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Aiello F, Gallo Afflitto G, 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 sight-threatening cause of infectious keratitis, a comprehensive assessment of the incidence of AK is lacking. METHODS Incidence of AK was computed as the number of eyes with AK per health care center, per year (annualized center incidence [ACI]). Two meta-analytical ratios also were calculated: (1) the ratio of eyes with AK to the count of eyes with nonviral microbial keratitis (MK) and (2) the ratio of eyes with AK to the overall population (i.e., the total number of people in a nation or region, as indicated by the authors in each study). Center was defined as the health care facility where the study took place. Actual and projected estimates of the number of eyes with AK in years were calculated multiplying the ratio of eyes with AK to the total population and the corresponding population estimates, sourced from the United Nations Population Prospects. RESULTS Overall, 105 articles were included, published between 1987 and 2022. The total number of eyes identified was 91 951, with 5660 eyes affected by AK and 86 291 eyes affected by nonviral MK. The median ACI was 1.9 eyes with AK per health care center per year (95% confidence interval [CI], 1.5-2.6 eyes), with no statistically significant differences among continents. The ratio of eyes with AK to the total number of eyes with MK was 1.52% (95% CI, 1.03%-2.22%), whereas the ratio of eyes with AK in relationship to the entire population was estimated at 2.34 eyes per 1 000 000 people (95% CI, 0.98-5.55 per 1 000 000 people). The projected increase in the numbers of eyes with AK indicated an increase of 18.5% (n = 15 355 eyes with AK) in 2053 and 25.5% (n = 16 253 eyes with AK) in 2073, compared with the baseline of 2023 (n = 12 953 eyes with AK). DISCUSSION Acanthamoeba keratitis emerged as a relatively low-incident disorder, and no significant differences in terms of its incidence were found among different continents. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
| | - Francesca Ceccarelli
- Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy
| | - Maria Vittoria Turco
- Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy
| | - Yuyi Han
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - John K Dart
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research (NIHR) Moorfields Biomedical Research Centre, London, United Kingdom
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy
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Soleimani M, Najafabadi SJ, Razavi A, Tabatabaei SA, Mirmoosavi S, Asadigandomani H. Clinical characteristics, predisposing factors, and management of moraxella keratitis in a tertiary eye hospital. J Ophthalmic Inflamm Infect 2024; 14:36. [PMID: 39080177 PMCID: PMC11289192 DOI: 10.1186/s12348-024-00417-x] [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: 05/12/2024] [Accepted: 07/19/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE The Moraxella species is a very uncommon pathogen that leads to microbial keratitis (MK). This study aimed to evaluate the clinical features, predisposing factors, and outcomes of Moraxella keratitis in patients of a tertiary eye hospital. METHODS This retrospective study was conducted from 2015 to 2022, on patients who were admitted with the diagnosis of Moraxella keratitis confirmed by positive culture in a referral eye hospital. Demographics, predisposing factors, best-corrected visual acuity (BCVA), and prognosis were assessed. RESULTS A total of 106 individuals diagnosed with Moraxella keratitis, were analyzed. The mean age was 54.42 ± 19.43 years. The mean baseline BCVA of the patients was 2.28 ± 0.6 LogMAR, while this amount reached 1.49 ± 0.81 in the 6-month follow-up (P-value = 0.02). The mean BCVA in the six-month follow-up of the patients who needed surgical interventions was significantly lower than the patients who received only medical treatment (2.15 ± 0.65 vs. 1.29 ± 0.75 LogMAR, P-value = 0.02). Patients with diabetes and those without diabetes did not substantially vary in the prevalence of corneal perforation (P-value = 0.515). Three predisposing factors including corneal perforation (odds ratio = 19.27, P-value = 0.001), hypertension (HTN) (odds ratio = 3.62, P-value = 0.03), and older age (odds ratio = 1.03, P-value = 0.008) were significantly associated with more need for surgical interventions. CONCLUSION In this cohort, poor prognosis necessitating surgical interventions in Moraxella keratitis was found to be associated with corneal perforation, HTN, and older age.
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Affiliation(s)
- Mohammad Soleimani
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Qazvin Street, Tehran, Iran
| | - Sadra Jalali Najafabadi
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Qazvin Street, Tehran, Iran
| | - Alireza Razavi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Qazvin Street, Tehran, Iran
| | - Saeed Mirmoosavi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Asadigandomani
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Qazvin Street, Tehran, Iran.
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Das AV, Bagga B, Joseph J. Clinical Profile and Demographic Distribution of Acanthamoeba Keratitis: An Electronic Medical Record-Driven Data Analytics from an Eye Care Network in India. Ocul Immunol Inflamm 2024; 32:722-726. [PMID: 37084281 DOI: 10.1080/09273948.2023.2199331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To describe the clinical profile of patients presented with Acanthamoeba keratitis (AK) to a multi-tier ophthalmology hospital network in India. METHODS This cross-sectional hospital-based study included 1945339 new patients registering between September 2016 and May 2022. Patients with clinically confirmed diagnosis of AK in one or both eyes were included in the study. All the relevant data were documented using an electronic medical record (EMR) system. RESULTS A total of 245 (0.013%) patients were diagnosed with AK and majority were male (62.86%) with unilateral (99.59%) affliction. The most common age group was during the fourth decade of life, 65 (26.53%) patients and predominantly were adults (95.51%). The prevalence of the infection was higher in patients from a lower socioeconomic status (43.27%) from rural geography (52.24%) and in agriculture-related work (28.16%). The most common inciting factor was injury with vegetative matter (8.98%), dust (7.76%) and contact lens wear (4.49%). The majority of the eyes had blindness (20/400 to 20/1200) in 116 (47.15%) eyes with a presenting visual acuity (logMAR) of 2.14 ± 1.04. Among the surgical interventions, therapeutic keratoplasty was performed in 41 (16.67%) eyes, penetrating keratoplasty in 22 (8.94%) eyes, and evisceration in 2 (0.81%) eyes. CONCLUSION AK more commonly affects males presenting during the fourth decade of life from lower socio-economic status and is predominantly unilateral. A fourth of the affected eyes underwent keratoplasty and the majority had significant visual impairment at presentation.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research Centre, Hyderabad, India
| | - Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- The Ramoji Foundation Centre for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- The Ramoji Foundation Centre for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India
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Petrillo F, Tortori A, Vallino V, Galdiero M, Fea AM, De Sanctis U, Reibaldi M. Understanding Acanthamoeba Keratitis: An In-Depth Review of a Sight-Threatening Eye Infection. Microorganisms 2024; 12:758. [PMID: 38674702 PMCID: PMC11052265 DOI: 10.3390/microorganisms12040758] [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: 03/13/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but potentially sight-threatening corneal infection caused by the Acanthamoeba parasite. This microorganism is found ubiquitously in the environment, often in freshwater, soil, and other sources of moisture. Despite its low incidence, AK presents significant challenges due to delayed diagnosis and the complex nature of therapeutic management. Early recognition is crucial to prevent severe ocular complications, including corneal ulceration and vision loss. Diagnostic modalities and treatment strategies may vary greatly depending on the clinical manifestation and the available tools. With the growing reported cases of Acanthamoeba keratitis, it is essential for the ophthalmic community to thoroughly understand this condition for its effective management and improved outcomes. This review provides a comprehensive overview of AK, encompassing its epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
- Francesco Petrillo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Antonia Tortori
- Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy;
| | - Veronica Vallino
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Antonio M. Fea
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Ugo De Sanctis
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
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Vilares-Morgado R, Ferreira AM, Marques-Couto P, Madeira C, Moreira R, Torrão L, Neves-Cardoso P, Cunha AM, Rebelo S, Pinheiro-Costa J. Clinical outcomes and prognostic factors in Acanthamoeba keratitis. Cont Lens Anterior Eye 2024; 47:102119. [PMID: 38220498 DOI: 10.1016/j.clae.2023.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To report clinical findings and prognostic factors for visual and morphological outcomes in patients with Acanthamoeba keratitis (AK). METHODS Single-center, retrospective, longitudinal study of 51 cases of AK diagnosed by real-time polymerase chain reaction (RT-PCR) between March 2010 and October 2022. The primary outcome was the final best corrected visual acuity (BCVA). Poor visual outcome was defined as a final BCVA ≥ 1 logMAR unit, while good visual outcome was defined as a final BCVA < 1 logMAR unit. Eyes from these two groups were compared, regarding demographic and initial clinical variables, anti-Acanthamoeba treatment used, and complications of the disease. Early diagnosis was defined as ≤ 14 days from symptom onset to diagnostic confirmation and initiation of Acanthamoeba medical treatment. Multivariable logistic regression was used to determine predictors of poor visual outcome. RESULTS A total of 51 eyes from 46 patients diagnosed with AK, all contact lens (CL) wearers, were included in this study. Average follow-up was 39.0 ± 30.2 [total range 14-120] months. Thirty-one eyes (60.8 %) presented good visual outcome, with a lower baseline age (30.5 ± 9.0 vs. 42.3 ± 15.8; p = 0.020), better initial BCVA (0.8 ± 0.7 logMAR units vs. 1.3 ± 0.9 logMAR units; p = 0.047), higher rate of early diagnosis (45.2 % vs. 5.6 %; p = 0.004), and higher rate of therapeutic epithelial debridement (64.5 % vs. 10 %; p < 0.001). 20 eyes (39.2 %) presented poor visual outcome, with 12 eyes undergoing evisceration/enucleation (23.5 %). These 20 eyes presented a higher rate of complications (90 % vs. 61.3 %; p = 0.031). In multivariable analysis, early diagnosis of AK (OR 19.78; 95 % CI 2.07-189.11; p = 0.010) and therapeutic epithelial debridement (OR 19.02; 95 % CI 3.27-110.57; p = 0.001) were associated with a good visual outcome. CONCLUSIONS In the present study, poor visual outcome was present in 39 % of affected eyes. Early AK diagnosis (≤14 days from symptom onset) and therapeutic epithelial debridement were associated with good final visual outcome.
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Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ana Margarida Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Pedro Marques-Couto
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Neves-Cardoso
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Rebelo
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Molecular Biology Laboratory, Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Qi X, Mao H, Liu J, Dong Y, Du M, Liu T, Zhang T, Lu X, Gao H. Comparison of therapeutic effects between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis. BMC Infect Dis 2024; 24:276. [PMID: 38438857 PMCID: PMC10910827 DOI: 10.1186/s12879-024-09147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
PURPOSE To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK). METHODS This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed. RESULTS The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively. CONCLUSION Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
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Affiliation(s)
- Xiaolin Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Huilin Mao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Jinhui Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Yanling Dong
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Man Du
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Ting Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Xiuhai Lu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Hua Gao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
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Rayamajhee B, Williams NLR, Siboni N, Rodgers K, Willcox M, Henriquez FL, Seymour JR, Potts J, Johnson C, Scanes P, Carnt N. Identification and quantification of Acanthamoeba spp. within seawater at four coastal lagoons on the east coast of Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:165862. [PMID: 37541500 DOI: 10.1016/j.scitotenv.2023.165862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/08/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
Acanthamoeba is an opportunistic free-living heterotrophic protist that is the most predominant amoeba in diverse ecological habitats. Acanthamoeba causes amoebic keratitis (AK), a painful and potentially blinding corneal infection. Major risk factors for AK have been linked to non-optimal contact lens hygiene practices and Acanthamoeba contamination of domestic and recreational water. This study investigated the incidence and seasonal variation of Acanthamoeba spp. within coastal lagoons located on the eastern coast of Australia and then examined the association between Acanthamoeba and water abiotic factors and bacterial species within the water. Water samples were collected from four intermittently closed and open lagoons (ICOLLs) (Wamberal, Terrigal, Avoca and Cockrone) every month between August 2019 to July 2020 except March and April. qPCR was used to target the Acanthamoeba 18S rRNA gene, validated by Sanger sequencing. Water abiotic factors were measured in situ using a multiprobe metre and 16S rRNA sequencing (V3-V4) was performed to characterise bacterial community composition. Network analysis was used to gauge putative associations between Acanthamoeba incidence and bacterial amplicon sequence variants (ASVs). Among 206 water samples analysed, 79 (38.3%) were Acanthamoeba positive and Acanthamoeba level was significantly higher in summer compared with winter, spring, or autumn (p = 0.008). More than 50% (23/45) water samples of Terrigal were positive for Acanthamoeba which is a highly urbanised area with extensive recreational activities while about 32% (16/49) samples were positive from Cockrone that is the least impacted lagoon by urban development. All sequenced strains belonged to the pathogenic genotype T4 clade except two which were of genotype clades T2 and T5. Water turbidity, temperature, intl1 gene concentration, and dissolved O2 were significantly associated with Acanthamoeba incidence (p < 0.05). The ASVs level of cyanobacteria, Pseudomonas spp., Candidatus spp., and marine bacteria of the Actinobacteria phylum and Acanthamoeba 18S rRNA genes were positively correlated (Pearson's r ≥ 0.14). The presence of Acanthamoeba spp. in all lagoons, except Wamberal, was associated with significant differences in the composition of bacterial communities (beta diversity). The results of this study suggest that coastal lagoons, particularly those in urbanised regions with extensive water recreational activities, may pose an elevated risk to human health due to the relatively high incidence of pathogenic Acanthamoeba in the summer. These findings underscore the importance of educating the public about the rare yet devastating impact of AK on vision and quality of life, highlighting the need for collaborative efforts between public health officials and educators to promote awareness and preventive measures, especially focusing lagoons residents and travellers.
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Affiliation(s)
- Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia.
| | - Nathan L R Williams
- Climate Change Cluster, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Nachshon Siboni
- Climate Change Cluster, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Kiri Rodgers
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, Blantyre, South Lanarkshire, G72 0LH, Scotland, UK
| | - 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, Blantyre, South Lanarkshire, G72 0LH, Scotland, UK
| | - Justin R Seymour
- Climate Change Cluster, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Jaimie Potts
- Estuaries and Catchments Team, Waters Wetland Coastal Science Branch, NSW Department of Planning, Industry and Environment, Lidcombe, NSW 2141, Australia
| | - Colin Johnson
- Estuaries and Catchments Team, Waters Wetland Coastal Science Branch, NSW Department of Planning, Industry and Environment, Lidcombe, NSW 2141, Australia
| | - Peter Scanes
- Estuaries and Catchments Team, Waters Wetland Coastal Science Branch, NSW Department of Planning, Industry and Environment, Lidcombe, NSW 2141, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
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Zhang Y, Xu X, Wei Z, Cao K, Zhang Z, Liang Q. The global epidemiology and clinical diagnosis of Acanthamoeba keratitis. J Infect Public Health 2023; 16:841-852. [PMID: 37030037 DOI: 10.1016/j.jiph.2023.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/10/2023] Open
Abstract
Acanthamoeba keratitis is a rare parasitic infection of the cornea that can lead to permanent blindness if not diagnosed and treated promptly. We collected data on the incidences of Acanthamoeba keratitis from 20 countries and calculated an annual incidence of 23,561 cases, with the lowest rates in Tunisia and Belgium, and the highest in India. We analyzed 3755 Acanthamoeba sequences from the GenBank database across Asia, Europe, North America, South America, and Oceania and genotyped them into T1, T2, T3, T4, T5, T10, T11, T12, and T15. Many genotypes possess different characteristics, yet T4 is the most prevalent genotype. As efficient treatment against Acanthamoeba remains lacking, prevention from early diagnosis via staining, PCR, or in vivo confocal microscopy (IVCM) becomes significant for the condition's prognosis. IVCM is the most recommended approach for the early detection of Acanthamoeba. If IVCM is unavailable, PCR should be used as an alternative.
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Affiliation(s)
- Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China.
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Soleimani M, Izadi A, Khodavaisy S, dos Santos CO, Tehupeiory-Kooreman MC, Ghazvini RD, Hashemi SJ, Mousavi SAA, Aala F, Abdorahimi M, Aminizadeh M, Abedinifar Z, Mahmoudi S, Mohamadi A, Rezaie S, Verweij PE. Fungal keratitis in Iran: Risk factors, clinical features, and mycological profile. Front Cell Infect Microbiol 2023; 13:1094182. [PMID: 36794001 PMCID: PMC9922867 DOI: 10.3389/fcimb.2023.1094182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction This study was intended to investigate the clinical features and predisposing factors of fungal keratitis (FK), as well as molecular identification and antifungal susceptibility of causative agents in Tehran, Iran. Methods This cross-sectional study was carried out from April 2019 to May 2021. All fungi isolates were identified using conventional methods and were confirmed by DNA-PCR-based molecular assays. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) was used to identify yeast species. Minimum inhibitory concentrations (MIC) of eight antifungal agents were assessed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) microbroth dilution reference method. Results Fungal etiology was confirmed in 86 (7.23%) of 1189 corneal ulcers. A significant predisposing factor for FK was ocular trauma caused by plant materials. Therapeutic penetrating keratoplasty (PKP) was required in 60.4% of cases. The predominant fungal species isolated was Fusarium spp. (39.5%) followed by Aspergillus spp. (32.5%) and Candida spp. (16.2%). Discussion The MIC results indicate that amphotericin B may be appropriate for treating FK caused by Fusarium species. FK caused by Candida spp. can be treated with flucytosine, voriconazole, posaconazole, miconazole, and caspofungin. In developing countries such as Iran, corneal infection due to filamentous fungi is a common cause of corneal damage. In this region, fungal keratitis is observed primarily within the context of agricultural activity and subsequent ocular trauma. Fungal keratitis can be managed better with understanding the "local" etiologies and antifungal susceptibility patterns.
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Affiliation(s)
- Mohammad Soleimani
- Department of Ocular Trauma and Emergency, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Izadi
- Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran,Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,*Correspondence: Paul E. Verweij, ; Sadegh Khodavaisy,
| | - Claudy Oliveira dos Santos
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands,Laboratory of Clinical Microbiology and Infectious Diseases, Isala Hospital, Zwolle, Netherlands
| | - Marlou C. Tehupeiory-Kooreman
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Amin Ayatollahi Mousavi
- Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran,Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farzad Aala
- Department of Parasitology and Mycology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mahsa Abdorahimi
- Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
| | - Mehdi Aminizadeh
- Department of Ocular Trauma and Emergency, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Abedinifar
- Department of Ocular Trauma and Emergency, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Mohamadi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Rezaie
- Department of Chemistry and Biology, Ryerson University, Toronto, Canada
| | - Paul E. Verweij
- Centre for Expertise in Mycology, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Paul E. Verweij, ; Sadegh Khodavaisy,
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10
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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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Brown L, Leck AK, Gichangi M, Burton MJ, Denning DW. The global incidence and diagnosis of fungal keratitis. THE LANCET. INFECTIOUS DISEASES 2021; 21:e49-e57. [PMID: 33645500 DOI: 10.1016/s1473-3099(20)30448-5] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
Fungal keratitis is a severe corneal infection that often results in blindness and eye loss. The disease is most prevalent in tropical and subtropical climates, and infected individuals are frequently young agricultural workers of low socioeconomic status. Early diagnosis and treatment can preserve vision. Here, we discuss the fungal keratitis diagnostic literature and estimate the global burden through a complete systematic literature review from January, 1946 to July, 2019. An adapted GRADE score was used to evaluate incidence papers-116 studies provided the incidence of fungal keratitis as a proportion of microbial keratitis and 18 provided the incidence in a defined population. We calculated a minimum annual incidence estimate of 1 051 787 cases (736 251-1 367 323), with the highest rates in Asia and Africa. If all culture-negative cases are assumed to be fungal, the annual incidence would be 1 480 916 cases (1 036 641-1 925 191). In three case series, 8-11% of patients had to have the eye removed, which represents an annual loss of 84 143-115 697 eyes. As fungal keratitis probably affects over a million people annually, an inexpensive, simple diagnostic method and affordable treatment are needed in every country.
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Affiliation(s)
| | - Astrid K Leck
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital NHS Trust, London, UK
| | - David W Denning
- University of Manchester, Manchester, UK; National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester UK; Global Action Fund for Fungal Infections, Geneva, Switzerland.
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12
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Konda N, Garg P, Sharma S, Willcox MDP. Risk Factors for Contact Lens-Related Microbial Keratitis and Associated Vision Loss in a South Indian Population. Eye Contact Lens 2021; 47:118-126. [PMID: 33009258 DOI: 10.1097/icl.0000000000000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify risk factors associated with contact lens-related microbial keratitis (CL-MK) and subsequent vision loss in a south Indian population. METHODS A retrospective study of medical records at the LV Prasad Eye Institute in Hyderabad, India, of patients diagnosed with CL-MK and of controls who had no history of corneal inflammation during contact lens wear was undertaken. Variables such as demographic data, contact lens wear details, duration of the event, visual acuity, epithelial defect and infiltrate size, and microbiology of the cornea during the event were collected. Differences between cases and controls were analyzed using parametric and nonparametric tests. Logistic regression was used to calculate the odds ratio (OR) and associated 95% confidence intervals in univariate and multivariate analyses for cases vs. controls and for factors associated with vision loss. RESULTS One hundred sixty-seven cases of CL-MK and 153 controls were included in the analyses. Risk factors associated with the greatest increased OR for CL-related MK were: being in professional employment vs. a student (OR=3.9), disposing lenses yearly versus monthly or biweekly (OR=2.2), and any overnight wear (OR=2.8). Risk factors associated with vision loss were: high myopia (OR=3.6), severe vs. mild severity (OR=16.0), and hypopyon (OR=4.3). CONCLUSIONS Identification of these risk factors may help inform safe contact lens wear habits and management strategies.
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Affiliation(s)
- Nagaraju Konda
- School of Optometry and Vision Science (N.K., M.D.P.W.), University of New South Wales, Australia; Brien Holden Vision Institute (N.K.), Sydney, Australia; Cornea Service (P.G.), L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and Jhaveri Microbiology Centre (S.S.), Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Lacerda AG, Lira M. Acanthamoeba
keratitis: a review of biology, pathophysiology and epidemiology. Ophthalmic Physiol Opt 2020; 41:116-135. [DOI: 10.1111/opo.12752] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 01/13/2023]
Affiliation(s)
| | - Madalena Lira
- Centre of Physics University of Minho Braga Portugal
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14
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Chopra R, Mulholland PJ, Hau SC. In Vivo Confocal Microscopy Morphologic Features and Cyst Density in Acanthamoeba Keratitis. Am J Ophthalmol 2020; 217:38-48. [PMID: 32278770 DOI: 10.1016/j.ajo.2020.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To correlate in vivo confocal microscopy morphologic features (IVCM-MF) and Acanthamoeba cyst density (ACD) with final best-corrected visual acuity (BCVA) in Acanthamoeba keratitis (AK). DESIGN Retrospective cohort study. METHODS Patient demographics, treatment outcome, and corresponding IVCM-MF performed at the acute stage of infection were analyzed. Inclusion criteria were microbiological positive AK cases seen at Moorfields Eye Hospital between February 2013 and October 2017. Statistical significance was assessed by multinomial regression and multiple linear regression analysis. Main outcome measure was final BCVA. RESULTS A total of 157 eyes (157 patients) had AK. Absence of single-file round/ovoid objects was associated with a BCVA of 6/36 to 6/9 (odds ratio [OR] 8.13; 95% confidence interval [CI], 1.55-42.56, P = .013) and ≥6/6 (OR 10.50; 95% CI, 2.12-51.92, P = .004) when compared to no perception of light to 6/60. Absence of rod/spindle objects was associated with a BCVA of ≥6/6 (OR 4.55; 95% CI, 1.01-20.45, P = .048). Deep stromal/ring infiltrate was associated with single-file round/ovoid objects (OR 7.78; 95% CI, 2.69-22.35, P < .001), rod/spindle objects (OR 7.05; 95% CI, 2.11-23.59, P = .002), and binary round/ovoid objects (OR 3.45; 95% CI, 1.17-10.14, P = .024). There was a positive association between ACD and treatment duration (β = 0.14, P = .049), number of IVCM-MF (β = 0.34, P = .021), and clusters of round/ovoid objects (β = 0.29, P = .002). CONCLUSIONS Specific IVCM-MF correlate with ACD and clinical staging of disease, and are prognostic indicators for a poorer visual outcome.
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15
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Nielsen SE, Ivarsen A, Hjortdal J. Increasing incidence of Acanthamoeba keratitis in a large tertiary ophthalmology department from year 1994 to 2018. Acta Ophthalmol 2020; 98:445-448. [PMID: 31885189 DOI: 10.1111/aos.14337] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/01/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Acanthamoeba (AA) keratitis is a rare and severe infection with poor prognosis. The aim was to investigate the incidence and risk factors of AA keratitis in a large tertiary ophthalmology department in Denmark. METHODS A search was performed in our electronic patient records by the keywords: 'PHMB/polyhexanid', 'Brolene' or 'amoeba and chlorhexidine' from year 1994 to 2018, and afterwards medical records were reviewed. A total of 65 cases of AA keratitis were hereby identified. RESULTS Patients were relatively young, median (range) age of 38 (15-70) years. A significant increase of diagnosing AA keratitis occurred from 0.13 cases per million per year in the first 5 years to 2.7 cases per million per year the last 5 years. Eighty-nine per cent of patients were contact lens users, and 49% had received corticosteroids before the diagnosis was established. Severe pain was present in 34% of patients. Prognosis was poor with final visual acuity of logMAR (mean, 95% CI) 0.30 (0.18-0.41), 18% had transplantation à chaud, and 2% were enucleated. CONCLUSION The study indicates that the incidence of AA keratitis is increasing, also in Denmark. Most patients were young contact lens users. The course of the disease is long and often painful, and the prognosis is poor despite relevant treatment.
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Affiliation(s)
| | - Anders Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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16
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Naranjo A, Martinez JD, Miller D, Tonk R, Amescua G. Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis. Ocul Immunol Inflamm 2020; 29:1576-1584. [DOI: 10.1080/09273948.2020.1758156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andrea Naranjo
- Anne Bates Leach Eye Clinics, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jaime D. Martinez
- Anne Bates Leach Eye Clinics, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darlene Miller
- Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rahul Tonk
- Anne Bates Leach Eye Clinics, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Guillermo Amescua
- Anne Bates Leach Eye Clinics, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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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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18
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Orosz E, Kriskó D, Shi L, Sándor GL, Kiss HJ, Seitz B, Nagy ZZ, Szentmáry N. Clinical course of Acanthamoeba keratitis by genotypes T4 and T8 in Hungary. Acta Microbiol Immunol Hung 2019; 66:289-300. [PMID: 30835133 DOI: 10.1556/030.66.2019.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Genus Acanthamoeba is an opportunistic protozoan that is widely distributed in the environment. Within this genus, numerous species are recognized as human pathogens, potentially causing Acanthamoeba keratitis (AK). AK is a corneal disease, associated predominantly with contact lens (CL) wear; its epidemiology is related to the specific Acanthamoeba genotypes. This study reports seven CL wearer, Acanthamoeba PCR-positive patients with AK, diagnosed between January 2015 and 2018. Patients had the diagnosis of AK 1.36 months after first symptoms. Genotyping allowed the identification of six isolates of the T4 and one of the T8 genotypes. At first presentation, pseudendritiformic epithelopathy/dirty epithelium (four eyes, 57.1%), multifocal stromal infiltrates (five eyes, 71.4%), ring infiltrate (three eyes, 42.8%), and perineuritis (one eye, 14.3%) were observed. AK was healed without later recurrence in two eyes (28.5%) using triple-topical therapy, in three eyes (42.8%) following additional penetrating keratoplasty. In one patient (14.3%), AK recurred following successful application of triple-therapy and was treated successfully with repeated triple-topical therapy and in one patient (14.3%), no follow-up data were available after diagnosis. We could not observe correlation of genotype and clinical course or the necessity of corneal transplantation in our case series.
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Affiliation(s)
- Erika Orosz
- 1 Department of Parasitology, National Public Health Center, Budapest, Hungary
| | - Dorottya Kriskó
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lei Shi
- 3 Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Gábor L. Sándor
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Huba J. Kiss
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Berthold Seitz
- 3 Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Zoltán Zsolt Nagy
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Nóra Szentmáry
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- 3 Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
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Willcox MDP, Chen R, Kalaiselvan P, Yasir M, Rasul R, Kumar N, Dutta D. The Development of an Antimicrobial Contact Lens - From the Laboratory to the Clinic. Curr Protein Pept Sci 2019; 21:357-368. [PMID: 31429686 DOI: 10.2174/1389203720666190820152508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 11/22/2022]
Abstract
Contact lens wear is generally safe and provides excellent vision. However, contact lens wear is often associated with the risk of developing ocular surface infection and inflammation, and in severe cases, the infection can result in loss of vision. Antimicrobial peptide-coated contact lenses have been made to help reduce the incidence of infection and inflammation. This paper reviews the research progress from conception, through the laboratory and preclinical tests to the latest information on clinical testing of an antimicrobial contact lens. We provide insights into the pathways followed and pitfalls that have been encountered. The journey has not always been linear or smooth, but has resulted in some of the first published clinical testing of antimicrobial peptide-coated contact lenses in humans. We hope this may help lead to the development and commercialisation of antimicrobial contact lenses in the future.
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Affiliation(s)
- Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - R Chen
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - P Kalaiselvan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - M Yasir
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - R Rasul
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - N Kumar
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - D Dutta
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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20
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Shimmura-Tomita M, Takano H, Kinoshita N, Toyoda F, Tanaka Y, Takagi R, Kobayashi M, Kakehashi A. Risk factors and clinical signs of severe Acanthamoeba keratitis. Clin Ophthalmol 2018; 12:2567-2573. [PMID: 30573947 PMCID: PMC6292401 DOI: 10.2147/opth.s179360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine risk factors and clinical signs for severe Acanthamoeba keratitis (AK) by comparing severe cases with mild cases with good prognosis. Patients and methods We reviewed medical records of ten cases of AK (five males and five females) referred to our hospital and classified cases into two groups. One eye that required therapeutic keratoplasty and three eyes with a poor visual acuity (<0.2) on last visit were included in the severe group. Six eyes that had good prognosis with a visual acuity of 1.2 on last visit were classified as mild group. We compared patients’ age, the time required for diagnosis, visual acuity on first visit, the history of steroid eye drops use, and other clinical findings. Results The average age of the severe group was older than the mild group (P=0.04). The duration between onset and diagnosis of AK and visual acuity on first visit was not statistically different. A history of steroid eye drop use was found in four eyes of the severe group (100%) and four eyes of the mild group (67%). Keratoprecipitates were found in all severe group eyes and one mild group eye during follow-up (P=0.01). One case in the severe group was diagnosed with diabetes mellitus at initial examination. We detected Staphylococcus epidermis by palpebral conjunctival culture in one case of the severe group. Conclusion Aging may be a possible risk factor for severe AK. The presence of keratoprecipitates is a possible sign of severe AK. Attention is also required in patients with comorbidities such as diabetes mellitus and bacterial infection.
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Affiliation(s)
- Machiko Shimmura-Tomita
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Hiroko Takano
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Nozomi Kinoshita
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Fumihiko Toyoda
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Yoshiaki Tanaka
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Rina Takagi
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Mina Kobayashi
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Akihiro Kakehashi
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
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Park YM, Lee JS, Yoo JM, Park JM, Seo SW, Chung IY, Kim SJ. Comparison of anterior segment optical coherence tomography findings in acanthamoeba keratitis and herpetic epithelial keratitis. Int J Ophthalmol 2018; 11:1416-1420. [PMID: 30140650 DOI: 10.18240/ijo.2018.08.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/05/2018] [Indexed: 11/23/2022] Open
Abstract
This study is to investigate the characteristic features of Acanthamoeba keratitis (AK) that differentiating it from herpetic epithelial keratitis (HEK) using anterior segment optical coherence tomography (AS-OCT). Medical records of three eyes of each AK and herpetic keratitis who had AS-OCT examination were reviewed in this study. Slit-lamp biomicroscopy and AS-OCT was performed on the initial visit and on every follow-up visits in all patients. In all three AK cases, reflective bands in the corneal stroma that correspond to the area of radial keratoneuritis were observed. The depth of the reflective bands varied in each case. After AK treatment, slit-lamp biomicroscopy confirmed that radial keratoneuritis had resolved and AS-OCT confirmed that reflective bands in the corneal stroma had also disappeared in all patients. Unlike the AS-OCT results found in AK, highly reflective HEK lesions were observed only in the subepithelial area, not in the stroma. AS-OCT seems to be helpful analyzing the specific depth of the lesion which enables to distinguish AK from HEK.
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Affiliation(s)
- Young Min Park
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju 52727, South Korea.,Gyeongsang National University Changwon Hospital, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do 51472, South Korea
| | - Jong Soo Lee
- Department of Ophthalmology, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan 49241, South Korea
| | - Ji-Myong Yoo
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju 52727, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju 52727, South Korea
| | - Jong Moon Park
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju 52727, South Korea.,Gyeongsang National University Changwon Hospital, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do 51472, South Korea
| | - Seong-Wook Seo
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju 52727, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju 52727, South Korea
| | - In-Young Chung
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju 52727, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju 52727, South Korea
| | - Seong Jae Kim
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju 52727, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju 52727, South Korea
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Lin IH, Tseng SH, Huang FC, Huang YH. Effect of ethanol pretreatment in Acanthamoeba keratitis: a long-term follow-up study. Infect Drug Resist 2018; 11:937-943. [PMID: 30013376 PMCID: PMC6038874 DOI: 10.2147/idr.s167775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this study was to evaluate the long-term outcomes of ethanol pretreatment in Acanthamoeba keratitis (AK). Patients and methods This single-center, retrospective, interventional study included 22 patients (24 eyes) who developed AK and underwent ethanol pretreatment between 2009 and 2015. Samples for smears, polymerase chain reaction, and culture for evidence of Acanthamoeba were collected. After ethanol pretreatment, the patients were treated with corneal epithelial debridement, topical 0.02% polyhexamethylene biguanide, and 0.1% propamidine isethionate. The primary outcomes were a clinically stable ocular surface, complete recovery from corneal infection, and acceptable corneal haze. The secondary outcome measure was improvement in best-corrected visual acuity. Complications and predictors of the visual outcome were also recorded. Results Ethanol pretreatment was successful in 20 (83.3%) of the 24 eyes, and no further optical keratoplasty was required. Four eyes required rescue therapeutic keratoplasty because of rapid progression of AK. Patients in whom ethanol pretreatment was successful achieved good final visual outcomes regardless of sex, age, or causative Acanthamoeba species. Patients with worse initial best-corrected visual acuity and rigid gas permeable lens-related AK had better improvement in vision. Conclusion Ethanol as a pretreatment for AK is safe and effective. Combined with corneal epithelial debridement, ethanol pretreatment may preclude the need for optical and therapeutic keratoplasty. This technique is suitable for all stages of AK presenting within 3 weeks of symptom onset and achieves favorable results especially in early AK.
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Affiliation(s)
- I-Huang Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| | - Fu-Chin Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China, .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
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