The First Acanthamoeba keratitis Case of Non-Contact Lens Wearer with HIV Infection in Thailand

Acanthamoeba keratitis (AK) is a rare sight-threatening corneal infection, often reporting from contact lens wearers. An asymptomatic human immunodeficiency virus (HIV)-infected Thai male without history of contact lens use complained foreign body sensation at his left eye during motorbike riding. He had neither specific keratitis symptoms nor common drugs responding, which contributed to delayed diagnosis. By corneal re-scraping, Acanthamoeba-like cysts were detected by calcofluor white staining and agar culture. The etiological agent obtained from the culture was molecularly confirmed by Acanthamoeba spp.-specific PCR, followed by DNA sequencing. The results from BLAST and phylogenetic analysis based on the DNA sequences, revealed that the pathogen was Acanthamoeba T4, the major genotype most frequently reported from clinical isolates. The infection was successfully treated with polyhexamethylene biguanide resulting in corneal scar. This appears the first reported AK case from a non-contact lens wearer with HIV infection in Thailand. Although AK is sporadic in developing countries, a role of free-living Acanthamoeba as an opportunistic pathogen should not be neglected. The report would increase awareness of AK, especially in the case presenting unspecific keratitis symptoms without clinical response to empirical antimicrobial therapy.

LEBER’S HEREDITARY OPTIC NEUROPATHY (LHON): A CASE REPORT

Purpose   To report the first case of Leber’s hereditary optic neuropathy (LHON) diagnosed in Maharaj Nakorn Chiang Mai Hospital. Methods Case report. Results A 13-year-old boy was referred for bilateral progressive painless visual loss. Ophthalmic examination revealed temporal disc pallor in the right eye and pseudoedema of the optic disc with peripapillary telangiectasia in the left eye. There was no staining or leakage on a fundus fluorescein angiogram. The visual field had bilateral cecocentral scotoma. On examination of the patient’s mitochondrial DNA from a blood sample, a point mutation 11778 was found. Conclusions LHON is a maternally inherited disorder, characterized by a bilateral painless simultaneous or sequential loss of vision, predominantly in young men. This disorder has been associated with point mutations in the mitochondrial genomes. As there is currently no treatment that improves the final visual outcome, long term management is mainly supportive. In this case, optical aids were prescribed and genetic counseling was given to the patient and other family members. Chiang Mai Med Bull 2005;44(3):115-120.

MICROBIAL KERATITIS LEADING TO ADMISSION AT MAHARAJ NAKORN CHIANG MAI HOSPITAL

Objective Methods Results Pseudomonas (39%) was the most common bacteria isolated. The principalfungal species isolated werefusarium (14%) and aspergillus (7%). Sixty nine eyes requiredsurgical interventions and 16 of these eventually underwent either evisceration or enucleation.One hundred and twenty seven eyes (60%) improved in unaided visual acuity of one or morelines after treatment.Conclusion Pseudomonas is the predominant causative organism in bacterial keratitis,and filamentous fungi are the principal causes of fungal keratitis. A bacterial: fungal ratio inthis setting is 3 : 2, which appears to be expected in the tropic.Chiang Mai Med Bull2004;43(3):93-103.Antecedent ocular trauma is the main risk factor for microbial keratitis innorthern Thailand.Two hundred and fourteen eyes of 213 consecutive patients (mean age 44.4 (SD36)years) were studied. The common risk factors in this study were trauma including foreignbodies (44%), preexisting ocular diseases (14%), contact lens wear (11%), and undeterminedcause (18%). Most of the patients (74%) had prior treatment from ophthalmologists, generalpractitioners and drug stores. Corneal scraping was performed in 190 eyes and 30% hadpositive culture results. Sixty percent of the offending organisms were bacteria and 40%were fungi.New cases of microbial keratitis were retrospectively reviewed over a period of 36months. Clinical features (demographics, risk factors, visual acuity), microbiologic studiesand clinical outcome were analyzed.To report the risk factors, microbiologic profile, therapeutic and visual results inpatients with microbial keratitis in the tertiary eye care center setting in northern Thailand.

ANTERIOR NODULAR SCLERITIS ASSOCIATED WITH VOGT-KOYANAGI-HARADA DISEASE: A CASE REPORT

Purpose: To report a young patient who initially manifested with bilateral anterior nodular scleritis and subsequently developed ocular features typical of Vogt-Koyanagi-Harada (VKH) disease. Case description: A 9-year-old girl was diagnosed with bilateral anterior nodular scleritis, which improved with topical administration of corticosteroids and systemic nonsteroidal anti-inflammatory drugs. Four months later, after the treatment was withdrawn, she developed a recurrence of scleritis together with sunset glow fundus and Dalen-Fuchs nodules in both eyes. Conclusions: Vogt-Koyanagi-Harada (VKH) disease might be associated with anterior nodular scleritis.