Posters

Detection of acanthamoeba in contact lens-related polymicrobial keratitis using in vivo confocal microscopy

Poster Details

First Author: P.Pinyoseth THAILAND

Co Author(s):    C. Chirapapaisan   S. Srivannaboon   M. Uiprasertkul              

Abstract Details

Purpose:

To present a case of contact lens (CL) related keratitis, which was primarily diagnosed with multi-strain bacterial keratitis by microbiological culture. A co-infection with acanthamoeba was subsequently detected by an in vivo confocal microscopy (IVCM).

Setting:

An observational case report conducted in Siriraj Hospital, Mahidol University, Bangkok, Thailand

Methods:

A 14-year-old girl presented with severe CL-related keratitis in the right eye. Her vision was 20/100 on admission. Primary specimens from corneal scraping showed multiple strains of bacteria in culture media. Empiric antibiotics (ATBs), covering those organisms were prescribed. Clinical conditions seemed improved at the beginning, but they became worse later on. Then, IVCM was performed to exclude other co-infections. Multiple cyst-like granules in the superficial cornea were identified and acanthamoeba keratitis was most suspected. Therefore, corneal scraping was repeated and sent for acanthamoeba culture including histological exam. A combination of anti-acanthamoebic drops (PHMB0.02% ,propamidine0.1% and moxifloxacin0.5%) was aggressively administered.

Results:

cA 14-year-old girl presented with severe CL-related keratitis in the right eye. Her vision was 20/100 on admission. Primary specimens from corneal scraping showed multiple strains of bacteria in culture media. Empiric antibiotics (ATBs), covering those organisms were prescribed. Clinical conditions seemed improved at the beginning, but they became worse later on. Then, IVCM was performed to exclude other co-infections. Multiple cyst-like granules in the superficial cornea were identified and acanthamoeba keratitis was most suspected. Therefore, corneal scraping was repeated and sent for acanthamoeba culture including histological exam. A combination of anti-acanthamoebic drops (PHMB0.02% ,propamidine0.1% and moxifloxacin0.5%) was aggressively administered.

Conclusions:

IVCM is a non-invasive tool, assisting in diagnosis of various infectious keratitis, particularly in acanthamoeba keratitis. Early detection of trophozoites and cysts by IVCM allows prompt treatment, which may result in good visual outcomes.

Financial Disclosure:

None