ENHANCED DIAGNOSIS OF ACANTHAMOEBA KERATITIS

描述：棘阿米巴角膜炎被认为是一种相对罕见的疾病。 以及严重的角膜感染，导致视力下降。 它最常与隐形眼镜的使用联系在一起。这个 诊断是通过简单的上皮活检和组织学来确认的 由眼科病理学家进行的检查。在过去的三年里，我们有 检查了400名角膜炎患者，确定了106名患者 推测角膜中有棘阿米巴，每一种后来都用 上皮活组织检查。我们只在一个案例中成功地培养了 有机体。棘阿米巴角膜炎是PI的普遍假设 代表一种诊断不足的人类角膜机会性感染 这可能会对健康造成重大危害。它比 之前的想法是。这种疾病的诊断和治疗将是 通过更精确、更快速的诊断工具大幅改进，包括 共聚焦显微镜和聚合酶链式反应(PCR)。我们在此提出建议 研究：1)确定亚临床或无症状的患病率 共聚焦检测正常人群棘阿米巴感染 显微镜下，一系列正常患者和上皮下病变患者 近视PRK前摘除。共焦检查眼库眼 显微镜、组织学和聚合酶链式反应检测阿米巴的存在。2)确定 临床、亚临床或无症状角膜棘阿米巴的患病率 各种形式的角膜病变患者的感染，包括假定的 细菌性角膜炎，糖尿病上皮病变，基底膜营养不良， 单纯疱疹病毒性角膜炎和带状疱疹角膜炎 组织学、培养和聚合酶链式反应诊断。3)确定 临床或亚临床棘阿米巴感染 容易受到急性感染，包括戴隐形眼镜的患者 正常的上皮或上皮病的证据，如点状 角膜炎或微囊。有临床和共聚焦证据的患者 该病将进行上皮活检以作进一步诊断。4) 通过开发一种聚合酶来表征我们已经鉴定的生物 链式反应(PCR)分析，提高我们的培养技术，从而 更准确地描述这些有机体的特征。

DESCRIPTION: Acanthamoeba keratitis has been considered a relatively rare and severe form of corneal infection which causes debilitating visual loss. It has most frequently been associated with the use of contact lenses. The diagnosis is confirmed with a simple epithelial biopsy and histologic examination by an ophthalmic pathologist. In the last three years, we have examined 400 patients with keratitis and have identified 106 patients with presumed Acanthamoeba in the cornea, each subsequently confirmed with an epithelial biopsy. In only one case have we been successful in culturing the organism. It is the PI general hypothesis that Acanthamoeba keratitis represents an underdiagnosed opportunistic infection of the human cornea which can present a significant health hazard. It is much more common than previously thought. The diagnosis and management of this disease will be greatly improved with more precise and rapid diagnostic tools including confocal microscopy and polymerase chain reaction (PCR). We propose in this research to: 1) Determine the prevalence of subclinical or asymptomatic Acanthamoeba infection in the normal population by examining, with confocal microscopy, a series of normal patients and patients undergoing epithelial removal prior to PRK for myopia. Examine Eye Bank eyes with confocal microscopy, histology, and PCR for the presence of amoeba. 2) Determine the prevalence of clinical, subclinical, or asymptomatic corneal acanthamoeba infections in patients with various forms of keratopathy including presumed bacterial keratitis, diabetic epitheliopathy, basement membrane dystrophy, herpes simplex keratitis and herpes zoster keratitis and confirm the diagnosis with histology, culture and PCR. 3) Determine the prevalence of clinical or subclinical acanthamoeba infection in patients particularly prone to acute infection including patients wearing contact lenses who have normal epithelium or evidence of epithelial disease such as punctate keratitis or microcysts. Patients with clinical and confocal evidence of disease will have an epithelial biopsy for further diagnosis. 4) Characterize the organisms we have identified by developing a polymerase chain reaction (PCR) assay, enhance our culture techniques, and thereby characterize more precisely these organisms.