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Fan W, Li P, Wei Q, Liu X, Cai Y, Li B, Lu Y. Metagenomic next-generation sequencing-assisted diagnosis of a rare case of primary cutaneous acanthamoebiasis in an HIV patient: a case report. Front Cell Infect Microbiol 2024; 14:1356095. [PMID: 38863830 PMCID: PMC11165212 DOI: 10.3389/fcimb.2024.1356095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Abstract
Pathogenic and free-living Acanthamoeba are widely distributed in the environment and have been reported to cause keratitis and universally fatal encephalitis. Primary cutaneous acanthamoebiasis caused by Acanthamoeba is exceedingly rare and presents as isolated necrotic cutaneous lesions without involvement of the cornea or central nervous system. Cutaneous acanthamoebiasis often occurs in immunocompromised patients and is likely overlooked or even misdiagnosed only by cutaneous biopsy tissue histopathological analysis. Here, we report a HIV-infected 63-year-old female with oral leukoplakia for 4 months and scattered large skin ulcers all over the body for 2 months. The cause of the cutaneous lesions was unclear through cutaneous specimens histopathological analysis, and subsequently Acanthamoeba were detected by metagenomic next-generation sequencing (mNGS), which may be the cause of cutaneous lesions. Based on the mNGS results, a pathologist subsequently reviewed the previous pathological slides and found trophozoites of Acanthamoeba so that the cause was identified, and the skin ulcers improved significantly after treatment with multi-drug combination therapy. Acanthamoeba is also a host of pathogenic microorganisms. The presence of endosymbionts enhances the pathogenicity of Acanthamoeba, and no other pathogens were reported in this case. mNGS is helpful for rapidly diagnosing the etiology of rare skin diseases and can indicate the presence or absence of commensal microorganisms.
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Affiliation(s)
- Wei Fan
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pin Li
- Research and Development Department, Sinopharm Medical Laboratory (Wuhan) Co., Ltd., Wuhan, China
| | - Qihao Wei
- Research and Development Department, Sinopharm Genomics Technology Co., Ltd., Wuhan, China
| | - Xinru Liu
- Research and Development Department, Sinopharm Medical Laboratory (Wuhan) Co., Ltd., Wuhan, China
| | - Yuxiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Li
- Research and Development Department, Sinopharm Genomics Technology Co., Ltd., Wuhan, China
| | - Yaping Lu
- Research and Development Department, Sinopharm Medical Laboratory (Wuhan) Co., Ltd., Wuhan, China
- Research and Development Department, Sinopharm Genomics Technology Co., Ltd., Wuhan, China
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Haapanen S, Barker H, Carta F, Supuran CT, Parkkila S. Novel Drug Screening Assay for Acanthamoeba castellanii and the Anti-Amoebic Effect of Carbonic Anhydrase Inhibitors. J Med Chem 2024; 67:152-164. [PMID: 38150360 PMCID: PMC10788897 DOI: 10.1021/acs.jmedchem.3c01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
Acanthamoeba castellanii is an amoeba that inhabits soil and water in every part of the world. Acanthamoeba infection of the eye causes keratitis and can lead to a loss of vision. Current treatment options are only moderately effective, have multiple harmful side effects, and are tedious. In our study, we developed a novel drug screening method to define the inhibitory properties of potential new drugs against A. castellanii in vitro. We found that the clinically used carbonic anhydrase inhibitors, acetazolamide, ethoxzolamide, and dorzolamide, have promising antiamoebic properties.
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Affiliation(s)
- Susanna Haapanen
- Faculty
of Medicine and Health Technology, Tampere
University, FI-33520 Tampere, Finland
| | - Harlan Barker
- Faculty
of Medicine and Health Technology, Tampere
University, FI-33520 Tampere, Finland
- Fimlab
Ltd, Tampere University Hospital, FI-33520 Tampere, Finland
| | - Fabrizio Carta
- Neurofarba
Department, Sezione di Chimica Farmaceutica e Nutraceutica, Università degli Studi di Firenze, Via U. Schiff 6, Sesto Fiorentino, I-50019 Firenze, Italy
| | - Claudiu T. Supuran
- Neurofarba
Department, Sezione di Chimica Farmaceutica e Nutraceutica, Università degli Studi di Firenze, Via U. Schiff 6, Sesto Fiorentino, I-50019 Firenze, Italy
| | - Seppo Parkkila
- Faculty
of Medicine and Health Technology, Tampere
University, FI-33520 Tampere, Finland
- Fimlab
Ltd, Tampere University Hospital, FI-33520 Tampere, Finland
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Rayamajhee B, Sharma S, Willcox M, Henriquez FL, Rajagopal RN, Shrestha GS, Subedi D, Bagga B, Carnt N. Assessment of genotypes, endosymbionts and clinical characteristics of Acanthamoeba recovered from ocular infection. BMC Infect Dis 2022; 22:757. [PMID: 36175838 PMCID: PMC9520893 DOI: 10.1186/s12879-022-07741-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Acanthamoeba is an emerging pathogen, infamous for its resilience against antiprotozoal compounds, disinfectants and harsh environments. It is known to cause keratitis, a sight-threatening, painful and difficult to treat corneal infection which is often reported among contact lens wearers and patients with ocular trauma. Acanthamoeba comprises over 24 species and currently 23 genotypes (T1-T23) have been identified. Aims This retrospective study was designed to examine the Acanthamoeba species and genotypes recovered from patients with Acanthamoeba keratitis (AK), determine the presence of endosymbionts in ocular isolates of Acanthamoeba and review the clinical presentations. Methodology Thirteen culture-confirmed AK patients treated in a tertiary eye care facility in Hyderabad, India from February to October 2020 were included in this study. The clinical manifestations, medications and visual outcomes of all patients were obtained from medical records. The Acanthamoeba isolates were identified by sequencing the ribosomal nuclear subunit (rns) gene. Acanthamoeba isolates were assessed for the presence of bacterial or fungal endosymbionts using molecular assays, PCR and fluorescence in situ hybridization (FISH). Results The mean age of the patients was 33 years (SD ± 17.4; 95% CI 22.5 to 43.5 years). Six (46.2%) cases had AK associated risk factors; four patients had ocular trauma and two were contact lens wearers. A. culbertsoni (6/13, 46.2%) was the most common species, followed by A. polyphaga and A. triangularis. Most of the isolates (12/13) belonged to genotype T4 and one was a T12; three sub-clusters T4A, T4B, and T4F were identified within the T4 genotype. There was no significant association between Acanthamoeba types and clinical outcomes. Eight (61.5%) isolates harboured intracellular bacteria and one contained Malassezia restricta. The presence of intracellular microbes was associated with a higher proportion of stromal infiltrates (88.9%, 8/9), epithelial defect (55.6%, 5/9) and hypopyon (55.6%, 5/9) compared to 50% (2/4), 25% (1/4) and 25% (1/4) AK cases without intracellular microbes, respectively. Conclusions Genotype T4 was the predominant isolate in southern India. This is the second report of T12 genotype identified from AK patient in India, which is rarely reported worldwide. The majority of the Acanthamoeba clinical isolates in this study harboured intracellular microbes, which may impact clinical characteristics of AK. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07741-4.
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Affiliation(s)
- Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, Hyderabad, India
| | - Mark Willcox
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Fiona L Henriquez
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland (UWS), Paisley, PA1 2BE, Scotland, UK
| | | | - Gauri Shankar Shrestha
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Dinesh Subedi
- School of Biological Sciences, Monash University, Clayton, VIC, 3800, Australia
| | - Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Nicole Carnt
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
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Karsenti N, Purssell A, Lau R, Ralevski F, Bhasker S, Raheel H, Boggild AK. Surveillance of Amoebic Keratitis-Causing Acanthamoebae for Potential Bacterial Endosymbionts in Ontario, Canada. Pathogens 2022; 11:pathogens11060661. [PMID: 35745515 PMCID: PMC9230791 DOI: 10.3390/pathogens11060661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Acanthamoeba spp. are the causative pathogens of several infections, including amoebic keratitis (AK), a vision-threatening infection. Acanthamoebae from corneal specimens of patients with AK harbor bacterial endosymbionts, which may increase virulence. We sought to understand the spectrum of bacterial endosymbionts present in clinical isolates of Acanthamoeba spp. identified in our reference parasitology laboratory. Isolates of Acanthamoeba spp. obtained from our biobank of anonymized corneal scrapings were screened for potential endosymbionts by PCR using primer pairs detecting bacteria belonging to orders Chlamydiales, Rickettsiales, or Legionellales and pan16S primers. Three primer pairs specific to the 18s rRNA gene of Acanthamoeba spp. were used for the amplification of Acanthamoeba DNA used for sequencing. Sanger sequencing of all PCR products was performed, followed by BLAST analysis for species identification. We screened 26 clinical isolates of Acanthamoeba spp. for potential endosymbionts. Five isolates (19%) were found to contain bacterial DNA belonging to Legionellales. Three (11%) contained members of the Rickettsiales and Pseudomonas genticulata was detected in a Rickettsia-positive sample. One strain (4%) contained Neochlamydia hartmannellae, a member of the Chlamydiales order. Bacterial endosymbionts are prevalent in clinical strains of Acanthamoeba causing AK isolated from corneal scrapings. The demonstration of these organisms in clinical Acanthamoeba isolates supports a potential exploration of anti-endosymbiont therapeutics as an adjuvant therapy in the treatment of AK.
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Affiliation(s)
- Nessika Karsenti
- Schulich School of Medicine & Dentistry, London, ON N6A 5C1, Canada; (N.K.); (H.R.)
| | - Andrew Purssell
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Rachel Lau
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON M5G 1M1, Canada; (R.L.); (F.R.)
| | - Filip Ralevski
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON M5G 1M1, Canada; (R.L.); (F.R.)
| | - Shveta Bhasker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Hira Raheel
- Schulich School of Medicine & Dentistry, London, ON N6A 5C1, Canada; (N.K.); (H.R.)
| | - Andrea K. Boggild
- Tropical Disease Unit, Division of Infectious Diseases, UHN-Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada
- Correspondence: ; Tel.: +1-416-340-3675
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Rayamajhee B, Subedi D, Peguda HK, Willcox MD, Henriquez FL, Carnt N. A Systematic Review of Intracellular Microorganisms within Acanthamoeba to Understand Potential Impact for Infection. Pathogens 2021; 10:pathogens10020225. [PMID: 33670718 PMCID: PMC7922382 DOI: 10.3390/pathogens10020225] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
Acanthamoeba, an opportunistic pathogen is known to cause an infection of the cornea, central nervous system, and skin. Acanthamoeba feeds different microorganisms, including potentially pathogenic prokaryotes; some of microbes have developed ways of surviving intracellularly and this may mean that Acanthamoeba acts as incubator of important pathogens. A systematic review of the literature was performed in order to capture a comprehensive picture of the variety of microbial species identified within Acanthamoeba following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Forty-three studies met the inclusion criteria, 26 studies (60.5%) examined environmental samples, eight (18.6%) studies examined clinical specimens, and another nine (20.9%) studies analysed both types of samples. Polymerase chain reaction (PCR) followed by gene sequencing was the most common technique used to identify the intracellular microorganisms. Important pathogenic bacteria, such as E. coli, Mycobacterium spp. and P. aeruginosa, were observed in clinical isolates of Acanthamoeba, whereas Legionella, adenovirus, mimivirus, and unidentified bacteria (Candidatus) were often identified in environmental Acanthamoeba. Increasing resistance of Acanthamoeba associated intracellular pathogens to antimicrobials is an increased risk to public health. Molecular-based future studies are needed in order to assess the microbiome residing in Acanthamoeba, as a research on the hypotheses that intracellular microbes can affect the pathogenicity of Acanthamoeba infections.
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Affiliation(s)
- Binod Rayamajhee
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, NSW 2052, Australia; (H.K.P.); (M.D.W.); (N.C.)
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur 44700, Nepal
- Correspondence: or
| | - Dinesh Subedi
- School of Biological Sciences, Monash University, Clayton, VIC 3800, Australia;
| | - Hari Kumar Peguda
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, NSW 2052, Australia; (H.K.P.); (M.D.W.); (N.C.)
| | - Mark Duncan Willcox
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, NSW 2052, Australia; (H.K.P.); (M.D.W.); (N.C.)
| | - Fiona L. Henriquez
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland (UWS), Paisley PA1 2BE, UK;
| | - Nicole Carnt
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, NSW 2052, Australia; (H.K.P.); (M.D.W.); (N.C.)
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In vitro reconstructed 3D corneal tissue models for ocular toxicology and ophthalmic drug development. In Vitro Cell Dev Biol Anim 2021; 57:207-237. [PMID: 33544359 DOI: 10.1007/s11626-020-00533-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
Testing of all manufactured products and their ingredients for eye irritation is a regulatory requirement. In the last two decades, the development of alternatives to the in vivo Draize eye irritation test method has substantially advanced due to the improvements in primary cell isolation, cell culture techniques, and media, which have led to improved in vitro corneal tissue models and test methods. Most in vitro models for ocular toxicology attempt to reproduce the corneal epithelial tissue which consists of 4-5 layers of non-keratinized corneal epithelial cells that form tight junctions, thereby limiting the penetration of chemicals, xenobiotics, and pharmaceuticals. Also, significant efforts have been directed toward the development of more complex three-dimensional (3D) equivalents to study wound healing, drug permeation, and bioavailability. This review focuses on in vitro reconstructed 3D corneal tissue models and their utilization in ocular toxicology as well as their application to pharmacology and ophthalmic research. Current human 3D corneal epithelial cell culture models have replaced in vivo animal eye irritation tests for many applications, and substantial validation efforts are in progress to verify and approve alternative eye irritation tests for widespread use. The validation of drug absorption models and further development of models and test methods for many ophthalmic and ocular disease applications is required.
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Kagkelaris KA, Makri OE, Georgakopoulos CD, Panayiotakopoulos GD. An eye for azithromycin: review of the literature. Ther Adv Ophthalmol 2018; 10:2515841418783622. [PMID: 30083656 PMCID: PMC6066808 DOI: 10.1177/2515841418783622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/08/2018] [Indexed: 12/24/2022] Open
Abstract
Azithromycin is used widely in clinical practice and recently it is available in
topical solution for ophthalmic use. The purpose of the current publication is
to summarize the newest information on azithromycin’s clinical usefulness over
ocular diseases. A PubMed (National Library of Medicine) and a ScienceDirect
search was conducted using the key phrases ‘azithromycin’, ‘meibomian’,
‘blepharitis’, ‘trachoma’, ‘toxoplasmosis’ from 2010 to 2017. Articles were
limited to articles published in English or at least having an English abstract.
There were no restrictions on age, ethnicity, or geographic locations of
patients. Topical azithromycin was found effective and safe in various ocular
surface infections, in meibomian gland dysfunction and in trachoma. Also, it may
substitute fluoroquinolones in corneal UV cross-linking. The World Health
Organization targets for trachoma elimination are being reached only after 3
years of annual mass drug administration. Oral azithromycin can participate in
combination regiments for toxoplasmosis, mainly because of its very good safety
profile and may play a significant role in toxoplasmosis in pregnancy.
Azithromycin is one of the safest antibiotics, well tolerated, and with special
pharmacokinetic properties. Also, it is characterized by a broad antimicrobial
spectrum. Azithromycin is efficacious for the treatment of a lot of ocular
diseases and may be included as monotherapy or in combination therapy in new
treatment protocols for more ocular infections. However, more research is needed
to determine this.
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Affiliation(s)
- Kostas A Kagkelaris
- Department of General Pharmacology, School of Medicine, University of Patras, Patras, Greece
| | - Olga E Makri
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
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