacto; ulcera de córnea Keratitis by Acanthamoeba sp. in users of contact lenses: clinical cases A B S T R A C TIntroduction. Amebic keratitis that often occurs in contact lens wearers are in a lot of pain and compromise vision. Symptomatology is non-specific and diagnosis is supported by laboratory studies based on culture and molecular methods for specific identification of Acanthamoeba. Case presentation. Three cases of amebic keratitis occur in contact lens wearers, two women and one male with pictures ranging from mild lesions to neoplasm, all contact lens wearers and a history of water exposure either in the shower or by storage contact lenses with cane water. The lesion is characterized by multifocal infiltrates, epithelopathy, central pseudodendrites and redial peurineritis. Microbiological methods detected the cultured parasite in a sample, while the molecular method was positive in two cases. Treatment was based on propamidine isethionate (Brolene), polyhexamethylbiguanide 0.02% and Abente et al.Queratitis por Acanthamoeba sp. en usuarios de lentes de contacto…
Free-living amoeba (FLA) exist widely distributed in nature, where the genus Acanthamoeba is the most isolated in various soil, air and water environments and has been associated with diseases in humans. Its ability to live in adverse environments is due to the low demand for food it has and that in its biological cycle has a cyst-shaped stage, which makes it very resistant. Man becoming his host, can cause infections in the central nervous system, disseminated infections in the skin and lungs, and keratitis, becoming a very important etiological agent of human pathologies. This review addresses characteristics that are known from Acanthamoeba spp., such as its biology, pathogenesis and human defense mechanisms against A c a n t h a m o e b a i n f e c t i o n ; I n a d d i t i o n , t h e microbiological and molecular diagnosis, which is a tool that has improved with the advancement of technology and are essential for timely identification and thus achieve a good clinical and therapeutic intervention. Finally, we present the current situation in Paraguay regarding the few existing clinical reports and the diagnostic methods available.
Los autores declaran no tener conflicto de intereses. Sin fuente de financiamento externa.Recibido: 23 de agosto de 2021 / Aceptado: 9 de febrero de 2022 ResumenSe presenta un caso clínico de queratitis por Mycobacterium abscessus en una mujer de 76 años, residente en la ciudad de Asunción, sin traumatismo ni cirugía ocular previa y con antecedente de una queratouveitis herpética. Por tratarse de una queratitis causada por un agente etiológico poco frecuente y por la importancia de un diagnóstico correcto y oportuno para la instauración del tratamiento adecuado, se comunica el primer caso de queratitis por micobacterias en Paraguay.
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