title: Acanthamoeba keratitis with symbiosis of Hartmannella ameba.
abstract: OBJECTIVE
  To report a case of severe amebic keratitis in which both Hartmannella and Acanthamoeba were isolated simultaneously from the same lesion.
  
  
  METHODS
  Case report. The deep corneal lesion was scraped for cytopathology and isolation of the pathogens. We tested the in vitro sensitivities of the pathogens to several drugs.
  
  
  RESULTS
  Cultures of the corneal scrapings and of the solution in the patient's contact lens storage case were positive for Acanthamoeba E9 cysts and trophozoites. Hartmannella ameba coexisted with Acanthamoeba in the cornea. When tested in vitro, Acanthamoeba trophozoites were sensitive to both miconazole nitrate and natamycin, while cysts were sensitive only to natamycin. However, the patient did not respond to these antiamebic drugs.
  
  
  CONCLUSIONS
  This case suggests that Acanthamoeba is not the only origin of amebic keratitis. Hartmannella may also cause severe drug-resistant keratitis.
authors.affiliation: Department of Ophthalmology, Osaka University Medical School, Suitasi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.forename: S
authors.initials: S
authors.lastname: Asari
authors.forename: K
authors.initials: K
authors.lastname: Tahara
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.forename: A
authors.initials: A
authors.lastname: Kiritoshi
authors.forename: Y
authors.initials: Y
authors.lastname: Shimomura
mesh_terms: D000048:Acanthamoeba / Q000187:drug effects / Q000302:isolation & purification*; D015823:Acanthamoeba Keratitis / Q000469:parasitology* / Q000473:pathology / Q000628:therapy; D000818:Animals; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D003261:Contact Lenses / Q000009:adverse effects / Q000469:parasitology; D003315:Cornea / Q000187:drug effects / Q000469:parasitology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006249:Hartmannella / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008825:Miconazole / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D010866:Natamycin / Q000494:pharmacology / Q000627:therapeutic use; D013559:Symbiosis
chemical_list: D000935:Antifungal Agents; D008825:Miconazole; D010866:Natamycin