ABSTRACT
Subacute Bacterial Endocarditis [SBE] is a flammable bacterial infection of the endocardium and usually builds on a pre-existing heart disease. Ocular events are a particularly rare complication that occurs in a child. A 10 year old patient having a history of recurrent tonsillitis and hospitalized in pediatric for kidney failure, shows a decrease in visual acuity reduced to finger counting at 1 meter. Ophthalmologic examination revealed papilledema, premacular hemorrhage, Roth spots and several intraretinal hemorrhages in both eyes and the presence of a segmental vasculitis in the left eye. Under etiological assessement, a transthoracic echocardiography was performed retaining the diagnosis of infective endocarditis. Blood culture isolated viridans streptococci. The patient received appropriate systemic antibiotics. Two months later, the evolution was marked by the recovery of visual acuity to 10/10 and net regression both papilledema as hemorrhagic lesions. Although rheumatic fever has become an exceptional condition in developed countries, it may still be a rheumatic valve that is grafted sepsis. In infective endocarditis, several ophthalmologic manifestations have been described in the literature. They result for most of infectious emboli in the retinal vessels and in some cases may reveal endocarditis. Besides vital prognosis engaged in bacterial endocarditis, visual functional prognosis may also be threatened by serious eye damage. Thus, an eye examination
ABSTRACT
Prognosis for Acanthamoeba is worse than for many other types of infectious keratitis. Treatment is difficult especially in advanced stages and it may result in permanent visual impairment or blindness. However, especially if caught early, satisfactory outcomes can certainly be achieved. The purpose was to evaluate the clinical features in five patients diagnosed in our department between 2007 and 2011. Risk factors, clinical diagnosis and therapeutic characteristics were studied retrospectively in this study. All patients were referred in a second or third intention. These are three women and two men with a mean age of 38.5 years admitted for corneal abcess in 3 cases and pseudendritic keratitis in 2 others. The risk factors found were: contact lens wear in 2 cases, contact with contaminated water in 2 cases and the laboratory tests revealed an unrecognized diabetes in a case. Corneal sampling allowed the isolation of Acanthamoeba in 3 cases and in two cases the diagnosis was made by Polymerase Chain Reaction. All patients received broad-spectrum antibiotics and Hexamidine. ketoconazole was associated in 3 cases and Polyhexamethylene biguanide [PHMB] in 1 case. Evolution was marked by panophthalmitis and eyeball phthysis in 1 case, corneal opacity with neovascularization in two cases justifying a corneal graft. Regression with ad integrum recovery was observed in 2 cases of epithelial keratitis. The incidence of Acanthamoeba keratitis varies from one country to another between 0.15 and 1.4 per million inhabitants. Acanthamoeba are naturally occurring amoeba [tiny, one-celled animals] commonly found in water sources, such as tap water, well water, hot tubs, and soil and sewage systems. Contact lenses are still responsible for the majority of cases [2 cases] despite knowledge of this now well-established major risk factor and its preventive measures including strict hygiene for the maintenance of contact lenses. Medical treatment is very disappointing in advanced forms [3 cases]. The dramatic consequences of this complication justify a systematic treatment against amoeba in each case of suspected diagnosis. Acanthamoeba keratitis is a serious vision-threatening disease. Early diagnosis and treatment are essential for improving visual outcome