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Aiello F, Afflitto GG, Ceccarelli F, Turco MV, Han Y, Amescua G, Dart JK, Nucci C. Perspectives on the incidence of Acanthamoeba Keratitis: A Systematic Review and Meta-Analysis. Ophthalmology 2024:S0161-6420(24)00462-7. [PMID: 39127408 DOI: 10.1016/j.ophtha.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
TOPIC To provide an overview on the incidence of Acanthamoeba Keratitis (AK). CLINICAL RELEVANCE Although being a major and sight-threatening cause of infectious keratitis in the population, a comprehensive assessment of the incidence of this condition is lacking. METHODS Incidence of AK was computed as the number of AK eyes, per healthcare center, per year (annualized-center-incidence, or ACI). Two meta-analytical ratios were also calculated: a) the ratio of AK eyes to the count of non-viral microbial keratitis (MK) eyes; b) the ratio of AK eyes to the overall population (i.e., the total number of subjects of a nation or region, as indicated by the authors in each study). Center was defined as the healthcare facility (e.g., Hospital, Private Practice, Clinic) where the study took place. Actual and projected estimates of the number of AK eyes in years were calculated multiplying the ratio of AK to the total population and the corresponding present and projected population estimates (age range: 15 to 70), sourced from the United Nations (UN) Population Prospects. RESULTS Overall, 105 articles were included, published between 1987 and 2022. The total number of eyes identified was 91,951, with 5,660 affected by AK and 86,291 by non-viral MK. The median ACI was 1.9 new AK eyes per healthcare center per year (95%CI of the median: 1.5 to 2.6), with no statistically significant differences observed among continents. The ratio of AK eyes to the total number of MK eyes was 1.52% (95%CI: 1.02% to 2.24%), while the ratio of AK in relation to the entire population was estimated at 0.0002% (95%CI: 0.0001 to 0.0006), or 2.34 eyes per 1,000,000 subjects (95%CI: 0.98 to 5.55 per 1.000.000 subjects). The projected increase in the numbers of AK eyes indicates a rise of +18.5% (15,356 AK eyes) in 2053 and +25.5% (16,253 AK eyes) in 2073, compared to the baseline of 2023 (12,954 AK eyes) CONCLUSION: AK emerged as a relatively low-incident disorder, and no significant differences in terms of its incidence were found among different continents.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Dpt. of Experimental Medicine, Università di Roma "Tor Vergata
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Dpt. of Experimental Medicine, Università di Roma "Tor Vergata; Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Francesca Ceccarelli
- Ophthalmology Unit, Dpt. of Experimental Medicine, Università di Roma "Tor Vergata
| | - Maria Vittoria Turco
- Ophthalmology Unit, Dpt. of Experimental Medicine, Università di Roma "Tor Vergata
| | - Yuyi Han
- Ophthalmology Department, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL
| | - John K Dart
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK; National Institute of Health Research (NIHR) Moorfields Biomedical Research Centre, London, UK
| | - Carlo Nucci
- Ophthalmology Unit, Dpt. of Experimental Medicine, Università di Roma "Tor Vergata
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Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05993-7. [PMID: 36795161 DOI: 10.1007/s00417-023-05993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE Acanthamoeba keratitis (AK) is a painful and possibly sight-threatening ocular infection. While the correct diagnosis and specific treatment in the early stages significantly improve the prognosis, the disease is often misdiagnosed and in clinical examination confused with other forms of keratitis. Polymerase chain reaction (PCR) for the detection of AK was first introduced in our institution in December 2013 to improve the timely diagnosis of AK. The aim of this study was to assess the impact of implementation of Acanthamoeba PCR on the diagnosis and treatment of the disease in a German tertiary referral center. PATIENTS AND METHODS Patients treated for Acanthamoeba keratitis between 1st of January 1993 and 31st of December 2021 in the Department of Ophthalmology of the University Hospital Duesseldorf were identified retrospectively via in-house registries. Evaluated parameters include age, sex, initial diagnosis, method of correct diagnosis, duration of symptoms until correct diagnosis, contact lens use, visual acuity, and clinical findings as well as medical and surgical therapy by keratoplasty (pKP). In order to assess the impact of implementation of Acanthamoeba PCR, the cases were divided into two groups (before (pre-PCR group) and after PCR implementation (PCR group). RESULTS Seventy-five patients with Acanthamoeba keratitis were included (69.3% female, median age 37 years). Eighty-four percent (63/75) of all patients were contact lens wearers. Until PCR was available, 58 patients with Acanthamoeba keratitis were diagnosed either clinically (n = 28), by histology (n = 21), culture (n = 6), or confocal microscopy (n = 2) with a median duration until diagnosis of 68 (18; 109) days. After PCR implementation, in 17 patients, the diagnosis was established with PCR in 94% (n = 16) and median duration until diagnosis was significantly shorter with 15 (10; 30.5) days. A longer duration until correct diagnosis correlated with a worse initial visual acuity (p = 0.0019, r = 0.363). The number of pKP performed was significantly lower in the PCR group (5/17; 29.4%) than in the pre-PCR group (35/58; 60.3%) (p = 0.025). CONCLUSIONS The choice of diagnostic method and especially the application of PCR have a significant impact on the time to diagnosis and on the clinical findings at the time of confirmation of diagnosis and the need for penetrating keratoplasty. In contact lens-associated keratitis, the first crucial step is to take AK into consideration and perform a PCR test as timely confirmation of diagnosis of AK is imperative to prevent long-term ocular morbidity.
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Therapeutic Corneal Transplantation in Acanthamoeba Keratitis: Penetrating Versus Lamellar Keratoplasty. Cornea 2021; 41:396-401. [PMID: 34690262 DOI: 10.1097/ico.0000000000002880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article was to compare clinical outcomes between therapeutic penetrating keratoplasty (TPK), therapeutic deep anterior lamellar keratoplasty (TDALK), and optical penetrating keratoplasty (OPK) in Acanthamoeba keratitis. METHODS A literature search was conducted in online libraries from 1980 to 2021. The primary end points were best-corrected visual acuity (VA), graft survival, and infection recurrence. In addition, we enrolled 35 consecutive patients with AK from our practice evaluating best-corrected VA and high-order aberrations. RESULTS A total of 359 AK eyes from 33 published studies were retrieved from 175 publications screened. One hundred sixty-five eyes (73%) that underwent TPK and 39 eyes (84%) treated with TDALK had a clear graft at the last follow-up visit. Only the patients treated with OPK had 82 clear grafts (94%) during the follow-up period. Forty-seven (21%) of TPK patients reached VA ≥20/30, compared with 11 (25%) of TDALK patients and 35 (40%) of OPK patients. Acanthamoeba infection recurrence occurred in 38 eyes (16.8%) that underwent TPK, 9 (19%) that underwent TDALK, and 8 (9.5%) that underwent OPK. In our series, best-corrected visual acuity in nonsurgically treated patients was 1 ± 0.50 logMAR compared with 0 logMAR of surgically treated patients. High-order aberrations were significantly lower in surgically treated eyes after AK resolution, particularly in TDALK when compared with TPK patients. Best-corrected visual acuity was better in TDALK patients compared with TPK patients. CONCLUSIONS After AK resolution by 6 to 12 months of medical treatment, OPK seems to be the best surgical choice in patients with AK. If AK could not be eradicated by medical therapy, TDALK may be chosen in the early disease stage and TPK in later stages.
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Nasef MH, El Emam SY, ElShorbagy MS, Allam WA. Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes. Clin Ophthalmol 2021; 15:1339-1347. [PMID: 33824578 PMCID: PMC8018414 DOI: 10.2147/opth.s301903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To study the predisposing factors, clinical manifestations, and treatment outcome of patients with Acanthamoeba keratitis (AK) at Tanta University’s Ophthalmology Hospital in Tanta, Egypt. Methods A retrospective study of 42 patients (44 eyes) with Acanthamoeba keratitis who had medical records available for review over 4 years. Results Forty-four eyes of 42 patients were treated for AK over the study period. In 29 eyes (65.8%), AK was related to contact lens wear. Severe ocular pain was the main presenting symptom in 38 eyes (86.3%). The most common ocular signs were radial perineural corneal infiltrates (65.9%), pseudo-dendrites (43.2%), ring infiltrates (45.5%), and diffuse stromal infiltration (59%). Acanthamoeba was detected by culture, smear, and in-vivo confocal microscopy (IVCM) in 25 eyes (56.8%), while in 19 eyes (43.2%) the diagnosis was based solely on the clinical findings. IVCM was effective in detection of Acanthamoeba in cases with early presentation, while culture was more sensitive in late presentation with corneal melting. The mean duration of treatment was 73.3 ± 23.7 days. Surgical intervention in the form of tectonic grafts or amniotic membrane transplant was required in five cases (11.3%) due to progressive corneal thinning and perforation. Seventeen patients (38.6%) had 0.2 or better final best-corrected visual acuity after treatment. Conclusion The diagnosis of AK remains a major challenge for most ophthalmologists. Contact lens abuse is the major risk factor. Early diagnosis and appropriate treatment of AK with biocidal agents can improve the final outcome and help avoid surgical intervention. IVCM is an excellent tool for early diagnosis of AK.
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Affiliation(s)
- Mohamed H Nasef
- Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Sharif Y El Emam
- Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
| | | | - Waleed A Allam
- Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
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Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years. Sci Rep 2021; 11:1036. [PMID: 33441799 PMCID: PMC7806847 DOI: 10.1038/s41598-020-80222-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/17/2020] [Indexed: 01/29/2023] Open
Abstract
To report on Acanthamoeba keratitis cases in a tertiary university eye-hospital in Graz, Austria, over a 21-year period. Retrospective study. Parameters included demographics, diagnostics, clinical courses, medical therapies, surgical interventions, secondary complications, and best spectacle-corrected visual acuity (BSCVA). Patient records for 44 eyes of 42 patients were analysed; 2 bilateral infections. Mean age at presentation was 31 ± 13 (16-65) years; contact lenses were used in 41 of 44 eyes (93.2%). Symptoms at initial presentation were mainly pain (41/43, 95.3%) and photophobia (16/43, 37.2%). Most frequent morphological findings were stromal infiltrates (30/44, 68.2%). Diagnosis was mainly confirmed by smears (40/42, 95.2%) and polymerase chain reaction (8/42, 19%). Antiamoebic treatment comprised biguanides and diamidines. Penetrating keratoplasty was performed in 10/44 (22.7%) eyes. Median time from symptom onset to initial visit was 2 (0-26) weeks; median follow-up was 30 (2-1008) weeks. BSCVA improved in 23/36 (63.9%) eyes, remained unchanged in 6/36 (16.7%) eyes and deteriorated in 7/36 (19.4%) eyes. Acanthamoeba keratitis predominantly occurs in young contact lens wearers. Diagnosis should be considered in patients with pain and stromal infiltrates. In the majority of cases, BSCVA can be improved. Early diagnosis and adequate treatment should be implemented to prevent complications.
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Moshtaghion SM, Abolhosseini M, Rezaei Kanavi M, Hosseini SB, Rezaei Kanavi M. Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study. Eur J Ophthalmol 2020; 31:943-950. [PMID: 32506955 DOI: 10.1177/1120672120932093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran. METHODS IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen's Kappa coefficient (CKC). RESULTS Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session. CONCLUSION Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.
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Affiliation(s)
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bagher Hosseini
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Central Eye Bank of Iran, Tehran, Iran
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A 5-Year Review of Acanthamoeba Keratitis Related to Wearing Contact Lenses in Korea. Eye Contact Lens 2020; 46:223-227. [DOI: 10.1097/icl.0000000000000669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Khan NA, Anwar A, Siddiqui R. Acanthamoeba Keratitis: Current Status and Urgent Research Priorities. Curr Med Chem 2019; 26:5711-5726. [DOI: 10.2174/0929867325666180510125633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/10/2018] [Accepted: 05/01/2018] [Indexed: 12/13/2022]
Abstract
Background:First discovered in the early 1970s, Acanthamoeba keratitis has remained a major eye infection and presents a significant threat to the public health, especially in developing countries. The aim is to present a timely review of our current understanding of the advances made in this field in a comprehensible manner and includes novel concepts and provides clear directions for immediate research priorities.Methods:We undertook a search of bibliographic databases for peer-reviewed research literature and also summarized our published results in this field.Results:The present review focuses on novel diagnostic and therapeutic strategies in details which can provide access to management and treatment of Acanthamoeba keratitis. This coupled with the recently available genome sequence information together with high throughput genomics technology and innovative approaches should stimulate interest in the rational design of preventative and therapeutic measures. Current treatment of Acanthamoeba keratitis is problematic and often leads to infection recurrence. Better understanding of diagnosis, pathogenesis, pathophysiology and therapeutic regimens, would lead to novel strategies in treatment and prophylaxis.
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Affiliation(s)
- Naveed Ahmed Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ayaz Anwar
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
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Hassan F, Bhatti A, Desai R, Barua A. Analysis from a year of increased cases of Acanthamoeba Keratitis in a large teaching hospital in the UK. Cont Lens Anterior Eye 2019; 42:506-511. [DOI: 10.1016/j.clae.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/30/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
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Acanthamoeba keratitis in Australia: demographics, associated factors, presentation and outcomes: a 15-year case review. Eye (Lond) 2019; 34:725-732. [PMID: 31554948 DOI: 10.1038/s41433-019-0589-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report the demographics, frequency of potential predisposing factors, presentation and outcomes of Acanthamoeba keratitis (AK) at a quaternary eye hospital in Sydney, Australia over a 15-year period. METHODS A retrospective review of all patients diagnosed with AK at the Sydney Eye Hospital, Sydney, Australia between January 2002 and December 2016 was conducted. RESULTS A total of 52 patients with AK at the quaternary referral hospital in Sydney, Australia, between January 2002 and December 2016, were included. The most commonly documented potential predisposing factors were contact lens wear (83%) and organic trauma (10%) in the non-contact lens wearers. An initial misdiagnosis of herpetic eye disease was made in 37% of patients. The presenting clinical features in order of frequency included; punctate epitheliopathy in 65% (n = 34), perineural infiltrate 46% (n = 24), stromal infiltrates 46% (n = 24), anterior uveitis 39% (n = 20), epithelial defect 35% (n = 18), limbitis 31% (n = 16), pseudo-dendrite 19% (n = 10), and ring infiltrate 4% (n = 7). Twenty-seven of the patients completed their follow-up at the Sydney Eye Hospital, improving their vision from 1.02 logMAR at presentation to 0.57 logMAR at last follow-up. Thirty-nine complications developed in 32 eyes and included corneal scarring and vascularisation, three patients experienced recurrences of AK and one patient developed a late-onset scleritis. CONCLUSION In Australia, AK occurred predominantly in contact lens wearers with typical clinical features including epitheliopathy and perineural infiltrates. The patient demographics, frequency of potential predisposing factors and clinical presentation of AK were similar to case series from the UK and New Zealand.
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Risk Factors for Acanthamoeba Keratitis-A Multistate Case-Control Study, 2008-2011. Eye Contact Lens 2018; 44 Suppl 1:S173-S178. [PMID: 28099282 DOI: 10.1097/icl.0000000000000365] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify modifiable risk factors contributing to Acanthamoeba keratitis (AK) infection. METHODS A case-control investigation was conducted. Case patients were soft contact lens wearers with laboratory-confirmed AK. Control were soft contact lens wearers ≥12 years of age, with no history of AK. Case patients were recruited from 14 ophthalmology referral centers and a clinical laboratory. Control were matched on state of residence and type of primary eye care provider (ophthalmologist or optometrist). Participants were interviewed using a standardized questionnaire. Univariable and multivariable conditional logistic regression analyses were conducted. Matched odds ratios (mORs) were calculated. RESULTS Participants included 88 case patients and 151 matched control. Case patients were more likely to be aged <25 years (unadjusted mOR 2.7, 95% confidence interval 1.3-5.5) or aged >53 years (mOR 2.5, 1.1-5.7), and more likely to be men (mOR 2.6, 1.4-4.8). Unadjusted analyses identified multiple risk factors: rinsing (mOR 6.3, 1.3-29.9) and storing lenses in tap water (mOR 3.9, 1.2-12.3), topping off solution in the lens case (mOR 4.0, 2.0-8.0), having worn lenses ≤5 years (mOR 2.4, 1.3-4.4), rinsing the case with tap water before storing lenses (mOR 2.1, 1.1-4.1), and using hydrogen peroxide (mOR 3.6, 1.1-11.7) versus multipurpose solution. Significant risk factors in multivariable modeling included age >53 years, male sex, topping off, and using saline solution. CONCLUSIONS Numerous modifiable risk factors for AK were identified, mostly involving hygiene practices. To reduce the risk of AK, lens wearers should observe recommended lens care practices.
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Zbiba W, Abdesslem NB. Acanthamoeba keratitis: An emerging disease among microbial keratitis in the Cap Bon region of Tunisia. Exp Parasitol 2018; 192:42-45. [PMID: 29859227 DOI: 10.1016/j.exppara.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/02/2018] [Accepted: 05/29/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The aim of this study was to describe the prevalence of AK among microbial keratitis as well as their clinical features and to compare their risk factors to those of other infectious keratitis, over the last five years in a referral center in the region of Cap Bon, Tunisia, North Africa. METHODS A retrospective review of the charts of 230 patients (230 eyes) diagnosed with presumed infectious keratitis between January 2011 and December 2016 at the department of ophthalmology of the university hospital of Nabeul in Tunisia. After a detailed ocular examination using standard technique, corneal scrapes were performed under aseptic conditions from each ulcer. Plates were incubated at 30 °C and screened daily for Amoeba. The treatment was adjusted according to the results of microbiological findings and the response of initial treatment. The mean follow up was 11.4 months (1 month-26 months). RESULTS A total of 230 corneas were scraped. The prevalence of Acanthamoeba keratitis was 6% (14 cases of 230). All cases of Acanthamoeba keratitis with a history of contact lenses were diagnosed thanks to the test of Contact lenses, their cases or their storage solution, while their corneal scrapings were negative. The corneal scraping was positive for Acanthamoeba only in 4 cases of 14. Acanthamoeba was identified more in young patients (92.8%). Significantly, more patients (54 of 74; 73%) with fungal keratitis and Acanthamoeba keratitis (11 of14; 78.6%) were rural population The most cases of Acanthamoeba keratitis (10 of 14; 71.4%) used contact lenses. Ocular injury was identified in 4 cases of 14 AK (28,5%). Coexistent ocular disease was seen in seven cases of 14 (50%). Of the 230 microbial keratitis, an early diagnosis (≤30 days) was done in 200 cases (86.95%), while a late diagnosis (≥30 days) was made in 30 cases (13%). In AK, most cases (11 of 14; 78,5%) were diagnosed with a delay of more than 30 days. Slit-lamp examination showed stromal infiltrate in 12 cases (85,7%), hypopion in 2 cases (14,3%), immunitary ring in 2 cases (14,3%) and radial keratoneuritis in one case (7,1%). CONCLUSION Contact lenses were identified as the main risk factor of Acanthamoeba keratitis in our study. The diagnosis of AK should be considered in case of atypical keratitis especially among CL wearers in the rural regions of CapBon where the rules of hygiene are not respected.
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Affiliation(s)
- W Zbiba
- Department of Ophthalmology, Taher Maamouri Hospital, Nabeul, Tunisia.
| | - N Ben Abdesslem
- Department of Ophthalmology, Taher Maamouri Hospital, Nabeul, Tunisia.
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McKelvie J, Alshiakhi M, Ziaei M, Patel DV, McGhee CNJ. The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation, diagnosis and outcomes (2009-2016). Clin Exp Ophthalmol 2018; 46:600-607. [DOI: 10.1111/ceo.13166] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/01/2018] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- James McKelvie
- The Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- The Department of Ophthalmology; Greenlane Clinical Centre, Auckland District Health Board; Auckland New Zealand
| | - Moaz Alshiakhi
- The Department of Ophthalmology; Greenlane Clinical Centre, Auckland District Health Board; Auckland New Zealand
| | - Mohammed Ziaei
- The Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- The Department of Ophthalmology; Greenlane Clinical Centre, Auckland District Health Board; Auckland New Zealand
| | - Dipika V Patel
- The Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- The Department of Ophthalmology; Greenlane Clinical Centre, Auckland District Health Board; Auckland New Zealand
| | - Charles NJ McGhee
- The Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- The Department of Ophthalmology; Greenlane Clinical Centre, Auckland District Health Board; Auckland New Zealand
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Carnt N, Robaei D, Minassian DC, Dart JKG. Acanthamoeba keratitis in 194 patients: risk factors for bad outcomes and severe inflammatory complications. Br J Ophthalmol 2018; 102:1431-1435. [DOI: 10.1136/bjophthalmol-2017-310806] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/10/2017] [Accepted: 12/09/2017] [Indexed: 11/04/2022]
Abstract
Background/aimsTo determine demographic and clinical features of patients with Acanthamoeba keratitis (AK) that are independent risk factors both for bad outcomes and for severe inflammatory complications (SIC).MethodsA retrospective audit of medical records of AK cases at Moorfields Eye Hospital from July 2000 to April 2012, including 12 earlier surgical cases. Cases with a bad outcome were defined as those having one or more of the following: corneal perforation, keratoplasty, other surgery (except biopsy), duration of antiamoebic therapy (AAT) ≥10.5 months (the 75th percentile of the whole cohort) and final visual acuity ≤20/80. SICs were defined as having scleritis and/or a stromal ring infiltrate. Multivariable analysis was used to identify independent risk factors for both bad outcomes and SICs.ResultsRecords of 194 eyes (194 patients) were included, having bad outcomes in 93 (48%). Bad outcomes were associated with the presence of SIC, aged >34 years, corticosteroids used before giving AAT and symptom duration >37 days before AAT. The development of SIC was independently associated with aged >34 years, corticosteroids used before giving AAT and herpes simplex virus (HSV) keratitis treatment before AAT.ConclusionsThe prompt diagnosis of AK, avoidance of a misdiagnosis of HSV keratitis and corticosteroid use before the exclusion of AK as a potential cause of keratitis are essential to the provision of a good outcome for patients and for the avoidance of SIC. Older age is an unmodifiable risk factor that may reflect differences in the immune response to AK in this patient subset.
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Juárez MM, Tártara LI, Cid AG, Real JP, Bermúdez JM, Rajal VB, Palma SD. Acanthamoeba in the eye, can the parasite hide even more? Latest developments on the disease. Cont Lens Anterior Eye 2017; 41:245-251. [PMID: 29273391 DOI: 10.1016/j.clae.2017.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
Acanthamoeba spp. is a free living protozoan in the environment, but can cause serious diseases. Acanthamoeba keratitis (AK), a severe and painful eye infection, must be treated as soon as possible to prevent ulceration of the cornea, loss of visual acuity, and eventually blindness or enucleation. Although the disease affects principally contact lens (CLs) wearers, it is recognized nowadays as a cause of keratitis also in non-CLs wearers. Although the number of infections caused by these amoebae is low, AK is an emerging disease presenting an extended number of cases each year worldwide mostly due to the increasing use of CLs, but also to better diagnostic methods and awareness. There are two principal causes that lead to severe outcomes: misdiagnosis or late diagnosis of the causal agent, and lack of a fully effective therapy due to the existence of a highly resistant cyst stage of Acanthamoeba. Recent studies have reported different genotypes that have not been previously associated with this disease. In addition, Acanthamoeba can act as a reservoir for phylogenetically diverse microorganisms. In this regard, recently giant viruses called Pandoravirus have been found within genotypes producing keratitis. What potential risk this poses is not yet known. This review focuses on an overview of the present status and future prospects of this re-emerging pathology, including features of the parasite, epidemiology, clinical aspects, diagnosis, and treatment.
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Affiliation(s)
- M M Juárez
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - L I Tártara
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina
| | - A G Cid
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - J P Real
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina
| | - J M Bermúdez
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - V B Rajal
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Singapore Centre on Environmental Life Sciences Engineering (SCELSE), School of Biological Sciences, Nanyang Technological University, Singapore
| | - S D Palma
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina.
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Lee MH, Abell RG, Mitra B, Ferdinands M, Vajpayee RB. Risk factors, demographics and clinical profile of Acanthamoeba keratitis in Melbourne: an 18-year retrospective study. Br J Ophthalmol 2017; 102:687-691. [DOI: 10.1136/bjophthalmol-2017-310428] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/01/2017] [Accepted: 08/13/2017] [Indexed: 11/04/2022]
Abstract
PurposeTo assess incidence, risk factors, presentation and final visual outcome of patients with Acanthamoebakeratitis (AK) treated at the Royal Victorian Eye and Ear Hospital (RVEEH), Melbourne, Australia, over an 18-year period.MethodsA retrospective review of all cases of AK managed at RVEEH between January 1998 and May 2016 was performed. Data collected included age, gender, affected eye, signs and symptoms, time between symptoms and diagnosis, risk factors, presenting and final visual acuity (VA), investigations, medical treatment, surgical interventions and length of follow-up.ResultsA total of 36 eyes affected by AK in 34 patients were identified. There were 26 cases diagnosed early (<30 days) and 10 were diagnosed late (≥30 days). There were 31 (86.1%) cases associated with contact lens (CL). Signs associated with early AK included epithelial infiltrates, while signs of late AK included uveitis, ring infiltrate, endothelial plaque and corneal thinning (p<0.05). Surgical treatment was required in seven cases (19.4%). There were 29 (80.6%) cases that reported improved VA. Median best corrected final VA was worse in patients with late diagnosis (logarithm of minimal angle of resolution (logMAR) 0.5, IQR: 0.2–0.8), compared with patients with early diagnosis (logMAR 0.0, IQR: 0.0–0.3; p=0.01). Late diagnosis was associated with a prolonged disease period.ConclusionAK was an uncommon cause of severe keratitis and was associated commonly with CL. Patients with late diagnosis had worse presenting and final VAs as well as a prolonged disease period, indicating need for early recognition and management.
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Carnt N, Robaei D, Watson SL, Minassian DC, Dart JKG. The Impact of Topical Corticosteroids Used in Conjunction with Antiamoebic Therapy on the Outcome of Acanthamoeba Keratitis. Ophthalmology 2016; 123:984-90. [PMID: 26952591 DOI: 10.1016/j.ophtha.2016.01.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To examine the impact of topical corticosteroid use after the start of antiamoebic therapy (AAT) on the outcomes of Acanthamoeba keratitis (AK) therapy. DESIGN Cohort study. PARTICIPANTS A total of 196 patients diagnosed with AK at Moorfields Eye Hospital, London, between January 1991 and April 2012. In 13 patients with bilateral AK, 1 eye was randomly excluded from analysis. METHODS Patient demographics and clinical examination findings were collected both at the start of AAT and subsequently at the time that topical corticosteroid therapy was initiated. Preliminary a priori investigations were used to identify effect modifiers/confounders and extreme associations requiring consideration in multivariate regression modeling. A multivariable logistic model, optimized for assessment of corticosteroid use after the start of AAT, was used to estimate the odds ratios (ORs) of a suboptimal outcome. MAIN OUTCOME MEASURES Suboptimal outcome was defined as final visual acuity ≤20/80, corneal perforation, or the need for keratoplasty. RESULTS In multivariable analysis, restricted to 129 eyes (1 eye per patient) free of scleritis and hypopyon at the start of AAT, topical corticosteroids were not associated with worse outcomes (OR, 1.08; 95% confidence interval [CI], 0.39-3.03), even when corticosteroids had been used before the start of AAT. Risk factors significantly associated with worse outcomes were topical corticosteroid use before the start of AAT (OR, 3.85; 95% CI, 1.35-11.03), a corneal ring infiltrate (together with at least 1 other feature of AK) present at the start of AAT (OR, 5.89; 95% CI, 1.17-29.67), and age ≥33 years at the start of AAT (OR, 4.02; 95% CI, 1.46-11.06). CONCLUSIONS Many corneal specialists currently are uncertain about the risk benefit associated with the use of topical corticosteroids for the management of inflammatory complications of AK. The evidence from this study gives clinicians and patients reassurance that the potential benefits of topical corticosteroid therapy, for treating pain and discomfort, are not associated with worse outcomes when initiated after starting modern AAT. Other potential benefits, in terms of resolution of inflammatory complications, will not be demonstrated without a carefully designed randomized clinical trial.
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Affiliation(s)
- Nicole Carnt
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Save Sight Institute, University of Sydney, Sydney, Australia
| | - Dana Robaei
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Save Sight Institute, University of Sydney, Sydney, Australia
| | | | | | - John K G Dart
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
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Feng X, Zheng W, Wang Y, Zhao D, Jiang X, Lv S. A Rabbit Model ofAcanthamoebaKeratitis That Better Reflects the Natural Human Infection. Anat Rec (Hoboken) 2015; 298:1509-17. [DOI: 10.1002/ar.23154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/20/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Xianmin Feng
- School of Laboratory Medicine, Jilin Medical College; Jilin China
| | - Wenyu Zheng
- Department of Hand Microsurgery; Central Hospital of Jilin City; Jilin China
| | - Yuehua Wang
- School of Laboratory Medicine, Jilin Medical College; Jilin China
- School of Basical Medicine, Jilin Medical College; Jilin China
| | - Donghai Zhao
- School of Basical Medicine, Jilin Medical College; Jilin China
| | - Xiaoming Jiang
- School of Laboratory Medicine, Jilin Medical College; Jilin China
| | - Shijie Lv
- School of Basical Medicine, Jilin Medical College; Jilin China
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Robaei D, Carnt N, Minassian DC, Dart JKG. The impact of topical corticosteroid use before diagnosis on the outcome of Acanthamoeba keratitis. Ophthalmology 2014; 121:1383-8. [PMID: 24630688 DOI: 10.1016/j.ophtha.2014.01.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the impact of topical corticosteroid use before the diagnosis of Acanthamoeba keratitis (AK) on final visual outcomes and to determine the prognostic factors predicting poorer outcomes. DESIGN Cohort study. PARTICIPANTS A total of 209 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, between January 1991 and April 2012. One eye was randomly excluded from analysis in the 13 cases of bilateral AK. METHODS Patient demographic, initial clinical examination findings, and management details were collected. The outcomes of patients treated with topical corticosteroids before diagnosis of AK were compared with those not treated with topical corticosteroids before diagnosis. A multivariable logistic model, optimized for prior corticosteroid use, was used to derive the odds ratios (ORs) of a suboptimal visual outcome. MAIN OUTCOME MEASURES Suboptimal visual outcome was defined as final visual acuity (VA) ≤ 20/80, corneal perforation, or need for keratoplasty. RESULTS Acanthamoeba keratitis was diagnosed on microbiological culture in 94 eyes (48.0%), on histopathologic examination in 27 eyes (13.8%), on confocal microscopy in 38 eyes (19.4%), and on the basis of a typical clinical course and response to treatment in 37 eyes (18.9%). Final VA and prior corticosteroid use data were available for 174 eyes (88.8%). In multivariable analysis, corticosteroid use before diagnosis was associated with suboptimal visual outcome (OR, 3.90; 95% confidence interval [CI], 1.78-8.55), as were disease stage 3 at presentation (OR, 5.62; 95% CI, 1.59-19.80) and older age (60+ years) at diagnosis (OR, 8.97; 95% CI, 2.13-37.79). CONCLUSIONS Corticosteroid use before diagnosis of AK is highly predictive of a poorer visual outcome. This is largely due to the initial misdiagnosis of AK as herpetic keratitis. It is important to include AK in the differential diagnosis of keratitis in all contact lens users with keratitis, particularly before making a diagnosis of herpes keratitis and before the use of topical corticosteroids in the therapy of any indolent keratitis.
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Affiliation(s)
- Dana Robaei
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Nicole Carnt
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - John K G Dart
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
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Patel DV, McGhee CN. Presumed late recurrence of Acanthamoeba keratitis exacerbated by exposure to topical corticosteroids. Oman J Ophthalmol 2014; 6:S40-2. [PMID: 24391372 PMCID: PMC3872843 DOI: 10.4103/0974-620x.122295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 28-year-old female with a history of contact lens wear presented with a 1 week history of pain and photophobia in her left eye. In vivo confocal microscopy (IVCM) and corneal scrape confirmed the diagnosis of Acanthamoeba keratitis (AK) which was treated with intensive topical propamidine isethionate (0.1%) and chlorhexidine (0.02%) with tapering dosage over 11 months. Five years after complete resolution of AK and cessation of all contact lens wear, the subject presented to her optometrist with a history of ocular discomfort and mild photophobia. Without further investigation she was prescribed topical corticosteroids. Three weeks later she presented with pain and reduced vision in the left eye. Slit-lamp examination revealed focal, inferior corneal stromal edema. IVCM confirmed widespread Acanthamoeba cysts. Treatment with topical polyhexamethylene biguanide (PHMB) 0.02% and propamidine isethionate 0.1% resulted in resolution of the AK. Despite an initially mild AK, this subject presumably retained viable Acanthamoeba cysts in her cornea 5 years after the initial episode. This report highlights the importance of caution when using corticosteroids in patients with a previous history of AK, even in the relatively distant past. Patients with AK should be warned regarding the risks of recurrence following presumed resolution.
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Affiliation(s)
- Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Nj McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Mascarenhas J, Lalitha P, Prajna NV, Srinivasan M, Das M, D'Silva SS, Oldenburg CE, Borkar DS, Esterberg EJ, Lietman TM, Keenan JD. Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features. Am J Ophthalmol 2014; 157:56-62. [PMID: 24200232 DOI: 10.1016/j.ajo.2013.08.032] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine risk factors and clinical signs that may differentiate between bacterial, fungal, and acanthamoeba keratitis among patients presenting with presumed infectious keratitis. DESIGN Hospital-based cross-sectional study. METHODS We examined the medical records of 115 patients with laboratory-proven bacterial keratitis, 115 patients with laboratory-proven fungal keratitis, and 115 patients with laboratory-proven acanthamoeba keratitis seen at Aravind Eye Hospital, Madurai, India, from 2006-2011. Risk factors and clinical features of the 3 organisms were compared using multinomial logistic regression. RESULTS Of 95 patients with bacterial keratitis, 103 patients with fungal keratitis, and 93 patients with acanthamoeba keratitis who had medical records available for review, 287 (99%) did not wear contact lenses. Differentiating features were more common for acanthamoeba keratitis than for bacterial or fungal keratitis. Compared to patients with bacterial or fungal keratitis, patients with acanthamoeba keratitis were more likely to be younger and to have a longer duration of symptoms, and to have a ring infiltrate or disease confined to the epithelium. CONCLUSIONS Risk factors and clinical examination findings can be useful for differentiating acanthamoeba keratitis from bacterial and fungal keratitis.
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Affiliation(s)
- Jeena Mascarenhas
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Care System, Madurai, India
| | - N Venkatesh Prajna
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Muthiah Srinivasan
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Manoranjan Das
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Sean S D'Silva
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | | | - Durga S Borkar
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California.
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Lorenzo-Morales J, Martín-Navarro CM, López-Arencibia A, Arnalich-Montiel F, Piñero JE, Valladares B. Acanthamoeba keratitis: an emerging disease gathering importance worldwide? Trends Parasitol 2013; 29:181-7. [PMID: 23433689 DOI: 10.1016/j.pt.2013.01.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 11/15/2022]
Abstract
Acanthamoeba keratitis (AK) is increasingly being recognized as a severe sight-threatening ocular infection worldwide. Although contact lens wear is the leading risk factor for AK, Acanthamoeba parasites are also an important cause of keratitis in non-contact lens wearers. Diagnosis of AK is challenging, and the available treatments are lengthy and not fully effective against all strains. The pathogenesis of Acanthamoeba is still under study, and the identification of the key factors involved in this process should be useful for the development of fully effective therapies. This review focuses on recent developments on AK pathogenesis and diagnosis as well as novel strategies for the evaluation of anti-amoebic agents that could be applied in the near future against these pathogens.
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Affiliation(s)
- Jacob Lorenzo-Morales
- University Institute of Tropical Diseases and Public Health of The Canary Islands, University of La Laguna, Avenida Astrofísico Francisco Sánchez SN, 38203 La Laguna, Tenerife, Canary Islands, Spain.
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Hildebrandt C, Wagner D, Kohlmann T, Kramer A. In-vitro analysis of the microbicidal activity of 6 contact lens care solutions. BMC Infect Dis 2012; 12:241. [PMID: 23033880 PMCID: PMC3519705 DOI: 10.1186/1471-2334-12-241] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contact lens-related infections are often associated with inadequate contact lens hygiene, and therefore, contact lens care products should be able to sufficiently minimise the amount of pathogens that are responsible for these infections. In 2001, the EN ISO 14729 was introduced to ensure adequate disinfection efficacy of contact lens care solutions, but this norm has recently been criticised. METHODS In this study, six frequently used contact lens care solutions were retested according to the Stand Alone Test of the EN ISO 14729 (2001). The Stand Alone Test is a quantitative suspension test. In addition, the products were tested in a modified setting adding an organic load. The load was a mixture of human blood serum, lysozyme, and mucine, which resembles tear fluid. RESULTS The criteria of the Stand Alone Test recommended in EN ISO 14729 were only met by Aosept Plus. This 3% hydrogen-peroxide-based contact lens care solution attained a reduction factor of > 5 log units for bacteria and > 4 for fungi in all cases. Two further contact lens care solutions, Blue Vision and Optifree Replenish, met the criteria of a reduction factor of > 3 log units for bacteria and > 1 log unit for fungi, but only in the presence of artificial tear fluid. The three remaining products did not exhibit adequate disinfecting efficacy, at least against one of the tested microorganisms. CONCLUSIONS Through the observation that the artificial tear fluid used in this study influences the disinfecting efficacy of contact lens care solutions, especially that of multi-purpose solutions, in a different way than does albumin, mucine, or even the organic load suggested in EN ISO 14729, it becomes obvious that the test conditions in the EN ISO 14729 should be revised in order to create more realistic conditions, e.g., by using a more realistic artificial tear fluid. Furthermore, we suggest adapting the EN ISO 14729 to the European test hierarchy for chemical disinfectants and antiseptics, which consists of three test phases and also requests meeting stricter criteria in order to pass the test. Unless the test conditions guarantee a sufficient reduction of potential pathogens, the risk of contact lens-related microbial keratitis and other infections will remain for the users.
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Affiliation(s)
- Claudia Hildebrandt
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Lalitha P, Lin CC, Srinivasan M, Mascarenhas J, Prajna NV, Keenan JD, McLeod SD, Acharya NR, Lietman TM, Porco TC. Acanthamoeba keratitis in South India: a longitudinal analysis of epidemics. Ophthalmic Epidemiol 2012; 19:111-5. [PMID: 22364672 DOI: 10.3109/09286586.2011.645990] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE In light of the increased incidence of contact lens associated Acanthamoeba keratitis in recent years, this study analyzed longitudinal trends of its incidence among predominantly non-contact lens wearers in a high-volume referral center in South India. METHODS A retrospective analysis of microbiology laboratory records at the Aravind Eye Hospital from 1988-2009 was performed. The Maximum Excess Events Test (MEET) was used to identify epidemics of Acanthamoeba keratitis. RESULTS There were a total of 38,529 unique cases of infectious keratitis evaluated over this time period, of which 372 were culture-positive for Acanthamoeba. Only three cases (0.9%) of Acanthamoeba keratitis occurred among contact lens wearers. MEET identified unique Acanthamoeba keratitis epidemics in 1993 and 2002. CONCLUSION Discrete epidemics of Acanthamoeba keratitis occurred among a rural, non-contact lens wearing, population in South India in 1993 and 2002.
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Siddiqui R, Khan NA. Biology and pathogenesis of Acanthamoeba. Parasit Vectors 2012; 5:6. [PMID: 22229971 PMCID: PMC3284432 DOI: 10.1186/1756-3305-5-6] [Citation(s) in RCA: 359] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/10/2012] [Indexed: 12/18/2022] Open
Abstract
Acanthamoeba is a free-living protist pathogen, capable of causing a blinding keratitis and fatal granulomatous encephalitis. The factors that contribute to Acanthamoeba infections include parasite biology, genetic diversity, environmental spread and host susceptibility, and are highlighted together with potential therapeutic and preventative measures. The use of Acanthamoeba in the study of cellular differentiation mechanisms, motility and phagocytosis, bacterial pathogenesis and evolutionary processes makes it an attractive model organism. There is a significant emphasis on Acanthamoeba as a Trojan horse of other microbes including viral, bacterial, protists and yeast pathogens.
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