Because this is what happens if you don’t:
Volume 17, Number 7–July 2011
Letter
Ameba-associated Keratitis, France
To the Editor: Amebic keratitis is an aggressive infection usually associated with soft contact lenses, and its poor outcome can lead to a corneal graft (1). Ameba can host ameba-resistant bacteria (2) and serve as a source for numerous organisms to exchange DNA, adapt to changing environments, and become pathogenic to the host (3). However, mixed keratitis caused by amebae in association with ameba-resistant pathogens is rarely seen.
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| Figure. Ameba-associated keratitis in a 17-year-old woman (contact lens wearer), France, showing a paracentral corneal scar (A) and recovery at 13-month follow-up (B). Original magnification ×10…. |
A 17-year-old woman who was myopic and had worn soft contact lenses for 3 years consulted our ophthalmology department for pain and redness of the left eye that had persisted for 2 weeks. No visual loss was reported, and a slit-lamp examination showed a millimetric epithelial defect associated with a round stromal infiltrate (Figure). No intraocular reaction was observed, and bacterial keratitis was diagnosed. Her condition improved after a 7-day topical fluoroquinolone treatment, and follow-up at 13 months showed only a slight superficial stromal scar. The patient reported that she had inappropriately worn monthly contact lenses for 3 months, cleaned and rinsed lenses with a commercial cleaning solution but diluted the solution with tap water, and washed her hands with tap water but did not dry them before handling the lenses.
Results of microbiologic analysis of a corneal scraping, which included molecular detection of ameba (18S rDNA), bacteria (16S rDNA), and herpesvirus (DNA polymerase), were negative. However, culture of contact lens storage case liquid in Page-modified Neff ameba saline enriched with heat-killed Enterobacter aerogenes (2) identified Pseudomonas fluorescens and Stenotrophomonas maltophilia, both of which were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (4); Mycobacterium chelonae, which was identified by rpoB gene sequencing; and Acanthamoeba polyphaga, which was identified by partial 18S rDNA sequencing.
