PubMed · 7848439
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D V Seal, J Hay. 1994-10-15. Acanthamoeba keratitis.. https://doi.org/10.1136/bmj.309.6960.1019b
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We report on two patients affected by Cogan's syndrome since infancy.Cogan's syndrome is described as the association of abrupt or intermittent worsening of vestibulo-auditory function and non-syphilic interstitial keratitis or, in patients with "atypical" Cogan's syndrome, various severe, inflammatory eye diseases. The first patient was affected with different inflammatory eye diseases from her fifth year and became blind in one eye when she was 7 years old. At that time, a deterioration of her hearing ability was also diagnosed. The hearing loss progressed to a severe hearing disorder. The second patient suffered from different inflammatory eye diseases from his second year. When he was 3 years old,he was diagnosed with a severe hearing disorder that progressed.Cogan's syndrome was diagnosed when he was 13 years old. The recognition of Cogan's syndrome is particularly complex in young patients. The difficulty of the diagnosis requires a search for ophthalmic diseases in young children with acute and progressive vestibulo-auditory symptoms.
PURPOSE: To compare the efficacy of a battery of routine and special histologic stains for the detection of acanthamoeba keratitis. DESIGN: Observational study. METHODS: Nine patients with culture-proven infectious keratitis whose clinical differential diagnosis included acanthamoeba and who had undergone penetrating keratoplasty were identified. Three cases each of culture-proven acanthamoeba, fungal, and herpes simplex keratitis were reviewed. Serial sections of the keratoplasty specimens were stained with hematoxylin and eosin, periodic acid-Schiff (PAS), Gomori methanamine silver (GMS), giemsa, Gram, calcofluor white, and acridine orange. Sections were reviewed in a random order and a masked fashion and classified as positive or negative for acanthamoeba, fungus, or herpes. RESULTS: The correct diagnosis was made by examination of the hematoxylin and eosin stained slides in all cases. Correct diagnoses in decreasing order of frequency were made for slides stained with PAS, GMS, acridine orange, calcofluor white, giemsa, and Gram. There were false-positive diagnoses made only with calcofluor white and acridine orange stained slides because of staining of extracellular debris and other material. CONCLUSIONS: When sections are examined by an experienced observer, hematoxylin and eosin is useful compared with calcofluor white, acridine orange, GMS, PAS, giemsa, and Gram stains for the detection of acanthamoeba keratitis.
Acanthamoeba keratitis is potentially blinding and often associated with contact lens wearing. A human immunodeficiency virus (HIV)-positive patient, a non-contact lens wearer, presented with keratitis. She experienced a protracted course of disease, characterized by exacerbations and remissions, and was treated with various topical antibiotics and steroids. 13 months after symptom onset the eye was removed owing to serious scarring of cornea and unbearable pain. Microbiological and histopathological examination of the cornea showed Acanthamoeba. In non-contact lens wearers suffering from Acanthamoeba keratitis the diagnosis is delayed, pathognomonic features are often not seen and visual outcome is usually poor. There is no known relation between HIV infection and Acanthamoeba keratitis.