Case 2 A college student is experiencing painful eye irritation in the past 2 weeks.

She bought some over-the-counter ophthalmic drops to relieve the symptoms, but the condition still became worse. This forced her to consult a doctor and detailed eye examination revealed a damaged corneal tissue characterized by annular infiltrates. The student was found out to be an avid contact lenses wearer. What particular parasite is associated with contact lens use? What are the 2 morphological life cycle forms of this parasite? Other than the eyes, what other organs may be affected with this parasite if the infection was left untreated?

Danielle : The subject is an avid contact lenses wearer that had somehow transmitted a parasite through contact lens use and has experienced painful eye irritation for the past two weeks. Raisa: The parasite was revealed to be the Acanthamoeba spp. General information about it is a microscopic, free-living amoeba which can be found in various places such as soil, freshwater, unmaintained swimming pools and contaminated contact lens equipments. Calvin: This parasite exists in two forms: an active, infective Trophozoite and a dormant, hard cyst, that can cause rare, but severe infections of the eye, skin, and central nervous system. Both Trophozoites and cysts can retain live bacteria and may serve as reservoirs for bacteria with human pathogenic potential. Kurt: Trophozoites are motile organisms have spine-like pseudopods; however, progressive movement is usually not very evident. It has an average diameter of 30 m. This morphology can be seen on a wet preparation. Jarrah: On the other hand, cysts are usually round with a single nucleus with double walls that are usually visible, with the slightly wrinkled outer cyst wall. Cyst formation occurs under adverse environmental condition Ley: Usually cysts are resistant to biocides, chlorination, and antibiotics. This cyst morphology can be seen in organisms cultured on agar plates. Danielle: The cysts can also survive low temperatures (0 to 2C), but remains viable in water at 4C for 24 years. Raisa: Acanthamoeba spp. are the causative agents of Granulomatous amebic encephalitis (GAE) and Amebic keratitis (AK) especially for the immunosuppressed and chronically ill patients.

Nic: Anyone can contract Amebic keratitis, but it is most common to contact lens users who often do improper handling, disinfection and storage of their lenses. Se-J: AK can infect our system through Corneal abrasion. Symptoms include Blurred vision, photophobia and corneal inflammation. It may result to ulceration of Cornea and ultimately loss of vision if left untreated.

Ley: That is true. Symptoms of infection include itchy, watery eyes, sensitivity to light, swelling in the upper eyelid, blurred vision, and extreme pain and vision damage. The irritation the subject felt was because this particular parasite has the potential to gnaw through the eyeball of an exposed contact lens wearer. Danielle: When corneal abrasions occur, the disease process is usually more rapid, with ulceration, corneal infiltration, iritis, scleritis, severe pain, and loss of vision.

Sej: To add to that, there is no known reported cases for person-to-person transmission. So its safe to assume that transmissions of the disease are mostly lens-care-related. Jarrah: Though aside from the eyes, It can also infect the skin and cause skin lesions which usually occur to the Immunosuppressed patients, though skin infections dont automatically lead to disseminated infection. Nic: That is correct. Symptoms include skin lesions, nodules, sinus lesions, sinusitis. If it is left untreated, it may result to Granulomatous reaction in skin. Jarrah: Acanthamoeba spp. can cause a serious infection of the brain and spinal cord called Granulomatous Encephalitis (GAE) Calvin: The amebae may enter through the lower respiratory tract or through ulcerated or broken skin, causing Granulomatous amoebic encephalitis (GAE). Danielle: GAE can be acquired through our Olfactory epithelium, respiratory tract, skin or sinuses. Symptoms include Confusion, headache, stiff neck, irritability that can last from week to months. If it is left untreated, it shall result to Focal necrosis and granulomas. Kurt: Within the CNS, the cerebral hemispheres are the most likely tissue to be involved. There may be edema and hemorrhagic necrosis within the temporal, parietal, and occipital lobes Ley: There are possible treatments for Trophozoites and cysts of Acanthamoeba spp. They are sensitive in vitro to ketoconazole, pentamidine, hydroxystilbamidine, paromomycin, 5fluorocytosine, polymyxin, sulfadiazine, azithromycin, especially to combinations of these drugs. Se-J: There are also different treatments for Amebic Keratitis. Successful treatment of keratitis consists of early diagnosis and aggressive surgical and medical therapies. Medical treatment consists of topical antimicrobial agents, which can achieve high concentrations at the site of the infection.

Nic: Unfortunately, most cases of Granulomatous Encephalitis are fatal, but if diagnosed at early stage, it can be treated with Ketoconazole and amphotericin B (alone or in combination), as well as sulfadiazine.

Kurt: To prevent and reduce the risk of infection, and individual must set for regular eye examinations. Contact lenses must be worn according to the schedule prescribed by your eye care provider. Calvin: It is also important to remove contact lenses before any activity involving contact with water, including taking a shower, using a hot tub, or swimming. Washing of hands with soap and drying before handling contact lenses are also recommended to prevent contamination.