饮用水对角膜接触镜保存盒棘阿米巴污染的影响

[目的]观察饮用水的棘阿米巴污染情况,研究其与角膜接触镜保存盒棘阿米巴污染的关系.[方法]对延吉市居民饮用水棘阿米巴污染情况及大学生角膜接触镜保存盒和保存液的棘阿米巴污染情况进行调查.将103份饮用水和93份角膜接触镜保存液及保存盒擦拭液接种于有灭活大肠杆菌的无营养琼脂培养基中在28℃条件下培养1周,观察棘阿米巴生长情况.[结果]93份角膜接触镜保存盒擦拭液及保存液中有1份(1%)检出棘阿米巴污染,103份饮用水中有41份(40%)检出棘阿米巴污染.[结论]角膜接触镜保存液和保存盒棘阿米巴污染可能与不正确地使用饮用水清洗和保存角膜接触镜有关.     

卡那霉素在体外对A.healyi的杀伤作用

[目的]观察卡那霉素在体外对棘阿米巴A.healyi的杀伤作用.[方法]用1.0,10.0,100.0g/L卡那霉素和0.2,2.0g/L甲硝唑在体外培养棘阿米巴3,8,24,48h,观察用药前及不同培养时间的生长情况.[结果]1.0g/L卡那霉素对棘阿米巴无抑制作用,10.0g/L卡那霉素在培养48h时及100.0g/L卡那霉素培养24h时抑制棘阿米巴生长,100.0g/L卡那霉素在培养48h时杀伤棘阿米巴.2.0g/L甲硝唑作用48h时仍无明显的杀伤作用.[结论]在体外卡那霉素质量浓度为10.0g/L时对棘阿米巴有抑制作用,100.0g/L时具有杀伤作用.     

Acanthamoeba Keratitis

Acanthamoeba species are an important cause of microbial keratitis that may cause severe ocular inflammation and visual loss. The first cases were recognized in 1973, but the disease remained very rare until the 1980s, when an increase in incidence mainly associated with contact lens wear was reported. There is an increased risk when contact lens rinsing and soaking solutions are prepared with nonsterile water and salt tablets. The clinical picture is often characterized by severe pain with an early superficial keratitis that is often treated as herpes simplex infection. Subsequently a characteristic radial perineural infiltration may be seen, and ring infiltration is common. Limbitis and scleritis are frequent. Laboratory diagnosis is primarily by culture of epithelial samples inoculated onto agar plates spread with bacteria. Direct microscopy of samples using stains for the cyst wall or immunostaining may also be employed. A variety of topically applied therapeutic agents are thought to be effective, including propamidine isethionate, clotrimazole, polyhexamethylene biguanide, and chlorhexidine. Various combinations of these and other agents have been employed, often resulting in medical cure, especially if treatment is commenced early in the course of the disease. Penetrating keratoplasty is preferably avoided in inflamed eyes, but may be necessary in severe cases to preserve the globe or, when the infection has resolved, to restore corneal clarity for optical reasons. (Surv Ophthalmol 42:493–508, 1998.     

自然环境中分离出致病性自由生活阿米巴

湘江、泳池等水源中采集样本236个,其中77.5％有自由生活阿米巴(FLA)生长,从属于9种不同类型。65个阳性样本经鼻滴注小鼠作致病试验,筛选出4个致病性FLA分离物。该分离物使部分小鼠死于阿米巴脑炎。死亡小鼠脑、鼻粘膜等组织可见棘阿米巴滋养体和包囊。进一步观察证明。此阿米巴经鼻粘膜和筛孔直接侵犯中枢神经系统,该种阿米巴初步鉴定为多噬棘阿米巴。     

兔棘阿米巴角膜炎IL-1β和MIP-1的表达

目的建立一种模拟临床人角膜棘阿米巴感染的动物模型,探讨角膜棘阿米巴原虫感染后角膜炎症细胞因子巨噬细胞炎性蛋白-1(macrophage inflammatory protein-1,MIP-1)、白细胞介素-1β(interleukin-1β,IL-1β)的表达。方法 20只新西兰白兔应用角膜表层镜片法,即刮除角膜上皮,覆盖角膜植片,右眼在层间注入棘阿米巴滋养体混悬液,左眼注入生理盐水,缝合眼睑24h,建立棘阿米巴角膜炎模型,观察角膜溃疡形态,并行角膜HE染色或PAS染色组织病理切片检查,应用逆转录聚合酶链反应(RT-PCR)技术检测不同病程角膜组织中的IL-1β、MIP-1的表达。结果 20只兔右眼均感染棘阿米巴性角膜炎,病变角膜组织中IL-1β含量与MIP-1含量于术后第1天、3天、5天、7天、9天均明显升高(均为P<0.01),分别于术后第5天(53.360±1.083)与术后第3天(34.445±1.072)达最高值,差异均有显著统计学意义(均为P<0.01),以后逐渐下降。结论 IL-1β是反映兔棘阿米巴感染角膜局部炎症反应程度的敏感指标;而MIP-1的表达则是兔棘阿米巴角膜炎中机体重要的防御和保护性因素。     

感染性角膜炎466例共焦显微镜检查结果临床分析

目的：探讨共焦显微镜在感染性角膜炎的病原学诊断上的意义。
　　方法：回顾性病例系列研究。对2010-01/2013-12共466例467眼感染性角膜炎共焦显微镜的检查结果进行回顾性分析,总结其共焦显微镜图像特点及各类型角膜炎的临床特征。
　　结果：患者466例平均54.4±13.0岁,男264例(56.7%),女202例(43.3%),诊断为真菌性角膜炎190例(40.8%),病毒性角膜炎148例(31.8%),细菌性角膜炎125例(26.8%),棘阿米巴角膜炎3例(0.6%),真菌性角膜炎可见大量真菌菌丝,棘阿米巴角膜炎可见典型阿米巴包囊。
　　结论：共焦显微镜是一种早期辅助诊断感染性角膜炎的有效方法,尤其对真菌及棘阿米巴角膜炎的早期诊断具有特异性,有利于感染性角膜炎的早期诊断及指导治疗。     

Comparison of anterior segment optical coherence tomography findings in acanthamoeba keratitis and herpetic epithelial keratitis

This study is to investigate the characteristic features of Acanthamoeba keratitis (AK) that differentiating it from herpetic epithelial keratitis (HEK) using anterior segment optical coherence tomography (AS-OCT). Medical records of three eyes of each AK and herpetic keratitis who had AS-OCT examination were reviewed in this study. Slit-lamp biomicroscopy and AS-OCT was performed on the initial visit and on every follow-up visits in all patients. In all three AK cases, reflective bands in the corneal stroma that correspond to the area of radial keratoneuritis were observed. The depth of the reflective bands varied in each case. After AK treatment, slit-lamp biomicroscopy confirmed that radial keratoneuritis had resolved and AS-OCT confirmed that reflective bands in the corneal stroma had also disappeared in all patients. Unlike the AS-OCT results found in AK, highly reflective HEK lesions were observed only in the subepithelial area, not in the stroma. AS-OCT seems to be helpful analyzing the specific depth of the lesion which enables to distinguish AK from HEK.     

聚合酶链反应快速诊断棘阿米巴角膜炎的研究

目的:探讨聚合酶链反应(PCR)技术快速诊断棘阿米巴角膜炎的价值。方法:建立棘阿米巴标准虫株的PCR检测方法,并应用于临床检测24例角膜刮片标本,结果与原虫培养及100g/L氢氧化钾湿封片镜检做比较。结果:PCR5h可检测出标本中微量棘阿米巴原虫,对照细菌、真菌、I型单纯疱疹病毒、正常人角膜均为阴性。临床标本PCR敏感性为46%,明显高于原虫培养与100g/L氢氧化钾湿封片镜检(P<0.05)。结论:PCR速度快、敏感性和特异性高,有助于棘阿米巴角膜炎的快速明确诊断。     

Acanthamoeba keratitis with live isolates treated with cryosurgery and fluconazole

PURPOSE: To report live, active trophozoites in an eye with Acanthamoeba keratitis that resembled Acanthamoeba polyphagia in the anterior chamber fluid obtained by transcorneal tap. METHOD: After prediagnostic therapy had failed, we performed cryosurgery to break the corneal cell walls and treated the patient with oral fluconazole. RESULTS: The condition resolved after 8 weeks of oral fluconazole therapy. Residual leukoma was treated by corneal graft. CONCLUSION: Live, motile Acanthamoeba can be isolated from an anterior chamber tap; combination therapy with oral fluconazole after corneal cryosurgery may be effective.     

棘阿米巴角膜炎的诊断和治疗探讨

目的 探讨棘阿米巴角膜炎的临床与实验室诊断方法,寻找有效滴眼液用以治疗。方法 观察分析２５例棘阿米巴角为感染各阶段的临床表现,通过角膜细胞学检查、阿米巴分离培养、角膜活检及组织病理学检查确诊,检测药物对棘阿米巴的抗原虫作用及临床疗效。结果感染自角膜上皮层开始,进行性侵入基质致盲。细胞泞凶世囊和／或滚养体（８８．９％）。棘阿米巴培养阳性率５７．９％。洗必泰、甲硝唑滴眼液治疗棘阿米巴角膜炎有良效。抗