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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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Raghavan A, Rammohan R. Acanthamoeba keratitis - A review. Indian J Ophthalmol 2024; 72:473-482. [PMID: 38454853 PMCID: PMC11149514 DOI: 10.4103/ijo.ijo_2627_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 03/09/2024] Open
Abstract
This is a comprehensive review after a thorough literature search in PubMed-indexed journals, incorporating current information on the pathophysiology, clinical features, diagnosis, medical and surgical therapy, as well as outcomes of Acanthamoeba keratitis (AK). AK is a significant cause of ocular morbidity, and early diagnosis with timely institution of appropriate therapy is the key to obtaining good outcomes. The varied presentations result in frequent misdiagnosis, and co-infections can increase the morbidity of the disease. The first line of therapy continues to be biguanides and diamidines, with surgery as a last resort.
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Affiliation(s)
- Anita Raghavan
- Cornea & Refractive Surgery, Department of Microbiology, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Messina M, Tucci D, Mocini S, Marruso V, Crotti S, Said D, Dua HS, Cagini C. Increasing incidence of contact-lens-related Acanthamoeba keratitis in a tertiary ophthalmology department in an Italian population. Eur J Ophthalmol 2024:11206721241242165. [PMID: 38509758 DOI: 10.1177/11206721241242165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this paper is to report the increasing incidence of contact-lens related Acanthamoeba keratitis (AK) in a tertiary ophthalmology department in Umbria, central Italy. METHODS Observational and retrospective case series were carried out. A total of nine eyes with a diagnosis of AK were examined. All patients underwent a full slit lamp examination, in vivo confocal microscopy (IVCM) and corneal scraping. The IVCM was repeated at one and two-week and at one, three and six-month intervals. Samples of domestic tap water were also examined for PCR analysis. Patients were treated with levofloxacin0,5%, Polyhexamethylene biguanide 0.02%, and Propamidine Isetionate0,1%. RESULTS All patients were contact lens wearers. The average patient age was 27.75 (range 18-45), with three men and five women. The main clinical features were ciliary congestion, diffuse epitheliopathy with punctuated keratitis, multiple, small sub-epithelial, greyish, corneal infiltrates with epithelial defect, pseudodendritic corneal lesions, perineural infiltrates, corneal stromal cellularity, and stromal infiltrates. IVCM was indicative of Acanthamoeba in seven out of the nine eyes. All the positive IVCM images were section images showing double walled, bright-spot cysts with a clear chain-like arrangement of five or more cysts identified in three of the patients. PCR analysis of the water was negative in all cases. CONCLUSION Although PCR is the most common method used, the increased incidence of AK could mainly be related to a proper IVCM interpretation. A broad-spectrum antibiotic, such as levofloxacin might play a role in the early treatment of AK reducing the virulence of the amoeba.
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Affiliation(s)
- Marco Messina
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Davide Tucci
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Stefano Mocini
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Virginia Marruso
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Silvia Crotti
- Diagnostic Laboratory, Sperimental Zooprophylactic Institute of Umbria and Marche "Togo Rosati", Perugia, Italy
| | - Dalia Said
- Department of Ophthalmology, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Harminder Singh Dua
- Department of Ophthalmology, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
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Crispim APC, Serafim MSM, Costa AO, Abrahão JS. Could giant viruses be considered as a biotechnological tool for preventing and controlling Acanthamoeba infections? J Appl Microbiol 2024; 135:lxae044. [PMID: 38373822 DOI: 10.1093/jambio/lxae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
AIM The aim of the study was to evaluate the efficiency of mimivirus as a potential therapeutic and prophylactic tool against Acanthamoeba castellanii, the etiological agent of Acanthamoeba keratitis, a progressive corneal infection, that is commonly associated with the use of contact lenses and can lead to blindness if not properly treated. METHODS AND RESULTS Mimivirus particles were tested in different multiplicity of infection, along with commercial multipurpose contact lenses' solutions, aiming to assess their ability to prevent encystment and excystment of A. castellanii. Solutions were evaluated for their amoebicidal potential and cytotoxicity in MDCK cells, as well as their effectiveness in preventing A. castellanii damage in Madin-Darby canine kidney (MDCK) cells. Results indicated that mimivirus was able to inhibit the formation of A. castellanii cysts, even in the presence of Neff encystment solution. Mimivirus also showed greater effectiveness in controlling A. castellanii excystment compared to commercial solutions. Additionally, mimivirus solution was more effective in preventing damage caused by A. castellanii, presented greater amoebicidal activity, and were less cytotoxic to MDCK cells than commercial MPS. CONCLUSIONS Mimivirus demonstrates a greater ability to inhibit A. castellanii encystment and excystment compared to commercial multipurpose contact lens solutions. Additionally, mimivirus is less toxic to MDCK cells than those commercial solutions. New studies utilizing in vivo models will be crucial for confirming safety and efficacy parameters.
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Affiliation(s)
- Ana Paula Correia Crispim
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Mateus Sá Magalhães Serafim
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Adriana Oliveira Costa
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Jônatas Santos Abrahão
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais 31270-901, Brazil
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Dart JKG, Papa V, Rama P, Knutsson KA, Ahmad S, Hau S, Sanchez S, Franch A, Birattari F, Leon P, Fasolo A, Kominek EM, Jadczyk-Sorek K, Carley F, Hossain P, Minassian DC. The Orphan Drug for Acanthamoeba Keratitis (ODAK) Trial: PHMB 0.08% (Polihexanide) and Placebo versus PHMB 0.02% and Propamidine 0.1. Ophthalmology 2024; 131:277-287. [PMID: 37802392 DOI: 10.1016/j.ophtha.2023.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
PURPOSE To compare topical PHMB (polihexanide) 0.02% (0.2 mg/ml)+ propamidine 0.1% (1 mg/ml) with PHMB 0.08% (0.8 mg/ml)+ placebo (PHMB 0.08%) for Acanthamoeba keratitis (AK) treatment. DESIGN Prospective, randomized, double-masked, active-controlled, multicenter phase 3 study (ClinicalTrials.gov identifier, NCT03274895). PARTICIPANTS One hundred thirty-five patients treated at 6 European centers. METHODS Principal inclusion criteria were 12 years of age or older and in vivo confocal microscopy with clinical findings consistent with AK. Also included were participants with concurrent bacterial keratitis who were using topical steroids and antiviral and antifungal drugs before randomization. Principal exclusion criteria were concurrent herpes or fungal keratitis and use of antiamebic therapy (AAT). Patients were randomized 1:1 using a computer-generated block size of 4. This was a superiority trial having a predefined noninferiority margin. The sample size of 130 participants gave approximately 80% power to detect 20-percentage point superiority for PHMB 0.08% for the primary outcome of the medical cure rate (MCR; without surgery or change of AAT) within 12 months, cure defined by clinical criteria 90 days after discontinuing anti-inflammatory agents and AAT. A prespecified multivariable analysis adjusted for baseline imbalances in risk factors affecting outcomes. MAIN OUTCOME MEASURES The main outcome measure was MCR within 12 months, with secondary outcomes including best-corrected visual acuity and treatment failure rates. Safety outcomes included adverse event rates. RESULTS One hundred thirty-five participants were randomized, providing 127 in the full-analysis subset (61 receiving PHMB 0.02%+ propamidine and 66 receiving PHMB 0.08%) and 134 in the safety analysis subset. The adjusted MCR within 12 months was 86.6% (unadjusted, 88.5%) for PHMB 0.02%+ propamidine and 86.7% (unadjusted, 84.9%) for PHMB 0.08%; the noninferiority requirement for PHMB 0.08% was met (adjusted difference, 0.1 percentage points; lower one-sided 95% confidence limit, -8.3 percentage points). Secondary outcomes were similar for both treatments and were not analyzed statistically: median best-corrected visual acuity of 20/20 and an overall treatment failure rate of 17 of 127 patients (13.4%), of whom 8 of 127 patients (6.3%) required therapeutic keratoplasty. No serious drug-related adverse events occurred. CONCLUSIONS PHMB 0.08% monotherapy may be as effective (or at worse only 8 percentage points less effective) as dual therapy with PHMB 0.02%+ propamidine (a widely used therapy) with medical cure rates of more than 86%, when used with the trial treatment delivery protocol in populations with AK with similar disease severity. 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)
- John K G Dart
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research, Moorfields Biomedical Research Centre, London, United Kingdom
| | | | - Paolo Rama
- Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Saj Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research, Moorfields Biomedical Research Centre, London, United Kingdom
| | - Scott Hau
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research, Moorfields Biomedical Research Centre, London, United Kingdom
| | - Sara Sanchez
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Pia Leon
- Ophthalmic Unit, Ospedale SS Giovanni e Paolo, Venice, Italy
| | - Adriano Fasolo
- Research Unit, The Veneto Eye Bank Foundation, Venice, Italy
| | - Ewa Mrukwa Kominek
- Professor K. Gibiński University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Jadczyk-Sorek
- Professor K. Gibiński University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Fiona Carley
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Parwez Hossain
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton & University Hospitals Southampton NHS Trust, Southampton, United Kingdom; National Institute of Health Research (NIHR), Southampton Clinical Research Facility, Southampton, United Kingdom
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dos Santos M, Oliveira Costa AL, Vaz GHDS, de Souza GCA, Vitor RWDA, Martins-Duarte ÉS. Medicines for Malaria Venture Pandemic Box In Vitro Screening Identifies Compounds Highly Active against the Tachyzoite Stage of Toxoplasma gondii. Trop Med Infect Dis 2023; 8:510. [PMID: 38133442 PMCID: PMC10747034 DOI: 10.3390/tropicalmed8120510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Toxoplasmosis is a disease that causes high mortality in immunocompromised individuals, such as AIDS patients, and sequelae in congenitally infected newborns. Despite its great medical importance, there are few treatments available and these are associated with adverse events and resistance. In this work, after screening the drugs present in the Medicines for Malaria Venture Pandemic Box, we found new hits with anti-Toxoplasma gondii activity. Through our analysis, we selected twenty-three drugs or drug-like compounds that inhibited the proliferation of T. gondii tachyzoites in vitro by more than 50% at a concentration of 1 µM after seven days of treatment. Nineteen of these compounds have never been reported active before against T. gondii. Inhibitory curves showed that most of these drugs were able to inhibit parasite replication with IC50 values on the nanomolar scale. To better understand the unprecedented effect of seven compounds against T. gondii tachyzoites, an ultrastructural analysis was carried out using transmission electron microscopy. Treatment with 0.25 µM verdinexor, 3 nM MMV1580844, and 0.25 µM MMV019724 induced extensive vacuolization, complete ultrastructural disorganization, and lytic effects in the parasite, respectively, and all of them showed alterations in the division process. Treatment with 1 µM Eberconazole, 0.5 µM MMV1593541, 1 µM MMV642550, 1 µM RWJ-67657, and 1 µM URMC-099-C also caused extensive vacuolization in the parasite. The activity of these drugs against intracellular tachyzoites supports the idea that the drugs selected in the Pandemic Box could be potential future drugs for the treatment of acute toxoplasmosis.
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Affiliation(s)
- Mike dos Santos
- Laboratório de Quimioterapia de Protozoários Egler Chiari, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (G.H.d.S.V.)
| | - Andréia Luiza Oliveira Costa
- Laboratório de Quimioterapia de Protozoários Egler Chiari, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (G.H.d.S.V.)
| | - Guilherme Henrique de Souza Vaz
- Laboratório de Quimioterapia de Protozoários Egler Chiari, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (G.H.d.S.V.)
| | - Gabriela Carolina Alves de Souza
- Laboratório de Quimioterapia de Protozoários Egler Chiari, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (G.H.d.S.V.)
| | - Ricardo Wagner de Almeida Vitor
- Laboratório de Toxoplasmose, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Érica S. Martins-Duarte
- Laboratório de Quimioterapia de Protozoários Egler Chiari, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (G.H.d.S.V.)
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Soleimani M, Haydar AA, Cheraqpour K, Zeidabadinejad H, Esfandiari A, Eshaghhosseiny N, Shahmohammadi A, Banz S, Djalilian AR. In praise of povidone-iodine application in ophthalmology. Surv Ophthalmol 2023:S0039-6257(23)00143-1. [PMID: 37944600 DOI: 10.1016/j.survophthal.2023.11.002] [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: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Polyvinyl pyrrolidone or povidone-iodine (PVP-I) is a water-soluble complex formed by the combination of iodine and a water-soluble polymer, polyvinyl pyrrolidone. This complex exerts bactericidal, fungicidal, and virucidal action by gradually releasing free iodine at the site of application to react with pathogens. In ophthalmology, PVP-I is used as a disinfectant and antiseptic agent for preoperative preparation of the skin and mucous membranes and for treating contaminated wounds. PVP-I has been shown to reduce effectively the risk of endophthalmitis in various ocular procedures, including cataract surgery and intravitreal injections; however, it has also been used in the treatment of conjunctivitis, keratitis, and endophthalmitis, with promising results especially in low-resource situations. PVP-I has been associated with complications such as postoperative eye pain, persistent corneal epithelial defects, ocular inflammation, and an attendant risk of keratitis. In cases of poor PVP-I tolerance, applying PVP-I at lower concentrations or using alternative antiseptics such as chlorhexidine should be considered. We provide an update on the efficacy of PVP-I in the prophylaxis and treatment of conjunctivitis, keratitis, and endophthalmitis and a comprehensive analysis of the current literature regarding the use of PVP-I in the management of these ocular conditions. Also, PVP-I-related adverse effects and toxicities and its alternatives are discussed. The goal is to present a thorough evaluation of the available evidence and to offer practical recommendations for clinicians regarding the therapeutic usage of PVP-I in ophthalmology.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ali A Haydar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Haniyeh Zeidabadinejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amirreza Esfandiari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Soraya Banz
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; University of Edinburgh, UK.
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
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Alantary N, Heaselgrave W, Hau S. Correlation of ex vivo and in vivo confocal microscopy imaging of Acanthamoeba. Br J Ophthalmol 2023; 107:1757-1762. [PMID: 35750477 DOI: 10.1136/bjophthalmol-2022-321402] [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: 03/16/2022] [Accepted: 06/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to correlate the various forms of Acanthamoeba on ex vivo confocal microscopy (EVCM) with in vivo confocal microscopy (IVCM) and findings from cultured positive cases of Acanthamoeba keratitis. METHODS Acanthamoeba live, dead and empty cysts, and live trophozoites were prepared in vitro and inoculated into porcine cornea using a sterile 26-gauge needle and examined ex vivo using the Heidelberg Retina Tomograph II/Rostock Corneal Module. IVCM images from 12 cultured positive Acanthamoeba cases, obtained using the same instrument, were compared with EVCM findings. Phase contrast images were also obtained to compare with both EVCM and IVCM findings. The change in cyst morphology with depth was evaluated by imaging the same cysts over a defined cornea depth measurement. RESULTS EVCM morphologies for live cysts included four main types-hyper-reflective central dot with hyper-reflective outer ring, hyper-reflective central dot with hyporeflective outer region, stellate shaped hyper-reflective centre with hyporeflective outer region and hyper-reflective round/polygonal shaped cyst; one main type for dead cysts-hyper-reflective central dot with hyporeflective outer region; two main types for empty cysts- hyper-reflective central dot with hyper-reflective outer ring/hyporeflective outer region; and one main type for trophozoites-large coarse speckled area of heterogeneous hyper-reflective material. Matching IVCM images show good correlation with EVCM. Cyst morphology altered when imaged at different depths. CONCLUSION EVCM demonstrated the various forms of Acanthamoeba cyst and trophozoites can be used as a reference to identify similar structures on IVCM.
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Affiliation(s)
- Noor Alantary
- Dept Biomedical Science, University of Wolverhampton Faculty of Science and Engineering, Wolverhampton, UK
- Aston Medical School, Aston University, Birmingham, UK
| | - Wayne Heaselgrave
- Dept Biomedical Science, University of Wolverhampton Faculty of Science and Engineering, Wolverhampton, UK
| | - Scott Hau
- External Disease, Moorfields Eye Hospital, London, UK
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Azzopardi M, Chong YJ, Ng B, Recchioni A, Logeswaran A, Ting DSJ. Diagnosis of Acanthamoeba Keratitis: Past, Present and Future. Diagnostics (Basel) 2023; 13:2655. [PMID: 37627913 PMCID: PMC10453105 DOI: 10.3390/diagnostics13162655] [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: 07/20/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.
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Affiliation(s)
- Matthew Azzopardi
- Department of Ophthalmology, Royal London Hospital, London E1 1BB, UK;
| | - Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Benjamin Ng
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Rippon M, Rogers AA, Westgate S, Ousey K. Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models. J Wound Care 2023; 32:359-367. [PMID: 37300862 DOI: 10.12968/jowc.2023.32.6.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions. METHOD Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified. RESULTS The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered. CONCLUSION This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.
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Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Medical Marketing Consultant, Daneriver Consultancy Ltd, Holmes Chapel, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | | | - Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK
- Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, RCSI, Dublin, Ireland
- Chair IWII
- President Elect ISTAP
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11
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Abdullah Hamad A. In vitro Evaluation the Efficacy of Some Nnew Plant Extracts and Biocides on the Viability of Acanthamoeba castellanii. Protist 2023; 174:125966. [PMID: 37229821 DOI: 10.1016/j.protis.2023.125966] [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: 08/21/2022] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to assess the efficacy of certain plant extracts and to compare them with current biocides on the viability of Acanthamoeba castellanii cysts and trophozoites in vitro. Amoebicidal and cysticidal assays were performed against both trophozoites and cysts of Acanthamoeba castellanii (ATCC 50370). Ten plant extracts were evaluated alongside the current agents included polyhexamethylene biguanide (PHMB), octenidine and chlorhexidine digluconate. A. castellanii (ATCC 50370) was treated to serial two-fold dilutions of the test compounds and extracts in microtitre plate wells to investigate the effect on trophozoites and cysts of A. castellanii (ATCC 50370). Furthermore, the toxicity of each of the test compounds and extracts were assessed towards a mammalian cell line. Minimum trophozoite inhibitory concentration (MTIC), minimum trophozoite amoebicidal concentration (MTAC), and minimum cysticidal concentration (MCC) were used to establish A. castellanii (ATCC 50370) in vitro sensitivity. The findings of this research revealed that the biguanides PHMB, chlorhexidine, and octenidine all had excellent effectiveness against trophozoites and cysts of A. castellanii (ATCC 50370). The plant extracts testing results showed that, great activity against trophozoites and cysts ofA. castellanii (ATCC 50370) at lower concentrations. This is the first study to demonstrate that the Proskia plant extract had the lowest MCC value, which was 3.9 µg/mL. The time kill experiment confirmed this finding, as this extract reduced cysts of A. castellanii (ATCC 50370) by more than 3-log at 6 hour and by 4-log after 24 hour. The anti-amoebic efficacy of new plant extracts on the viability of A. castellanii (ATCC 50370) cysts and trophozoites was comparable to existing biocide treatments and was not toxic when tested on a mammalian cell line. This could be a promising novel Acanthamoeba treatment by using the tested plant extracts as a monotherapy against trophozoites and cysts.
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Affiliation(s)
- Anas Abdullah Hamad
- University of Fallujah, College of Veterinary Medicine, Branch of Microbiology, Iraq, AL Anbar, Fallujah, Iraq.
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12
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Novel Map Biopsy Technique to Define the Extent of Infection Before Penetrating Keratoplasty for Acanthamoeba Keratitis. Cornea 2023; 42:365-368. [PMID: 36730013 DOI: 10.1097/ico.0000000000003150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to report a novel approach of prepenetrating keratoplasty (PKP) corneal map biopsies to define the extent of Acanthamoeba cyst infiltration in recalcitrant Acanthamoeba keratitis. METHODS Corneal map biopsies were performed 1 week before PKP. Four biopsies, 1 from each peripheral corneal quadrant, were obtained to delineate the extent of microscopic infection. Histological results of these map biopsies were used to determine the size and location of the subsequent PKP. RESULTS In our first case, map biopsies revealed Acanthamoeba cysts in 2 of the 4 biopsies. This led to an inferotemporally eccentric 8.5-mm PKP. The final histology report indicated that the closest resection margin was 0.08 mm. In our second case, the peripheral map biopsies were clear and an inferiorly eccentric 8.25-mm PKP was performed. The final histology report indicated that the closest resection margin was 2.3 mm. Both grafts have remained clear at 6 months postoperatively. CONCLUSIONS Map biopsies of the cornea can achieve total removal of the corneal tissues infested with Acanthamoeba cysts and prevent reinfection of the donor graft.
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13
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Nair S, Zhu A, Jaffry M, Choudhry H, Dastjerdi MH. Povidone-Iodine Adverse Effects and Alternatives for Ocular Procedures. J Ocul Pharmacol Ther 2023; 39:207-214. [PMID: 36763602 DOI: 10.1089/jop.2022.0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Purpose: Povidone-iodine (PVI), also known as Betadine, is a widely used antiseptic agent used in several fields of medicine. In ophthalmology, it is applied as a preoperative antiseptic to prevent infectious complications that can result from surgical procedures. PVI's safety and efficacy have been extensively studied and represented in the literature; however, the incidence of adverse effects has been reported in conjunction. The aim of this paper is to compile information regarding PVIs use, safety profile, adverse effects, and possible alternatives through a review of the existing literature. Methods: Literature was compiled utilizing the database PubMed and Google Scholar using specified keywords with a total of 86 reviewed articles, after excluding search results that did not meet the inclusion criteria. Results: While the allergic potential to PVI is a highly contested topic, there are several nonallergic adverse effects of PVI that should not be overlooked. These effects include chemical burn, cytotoxic effects, and general patient discomfort. In light of these adverse effects, alternatives to PVI may be considered. However, there has been little research identifying feasible alternatives in preoperative intraocular procedures. Alternatives including chlorhexidine, polyhexamethylene biguanide (polyhexanide), and octenidine were identified as potential substitutes for PVI. Conclusions: Further study is needed to provide robust evidence regarding the efficacy profiles of these alternatives in comparison with PVI and to demonstrate comparable tolerance to PVI in intraocular procedures.
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Affiliation(s)
- Smriti Nair
- Department of Ophthalmology and Visual Science, Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aretha Zhu
- Department of Ophthalmology and Visual Science, Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mustafa Jaffry
- Department of Ophthalmology and Visual Science, Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam Choudhry
- Department of Ophthalmology and Visual Science, Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mohammad H Dastjerdi
- Department of Ophthalmology and Visual Science, Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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14
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Rippon MG, Rogers AA, Ousey K. Polyhexamethylene biguanide and its antimicrobial role in wound healing: a narrative review. J Wound Care 2023; 32:5-20. [PMID: 36630111 DOI: 10.12968/jowc.2023.32.1.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A wound offers an ideal environment for the growth and proliferation of a variety of microorganisms which, in some cases, may lead to localised or even systemic infections that can be catastrophic for the patient; the development of biofilms exacerbates these infections. Over the past few decades, there has been a progressive development of antimicrobial resistance (AMR) in microorganisms across the board in healthcare sectors. Such resistant microorganisms have arisen primarily due to the misuse and overuse of antimicrobial treatments, and the subsequent ability of microorganisms to rapidly change and mutate as a defence mechanism against treatment (e.g., antibiotics). These resistant microorganisms are now at such a level that they are of grave concern to the World Health Organization (WHO), and are one of the leading causes of illness and mortality in the 21st century. Treatment of such infections becomes imperative but presents a significant challenge for the clinician in that treatment must be effective but not add to the development of new microbes with AMR. The strategy of antimicrobial stewardship (AMS) has stemmed from the need to counteract these resistant microorganisms and requires that current antimicrobial treatments be used wisely to prevent amplification of AMR. It also requires new, improved or alternative methods of treatment that will not worsen the situation. Thus, any antimicrobial treatment should be effective while not causing further development of resistance. Some antiseptics fall into this category and, in particular, polyhexamethylene hydrochloride biguanide (PHMB) has certain characteristics that make it an ideal solution to this problem of AMR, specifically within wound care applications. PHMB is a broad-spectrum antimicrobial that kills bacteria, fungi, parasites and certain viruses with a high therapeutic index, and is widely used in clinics, homes and industry. It has been used for many years and has not been shown to cause development of resistance; it is safe (non-cytotoxic), not causing damage to newly growing wound tissue. Importantly there is substantial evidence for its effective use in wound care applications, providing a sound basis for evidence-based practice. This review presents the evidence for the use of PHMB treatments in wound care and its alignment with AMS for the prevention and treatment of wound infection.
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Affiliation(s)
- Mark G Rippon
- Huddersfield University, Huddersfield, UK.,Dane River Consultancy Ltd, Cheshire, UK
| | | | - Karen Ousey
- University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK.,School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,RCSI, Dublin, Eire
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15
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McCoy C, Patel S, Thulasi P. Update on the Management of Acanthamoeba Keratitis. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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The Activity of PHMB and Other Guanidino Containing Compounds against Acanthamoeba and Other Ocular Pathogens. Microorganisms 2022; 10:microorganisms10071375. [PMID: 35889094 PMCID: PMC9323565 DOI: 10.3390/microorganisms10071375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
In recent years, a rise in the number of contact lens users in the UK and worldwide coincided with an increased incidence of microbial keratitis. The aim of this study was to investigate the antimicrobial activities of polyhexamethylene guanidine (PHMG), polyaminopropyl biguanide (PAPB), and guazatine in comparison to the common contact lens disinfectant constituent, polyhexamethylene biguanide (PHMB). The study investigated these compounds against a broad range of organisms, including Acanthamoeba castellanii, Acanthamoeba polyphaga, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. This study demonstrated that PHMG, PAPB, and guazatine are equal in activity to PHMB against Acanthamoeba trophozoites and cysts. PHMG and PAPB are also equal in activity to PHMB against S. aureus and P. aeruginosa, whereas PHMG shows significantly better activity than PHMB against C. albicans (p < 0.001). To our knowledge, this is the first study to demonstrate the effectiveness of PHMB, PHMG, PAPB, and guazatine against Acanthamoeba and other ocular pathogens. As alternatives to PHMB, these compounds warrant further investigation for inclusion in contact lens solutions and for the treatment of keratitis.
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17
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Kaufman AR, Tu EY. Advances in the management of Acanthamoeba keratitis: A review of the literature and synthesized algorithmic approach. Ocul Surf 2022; 25:26-36. [DOI: 10.1016/j.jtos.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023]
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18
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Evaluation of Amebicidal and Cysticidal Activities of Antifungal Drug Isavuconazonium Sulfate against Acanthamoeba T4 Strains. Pharmaceuticals (Basel) 2021; 14:ph14121294. [PMID: 34959694 PMCID: PMC8707217 DOI: 10.3390/ph14121294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Acanthamoeba species of amebae are often associated with Acanthamoeba keratitis, a severe corneal infection. Isavuconazonium sulfate is an FDA-approved drug for the treatment of invasive aspergillosis and mucormycosis. This prodrug is metabolized into the active isavuconazole moiety. Isavuconazole was previously identified to have amebicidal and cysticidal activity against Acanthamoeba T4 strains, but the activity of its prodrug, isavuconazonium sulfate, against trophozoites and cysts remains unknown. Since it is not known if isavuconazonium can be metabolized into isavuconazole in the human eye, we evaluated the activities of isavuconazonium sulfate against trophozoites and cysts of three T4 genotype strains of Acanthamoeba. Isavuconazonium displayed amebicidal activity at nanomolar concentrations as low as 1.4 nM and prevented excystation of cysts at concentrations as low as 136 μM. We also investigated the cysticidal activity of isavuconazonium sulfate in combination with a currently used amebicidal drug polyhexamethylene biguanide (PHMB). Although combination of isavuconazonium with PHMB did not elicit an obvious synergistic cysticidal activity, the combination did not cause an antagonistic effect on the cysts of Acanthamoeba T4 strains. Collectively, these findings suggest isavuconazonium retains potency against Acanthamoeba T4 strains and could be adapted for Acanthamoeba keratitis treatment.
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19
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Shing B, Balen M, McKerrow JH, Debnath A. Acanthamoeba Keratitis: an update on amebicidal and cysticidal drug screening methodologies and potential treatment with azole drugs. Expert Rev Anti Infect Ther 2021; 19:1427-1441. [PMID: 33929276 PMCID: PMC8551003 DOI: 10.1080/14787210.2021.1924673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/28/2021] [Indexed: 01/10/2023]
Abstract
Introduction: Acanthamoeba encompasses several species of free-living ameba encountered commonly throughout the environment. Unfortunately, these species of ameba can cause opportunistic infections that result in Acanthamoeba keratitis, granulomatous amebic encephalitis, and occasionally systemic infection.Areas covered: This review discusses relevant literature found through PubMed and Google scholar published as of January 2021. The review summarizes current common Acanthamoeba keratitis treatments, drug discovery methodologies available for screening potential anti-Acanthamoeba compounds, and the anti-Acanthamoeba activity of various azole antifungal agents.Expert opinion: While several biguanide and diamidine antimicrobial agents are available to clinicians to effectively treat Acanthamoeba keratitis, no singular treatment can effectively treat every Acanthamoeba keratitis case.Efforts to identify new anti-Acanthamoeba agents include trophozoite cell viability assays, which are amenable to high-throughput screening. Cysticidal assays remain largely manual and would benefit from further automation development. Additionally, the existing literature on the effectiveness of various azole antifungal agents for treating Acanthamoeba keratitis is incomplete or contradictory, suggesting the need for a systematic review of all azoles against different pathogenic Acanthamoeba strains.
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Affiliation(s)
- Brian Shing
- Biomedical Sciences Graduate Division, University of California San Diego, 9500 Gilman Drive, MC 0685, La Jolla, CA 92093-0756, USA
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
| | - Mina Balen
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
- Division of Biological Sciences, University of California San Diego, San Diego, 9500 Gilman Drive, MC 0346, La Jolla, CA 92093-0756, USA
| | - James H. McKerrow
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
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20
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Mungroo MR, Khan NA, Maciver S, Siddiqui R. Opportunistic free-living amoebal pathogens. Pathog Glob Health 2021; 116:70-84. [PMID: 34602025 DOI: 10.1080/20477724.2021.1985892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Pathogenic free-living amoebae affecting the central nervous system are known to cause granulomatous amoebic encephalitis (GAE) or primary amoebic meningoencephalitis (PAM). Although hosts with impaired immunity are generally at a higher risk of severe disease, amoebae such as Naegleria fowleri and Balamuthia mandrillaris can instigate disease in otherwise immunocompetent individuals, whereas Acanthamoeba species mostly infect immunocompromised people. Acanthamoeba also cause a sight-threatening eye infection, mostly in contact lens wearers. Although infections due to pathogenic amoebae are considered rare, recently, these deadly amoebae were detected in water supplies in the USA. This is of particular concern, especially with global warming further exacerbating the problem. Herein, we describe the epidemiology, presentation, diagnosis, and management of free-living amoeba infections.
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates.,Research Institute of Health and Medical Sciences, University of Sharjah, Sharjah, UAE
| | - Sutherland Maciver
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, Sharjah, UAE
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21
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Ahmed U, Anwar A, Ong SK, Anwar A, Khan NA. Applications of medicinal chemistry for drug discovery against Acanthamoeba infections. Med Res Rev 2021; 42:462-512. [PMID: 34472107 DOI: 10.1002/med.21851] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 01/16/2023]
Abstract
Acanthamoeba is a genus of free-living amoebae, pervasively found in the environment. Most of its pathogenic species are the causative agent of sight-threatening Acanthamoeba keratitis and fatal granulomatous amoebic encephalitis. Despite the advancements in the field of chemotherapy, treating Acanthamoeba infections is still challenging due to incomplete knowledge of the complicated pathophysiology. In case of infection, the treatment regimen for the patients is often ineffective due to delayed diagnosis, poor specificity, and side-effects. Besides the resistance of Acanthamoeba cysts to most of the drugs, the recurrence of infection further complicates the recovery. Thus, it is necessary to develop an effective treatment which can eradicate these rare, but serious infections. Based on various computational and in vitro studies, it has been established that the synthetic scaffolds such as heterocyclic compounds may act as potential drug leads for the development of antiamoebic drugs. In this review, we report different classes of synthetic compounds especially heterocyclic compounds which have shown promising results against Acanthamoeba. Moreover, the antiamoebic activities of synthetic compounds with their possible mode of actions against Acanthamoeba, have been summarized and discussed in this review.
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Affiliation(s)
- Usman Ahmed
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Ayaz Anwar
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Seng-Kai Ong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Areeba Anwar
- Faculty of Defence Science and Technology, National Defence University of Malaysia, Kuala Lampur, Malaysia
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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22
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Peguda HK, Mahbub SB, Sherpa TD, Subedi D, Habibalahi A, Anwer AG, Gu Z, Willcox MDP, Goldys EM, Carnt NA. The Autofluorescence Patterns of Acanthamoeba castellanii, Pseudomonas aeruginosa and Staphylococcus aureus: Effects of Antibiotics and Tetracaine. Pathogens 2021; 10:pathogens10070894. [PMID: 34358044 PMCID: PMC8308758 DOI: 10.3390/pathogens10070894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
Abstract
Acanthamoeba Keratitis (AK) can lead to substantial vision loss and morbidity among contact lens wearers. Misdiagnosis or delayed diagnosis is a major factor contributing to poor outcomes of AK. This study aimed to assess the effect of two antibiotics and one anaesthetic drug used in the diagnosis and nonspecific management of keratitis on the autofluorescence patterns of Acanthamoeba and two common bacteria that may also cause keratitis. Acanthamoeba castellanii ATCC 30868, Pseudomonas aeruginosa ATCC 9027, and Staphylococcus aureus ATCC 6538 were grown then diluted in either PBS (bacteria) or ¼ strength Ringer’s solution (Acanthamoeba) to give final concentrations of 0.1 OD at 660 nm or 104 cells/mL. Cells were then treated with ciprofloxacin, tetracycline, tetracaine, or no treatment (naïve). Excitation–emission matrices (EEMs) were collected for each sample with excitation at 270–500 nm with increments in 5 nm steps and emission at 280–700 nm at 2 nm steps using a Fluoromax-4 spectrometer. The data were analysed using MATLAB software to produce smoothed color-coded images of the samples tested. Acanthamoeba exhibited a distinctive fluorescence pattern compared to bacteria. The addition of antibiotics and anaesthetic had variable effects on autofluorescence. Tetracaine altered the fluorescence of all three microorganisms, whereas tetracycline did not show any effect on the fluorescence. Ciprofloxacin produced changes to the fluorescence pattern for the bacteria, but not Acanthamoeba. Fluorescence spectroscopy was able to differentiate Acanthamoeba from P. aeruginosa and S. aureus in vitro. There is a need for further assessment of the fluorescence pattern for different strains of Acanthamoeba and bacteria. Additionally, analysis of the effects of anti-amoebic drugs on the fluorescence pattern of Acanthamoeba and bacteria would be prudent before in vivo testing of the fluorescence diagnostic approach in the animal models.
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Affiliation(s)
- Hari Kumar Peguda
- School of Optometry and Vision Science, University of New South Wales, Sydney 2052, Australia; (T.D.S.); (D.S.); (M.D.P.W.); (N.A.C.)
- Correspondence:
| | - Saabah B. Mahbub
- ARC Centre of Excellence for Nanoscale Biophotonics, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, Australia; (S.B.M.); (A.H.); (A.G.A.); (E.M.G.)
| | - Tashi Doma Sherpa
- School of Optometry and Vision Science, University of New South Wales, Sydney 2052, Australia; (T.D.S.); (D.S.); (M.D.P.W.); (N.A.C.)
| | - Dinesh Subedi
- School of Optometry and Vision Science, University of New South Wales, Sydney 2052, Australia; (T.D.S.); (D.S.); (M.D.P.W.); (N.A.C.)
- School of Biological Sciences, Monash University, Clayton 3800, Australia
| | - Abbas Habibalahi
- ARC Centre of Excellence for Nanoscale Biophotonics, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, Australia; (S.B.M.); (A.H.); (A.G.A.); (E.M.G.)
| | - Ayad G. Anwer
- ARC Centre of Excellence for Nanoscale Biophotonics, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, Australia; (S.B.M.); (A.H.); (A.G.A.); (E.M.G.)
| | - Zi Gu
- School of Chemical Engineering, University of New South Wales, Sydney 2052, Australia;
| | - Mark D. P. Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney 2052, Australia; (T.D.S.); (D.S.); (M.D.P.W.); (N.A.C.)
| | - Ewa M. Goldys
- ARC Centre of Excellence for Nanoscale Biophotonics, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, Australia; (S.B.M.); (A.H.); (A.G.A.); (E.M.G.)
| | - Nicole A. Carnt
- School of Optometry and Vision Science, University of New South Wales, Sydney 2052, Australia; (T.D.S.); (D.S.); (M.D.P.W.); (N.A.C.)
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23
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Shi L, Muthukumar V, Stachon T, Latta L, Elhawy MI, Gunaratnam G, Orosz E, Seitz B, Kiderlen AF, Bischoff M, Szentmáry N. The Effect of Anti-Amoebic Agents and Ce6-PDT on Acanthamoeba castellanii Trophozoites and Cysts, In Vitro. Transl Vis Sci Technol 2020; 9:29. [PMID: 33262903 PMCID: PMC7691790 DOI: 10.1167/tvst.9.12.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/13/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this study was to analyze the concentration-dependent effects of biguanides (polyhexamethylene biguanide [PHMB], chlorhexidine [CH]); diamidines (hexamidine-diisethionate [HD], propamidine-isethionate [PD], dibromopropamidine-diisethionate [DD]); natamycin (NM); miltefosine (MF); povidone iodine (PVPI), and chlorin e6 PDT on Acanthamoeba trophozoites and cysts, in vitro. Methods Strain 1BU was cultured in peptone-yeast extract-glucose medium. Trophozoites or cysts were cultured in PYG medium containing each agent at 100%, 50%, and 25% of maximum concentration for 2 hours. The percentage of dead trophozoites was determined using a non-radioactive cytotoxicity assay and trypan blue staining. Treated cysts were also maintained on non-nutrient agar Escherichia coli (E. coli) plates and observed for 3 weeks. Results All tested drugs displayed significant cytotoxic effects on 1BU cells based on the biochemical and staining-based viability assays tested. On non-nutrient agar E. coli plates, neither trophozoites nor freshly formed cysts were observed after PHMB, PD, NM, and PVPI treatment, respectively, within 3 weeks. However, CH-, HD-, DD-, and MF-treated cysts could excyst, multiply, and encyst again. Conclusions The off-label drugs PHMB, PD, NM, and PVPI are under in vitro conditions more effective against strain 1BU than CH, HD, DD, and MF. Our findings also suggest that the non-nutrient agar E. coli plate assay should be considered as method of choice for the in vitro analysis of the treatment efficacy of anti-amoebic agents. Translational Relevance Ophthalmologists may optimize the treatment regime against Acanthamoeba keratitis by pre-testing the in vitro susceptibilities of the Acanthamoeba strain against drugs of interest with the non-nutrient E. coli agar plate assay.
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Affiliation(s)
- Lei Shi
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Vithusan Muthukumar
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Tanja Stachon
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Lorenz Latta
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Mohamed Ibrahem Elhawy
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Gubesh Gunaratnam
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Erika Orosz
- Department of Parasitology, National Public Health Center, Budapest, Hungary
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Markus Bischoff
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Wekerle M, Engel J, Walochnik J. Anti-Acanthamoeba disinfection: hands, surfaces and wounds. Int J Antimicrob Agents 2020; 56:106122. [PMID: 32739477 DOI: 10.1016/j.ijantimicag.2020.106122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022]
Abstract
Acanthamoebae are facultative parasites causing rare but serious infections such as keratitis and encephalitis and are also known as vectors for several bacterial pathogens, including legionellae and pseudomonads. Acanthamoeba cysts are particularly resilient and enable the amoebae to withstand desiccation and to resist disinfection and therapy. While the search for new therapeutic options has been intensified in the past years, hand and surface disinfectants as well as topical antiseptics for preventing infections have not been studied in detail to date. The aim of this study was to screen well-known and commonly used antimicrobial products in various formulations and different concentrations for their efficacy against Acanthamoeba trophozoites and cysts, including aliphatic alcohols, quaternary ammonium compounds (QACs), peracetic acid (PAA), potassium peroxymonosulfate sulfate (PPMS) and octenidine dihydrochloride (OCT). Of all products tested, OCT and QACs showed the highest efficacy, totally eradicating both trophozoites and cysts within 1 min. The determined 50% effective concentration (EC50) for cysts was 0.196 mg/mL for OCT and 0.119 mg/mL for QACs after 1 min of exposure. PAA and PPMS showed reliable cysticidal efficacies only with prolonged incubation times of 30 min and 60 min, respectively. Aliphatic alcohols generally had limited efficacy, and only against trophozoites. In conclusion, OCT and QACs are potent actives against Acanthamoeba trophozoites and cysts at concentrations used in commercially available products, within contact times suitable for surface and hand disinfection as well as topical antisepsis.
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Affiliation(s)
- Maximilian Wekerle
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Jan Engel
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Julia Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
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Rice CA, Troth EV, Russell AC, Kyle DE. Discovery of Anti-Amoebic Inhibitors from Screening the MMV Pandemic Response Box on Balamuthia mandrillaris, Naegleria fowleri, and Acanthamoeba castellanii. Pathogens 2020; 9:E476. [PMID: 32560115 PMCID: PMC7344389 DOI: 10.3390/pathogens9060476] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Pathogenic free-living amoebae, Balamuthia mandrillaris, Naegleria fowleri, and several Acanthamoeba species are the etiological agents of severe brain diseases, with case mortality rates > 90%. A number of constraints including misdiagnosis and partially effective treatments lead to these high fatality rates. The unmet medical need is for rapidly acting, highly potent new drugs to reduce these alarming mortality rates. Herein, we report the discovery of new drugs as potential anti-amoebic agents. We used the CellTiter-Glo 2.0 high-throughput screening methods to screen the Medicines for Malaria Ventures (MMV) Pandemic Response Box in a search for new active chemical scaffolds. Initially, we screened the library as a single-point assay at 10 and 1 µM. From these data, we reconfirmed hits by conducting quantitative dose-response assays and identified 12 hits against B. mandrillaris, 29 against N. fowleri, and 14 against A. castellanii ranging from nanomolar to low micromolar potency. We further describe 11 novel molecules with activity against B. mandrillaris, 22 against N. fowleri, and 9 against A. castellanii. These structures serve as a starting point for medicinal chemistry studies and demonstrate the utility of phenotypic screening for drug discovery to treat diseases caused by free-living amoebae.
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Affiliation(s)
- Christopher A. Rice
- Department of Cellular Biology, University of Georgia, Athens, GA 30602, USA
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
| | - Emma V. Troth
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - A. Cassiopeia Russell
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - Dennis E. Kyle
- Department of Cellular Biology, University of Georgia, Athens, GA 30602, USA
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
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26
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Hendiger EB, Padzik M, Sifaoui I, Reyes-Batlle M, López-Arencibia A, Rizo-Liendo A, Bethencourt-Estrella CJ, San Nicolás-Hernández D, Chiboub O, Rodríguez-Expósito RL, Grodzik M, Pietruczuk-Padzik A, Stępień K, Olędzka G, Chomicz L, Piñero JE, Lorenzo-Morales J. Silver Nanoparticles as a Novel Potential Preventive Agent against Acanthamoeba Keratitis. Pathogens 2020; 9:pathogens9050350. [PMID: 32380785 PMCID: PMC7281428 DOI: 10.3390/pathogens9050350] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022] Open
Abstract
Free living, cosmopolitan amoebae from Acanthamoeba genus present a serious risk to human health. As facultative human parasites, these amoebae may cause Acanthamoeba keratitis (AK). Acanthamoeba keratitis is a severe, vision-threatening corneal infection with non-specific symptoms. The number of reported AK cases worldwide has been increasing every year. Moreover, 90% of Acanthamoeba keratitis cases are related to contact lens use. Wearing and storage contact lenses not in accordance with the physicians and manufacturers recommendations are the primary key risk factors of this disease. Amoebae can easily adhere to the contact lens surface and transmit to the corneal epithelium. Preventing amoebae adhesion to the contact lens surface could significantly decrease the number of AK infections. Until now, the effective therapy against AK is still under development. Currently proposed therapies are mainly limited to the chlorhexidine digluconate combined with propamidine isethionate or hexamidine applications, which are insufficient and very toxic to the eye. Due to lack of effective treatment, looking for new potential preventive agents is crucial to decrease the number of Acanthamoeba keratitis infections, especially among contact lens users. Nanoparticles have been already included in several novel therapies against bacteria, viruses, fungi, and protist. However, their anti-amoebic potential has not been fully tested yet. The aim of this study was to assess silver nanoparticles (AgNPs) and platinum nanoparticles (PtNPs) anti-amoebic activity and influence on the amoebae adhesion to the surface of four different groups of contact lenses-classified according to the Food and Drugs Administration (FDA) guidelines. The obtained results show that both tested nanoparticles were effective against Acanthamoeba trophozoites and decreased the amoebae adhesion to the contact lens surface. AgNPs showed better anti-amoebic activity to cytotoxicity dependence and reduced amoebae adhesion in a wider spectrum of the tested contact lenses. Our studies also confirmed that ionization next to hydration of the contact lens material is a crucial parameter influencing the Acanthamoeba adhesion to the contact lens surface. In conclusion, silver nanoparticles might be considered as a novel preventive agent against Acanthamoeba keratitis infection.
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Affiliation(s)
- Edyta B. Hendiger
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
| | - Marcin Padzik
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
- Correspondence: ; Tel.: +48-503-151-318
| | - Ines Sifaoui
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - María Reyes-Batlle
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Atteneri López-Arencibia
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Aitor Rizo-Liendo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Carlos J. Bethencourt-Estrella
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Desirée San Nicolás-Hernández
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Olfa Chiboub
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
- Laboratoire Matériaux-Molécules et Applications, La Marsa, University of Carthage, 2070 Carthage, Tunisia
| | - Rubén L. Rodríguez-Expósito
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Marta Grodzik
- Department of Nanobiotechnology and Experimental Ecology, Institute of Biology, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
| | - Anna Pietruczuk-Padzik
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research and Technology (CePT), Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland; (A.P.-P.); (K.S.)
| | - Karolina Stępień
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research and Technology (CePT), Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland; (A.P.-P.); (K.S.)
| | - Gabriela Olędzka
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
| | - Lidia Chomicz
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
| | - José E. Piñero
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Jacob Lorenzo-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
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