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Feizi S, Karjou Z, Esfandiari H. Lately Diagnosed Acanthamoeba Keratitis Manifesting as an Intrastromal Corneal Abscess: A Case Report. Eye Contact Lens 2023; 49:569-571. [PMID: 37713628 DOI: 10.1097/icl.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/17/2023]
Abstract
ABSTRACT A 42-year-old female contact lens wearer presented to a local emergency department with a 3-day history of decreased vision and ocular discomfort in her right eye. She was started on topical fluorometholone and oral acyclovir with initial diagnosis of herpes simplex keratitis. After 3 weeks of worsening symptoms, she was diagnosed with bacterial corneal ulcer and treated with levofloxacin eye drops every 2 hr. After 14 days of no improvement, she was referred to our clinic for further workup. Slitlamp examination demonstrated a solitary dense 3×3-mm infiltration involving anterior and central corneal stroma. The overlying epithelium was intact, and there was no subepithelial infiltration, radial perineuritis, keratic precipitates, or anterior chamber reaction. Corneal sensation was normal. Confocal microscopy and corneal biopsy were definitive for Acanthamoeba infection. The patient received polyhexamethylene biguanide 0.02% every 2 hr and oral ketoconazole 200 mg twice a day, which resulted in improvement in her signs and symptoms within 10 days. The medications were gradually tapered off over 5 months per clinical response. At the 9-month follow-up visit, the best-corrected visual acuity was 5/10 with a superficial central stromal scar at slitlamp examination. Acanthamoeba infection should be considered in contact lens wearers who present with intrastromal corneal abscess.
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Affiliation(s)
- Sepehr Feizi
- Ocular Tissue Engineering Research Center (S.F., Z.K.), Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and Department of Ophthalmology (H.E.), Olmsted Medical Center, Rochester, MN
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Chomicz L, Szaflik JP, Szostakowska B, Izdebska J, Baltaza W, Łazicka-Gałecka M, Kuligowska A, Machalińska A, Zawadzki PJ, Szaflik J. Successive Acanthamoeba Corneal Isolates Identified in Poland Monitored in Terms of In Vitro Dynamics. Microorganisms 2023; 11:1174. [PMID: 37317148 DOI: 10.3390/microorganisms11051174] [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: 03/31/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Amoebae of the genus Acanthamoeba cause a sight-threatening infection called Acanthamoeba keratitis. It is considered a rare disease in humans but poses an increasing threat to public health worldwide, including in Poland. We present successive isolates from serious keratitis preliminary examined in terms of the identification and monitoring of, among others, the in vitro dynamics of the detected strains. METHODS Clinical and combined laboratory methods were applied; causative agents of the keratitis were identified at the cellular and molecular levels; isolates were cultivated in an axenic liquid medium and regularly monitored. RESULTS In a phase-contrast microscope, Acanthamoeba sp. cysts and live trophozoites from corneal samples and in vitro cultures were assessed on the cellular level. Some isolates that were tested at the molecular level were found to correspond to A. mauritanensis, A. culbertsoni, A. castellanii, genotype T4. There was variability in the amoebic strain dynamics; high viability was expressed as trofozoites' long duration ability to intense multiply. CONCLUSIONS Some strains from keratitis under diagnosis verification and dynamics assessment showed enough adaptive capability to grow in an axenic medium, allowing them to exhibit significant thermal tolerance. In vitro monitoring that was suitable for verifying in vivo examinations, in particular, was useful to detect the strong viability and pathogenic potential of successive Acanthamoeba strains with a long duration of high dynamics.
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Affiliation(s)
- Lidia Chomicz
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
| | - Jacek P Szaflik
- Department of Ophthalmology, Independent Public Clinical Ophthalmology Hospital, Medical University of Warsaw, 00-576 Warsaw, Poland
| | - Beata Szostakowska
- Department of Tropical Parasitology, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Justyna Izdebska
- Department of Ophthalmology, Independent Public Clinical Ophthalmology Hospital, Medical University of Warsaw, 00-576 Warsaw, Poland
| | - Wanda Baltaza
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Monika Łazicka-Gałecka
- Department of Ophthalmology, Independent Public Clinical Ophthalmology Hospital, Medical University of Warsaw, 00-576 Warsaw, Poland
| | - Agnieszka Kuligowska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Paweł J Zawadzki
- Clinic of Cranio-Maxillo-Facial and Oral Surgery and Implantology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Jerzy Szaflik
- Laser Eye Microsurgery Centre Clinic of Prof. Jerzy Szaflik, Brand Med Medical Research Centre, 00-215 Warsaw, Poland
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Padua MFFE, Masangkay FR, Alejandro GJD, Milanez GDJ. Detection of Acanthamoeba spp. in groundwater sources in a rural area in the Philippines. JOURNAL OF WATER AND HEALTH 2023; 21:138-146. [PMID: 36705503 DOI: 10.2166/wh.2023.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Research on free-living amoebae (FLA) and its public health implication as an etiologic agent of parasitic infection in humans has recently gained traction in the Philippines. This study aimed to identify potential FLAs in collected groundwater samples from Masinloc, Zambales, Philippines. Fifty-four (54) water samples were collected in 250-mL sterile polyethylene containers by purposive sampling from selected groundwater sources in six (6) barangays of Masinloc. The samples were vacuum filtered through a 1.2-μm pore glass microfiber filter, cultured onto non-nutrient agar (NNA) lawned with Escherichia coli, and observed microscopically for amoebic growth for 14 days using light microscopy. Amoebic growth was observed in 11.1% (6/54) of water samples. DNAs from positive samples were extracted and were made to react with polymerase chain reaction using Acanthamoeba-specific JDP1 (5'-GGCCCAGATCGTTTACCGTGAA-3') and JDP2 (5'-TCTCACAAGCTGCTAGGGAGTCA-3') primers, and universal primer Euk A (5'-AACCTGGTTGATCCTGCCAGT-3') and Euk B (5'-TGATCCTTCTGCAGGTTCACCTAC-3'). The presence of Acanthamoeba genotypes T4, T7, and T11 was confirmed using molecular and phylogenetic analysis. Our results confirmed that groundwater sources from two of six sampling sites (33.3%) in Masinloc, Zambales, were contaminated with potentially pathogenic FLAs. Proper identification of risk factors that may cause contamination consequently leads to the implementation of programs that will prevent future infections.
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Affiliation(s)
- Mark F F E Padua
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines; Department of Medical Technology, Far Eastern University, Manila 1008, Philippines
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1015, Philippines E-mail:
| | | | - Giovanni De Jesus Milanez
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1015, Philippines E-mail:
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Chen L, Kuang L, Ross AE, Farhat W, Boychev N, Sharfi S, Kanu LN, Liu L, Kohane DS, Ciolino JB. Topical Sustained Delivery of Miltefosine Via Drug-Eluting Contact Lenses to Treat Acanthamoeba Keratitis. Pharmaceutics 2022; 14:pharmaceutics14122750. [PMID: 36559244 PMCID: PMC9781349 DOI: 10.3390/pharmaceutics14122750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
This study aimed to develop a miltefosine-eluting contact lens (MLF-CL) device that would allow sustained and localized miltefosine release for the treatment of Acanthamoeba keratitis. MLF-CLs were produced in three different miltefosine doses by solvent-casting a thin miltefosine-polymer film around the periphery of a methafilcon hydrogel, which was then lathed into a contact lens. During seven days of in vitro testing, all three formulations demonstrated sustained release from the lens at theoretically therapeutic levels. Based on the physicochemical characterization of MLF-CLs, MLF-CL's physical properties are not significantly different from commercial contact lenses in terms of light transmittance, water content and wettability. MLF-CLs possessed a slight reduction in compression modulus that was attributed to the inclusion of polymer-drug films but still remain within the optimal range of soft contact lenses. In cytotoxicity studies, MLF-CL indicated up to 91% viability, which decreased proportionally as miltefosine loading increased. A three-day biocompatibility test on New Zealand White rabbits revealed no impact of MLF-CLs on the corneal tissue. The MLF-CLs provided sustained in vitro release of miltefosine for a week while maintaining comparable physical features to a commercial contact lens. MLF-CL has a promising potential to be used as a successful treatment method for Acanthamoeba keratitis.
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Affiliation(s)
- Lin Chen
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Liangju Kuang
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (L.K.); (J.B.C.)
| | - Amy E. Ross
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Wissam Farhat
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Nikolay Boychev
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Sina Sharfi
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Levi N. Kanu
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Daniel S. Kohane
- Department of Anesthesia, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Joseph B. Ciolino
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (L.K.); (J.B.C.)
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Taghipour T, Rasti S, Saba M, Delavari M, Moosavi GA, Hooshyar H, Eslamirad Z. Molecular detection and genotype identification of Acanthamoeba species from bronchoalveolar lavage of patients with pulmonary symptoms suspected of cancer. J Parasit Dis 2022; 46:1028-1035. [PMID: 36457768 PMCID: PMC9606164 DOI: 10.1007/s12639-022-01524-z] [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: 03/17/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022] Open
Abstract
Acanthamoeba spp. are the most common free-living amoeba worldwide, inducing life-threatening diseases such as Granulomatous Amoebic Encephalitis, pulmonary infection, and amoebic keratitis. This study aimed to identify the FLA and Acanthamoeba genotypes in patients with pulmonary symptoms suspected of cancer in Kashan's hospitals, Kashan, Iran. This cross-sectional study was conducted on 97 bronchoalveolar lavage samples of patients with respiratory symptoms suspected of lung cancer, who were admitted to the Shahid Beheshti Hospital of Kashan from 2019 to 2020. The samples were cultured onto 1.5% non-nutrient agar enriched with killed Escherichia coli and examined for the presence of FLA. Following amoeba isolation and DNA extraction, Acanthamoeba spp. were determined by Polymerase Chain Reaction using JDP1 and JDP2 primers, which amplified a 490 bp fragment from the 18 S rDNA gene. Eighteen Acanthamoeba isolates were sequenced, and the genotypes were identified. The prevalence of FLA and Acanthamoeba and the relationship between symptoms and demographic variables were analyzed with SPSS Software version 16. The prevalence rates of FLA and Acanthamoeba in the BAL samples was 86.6% and 73.2%, respectively. All Acanthamoeba isolates belonged to the T4 genotype. The most symptoms among Acanthamoeba-positive patients were dyspnea and cough; however, their difference was not statistically significant. The findings indicated the high prevalence of FLA and Acanthamoeba in BAL in the population suspected of cancer in Kashan. Since the T4 genotype is a pathogenic genotype of Acanthamoeba, training health and improving sanitation levels would help to prevent infection.
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Affiliation(s)
- Tayebeh Taghipour
- Department of Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Sima Rasti
- Department of Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammadali Saba
- Department of Internal Medicine, Faculty of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdi Delavari
- Department of Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Gholam Abbas Moosavi
- Department of Statistics and Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Hooshyar
- Department of Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Eslamirad
- Department of Parasitology and Mycology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
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Antiamoebic Activity of Imidazothiazole Derivatives against Opportunistic Pathogen Acanthamoeba castellanii. Antibiotics (Basel) 2022; 11:antibiotics11091183. [PMID: 36139962 PMCID: PMC9494960 DOI: 10.3390/antibiotics11091183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
We examined the antiamoebic effect of several imidazothiazole derivatives on Acanthamoeba castellanii of the T4 genotype. Trypan blue exclusion assays and haemocytometer counting were used to determine the reduction in A. castellanii trophozoite proliferation, in response to treatment with these compounds. To determine the effects of these compounds on host cells, lactate dehydrogenase assay was performed using HeLa cell lines. Amoebicidal assays revealed that the tested compounds at concentrations of 50 µM significantly inhibited amoebae trophozoites compared to controls. Compounds 1m and 1zb showed the highest amoebicidal effects eradicating 70% and 67% of A. castellanii, respectively. The compounds blocked both the encystation and excystation process in A. castellanii. Compounds 1m and 1zb blocked 61% and 55%, respectively, of amoeba binding to human cells. Moreover, the compounds showed minimal cytotoxic effects against host cells and considerably reduced amoeba-mediated host cell death. Overall, our study revealed that compounds 1m and 1zb have excellent antiamoebic potential, and should be considered in the development of curative antiamoebic medications in future studies. Further work is critical to determine the translational value of these findings.
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Shah YS, Stroh IG, Zafar S, Zhang N, Sriparna M, Shekhawat N, Ghos Z, Srikumaran D, Woreta FA. Delayed diagnoses of Acanthamoeba keratitis at a tertiary care medical centre. Acta Ophthalmol 2021; 99:916-921. [PMID: 33583148 DOI: 10.1111/aos.14792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/22/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the prevalence and reasons for delays in diagnosis in patients with Acanthamoeba keratitis (AK) presenting to Wilmer Eye Institute, Baltimore, Maryland. METHODS This retrospective study analysed all patients with culture-positive AK seen between 2012 and 2019 at a tertiary referral centre. Patient demographic information, clinical history, risk factors, symptom duration, referral patterns, slit lamp examination findings, visual acuity and need for surgery were collected. RESULTS The study included 45 eyes of 43 patients. On average, patients were symptomatic for 52.6 days before culture collection. Thirty-one percent of patients were diagnosed within 28 days of symptom onset while 69% were diagnosed after 28 days. Before presentation to a tertiary care centre, 69% of patients were evaluated by an ophthalmologist outside of this institution and 27% were evaluated by a provider other than an ophthalmologist. AK was most commonly misdiagnosed as herpetic keratitis, occurring in 38% of patients. The strongest risk factor for AK was contact lens use. Only 11% of patients presented with the classic ring infiltrate and 82% had pain. Patients with an early versus late diagnosis had a mean Snellen visual acuity (VA) of 20/224 versus 20/296 at presentation (p = 0.33) and a mean Snellen VA of 20/91 versus 20/240 at final visit (p = 0.07). 11% of patients required a therapeutic penetrating keratoplasty. CONCLUSION Delayed diagnosis of AK in our cohort occurred due to a misdiagnosis as herpetic keratitis, non-specific clinical signs including the lack of pain in a number of patients, and a delay in referral to a tertiary care centre. Any contact lens wearer with an atypical keratitis should be referred promptly for Acanthamoeba cultures.
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Affiliation(s)
- Yesha S Shah
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Inna G Stroh
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Zhang
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manjari Sriparna
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nakul Shekhawat
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zara Ghos
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Challenges in Acanthamoeba Keratitis: A Review. J Clin Med 2021; 10:jcm10050942. [PMID: 33804353 PMCID: PMC7957573 DOI: 10.3390/jcm10050942] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
To review challenges in the diagnosis and management of Acanthamoeba keratitis (AK), along with prognostic factors, in order to help ophthalmologists avoid misdiagnosis, protracted treatment periods, and long-term negative sequelae, with an overarching goal of improving patient outcomes and quality of life, we examined AK studies published between January 1998 and December 2019. All manuscripts describing clinical manifestations, diagnosis, treatment, prognosis, and challenges in short- and long-term management were included. The diagnosis of AK is often challenging. An increased time between symptom onset and the initiation of appropriate therapy is associated with poorer visual outcomes. The timely initiation of standardized antiamoebic therapies improves visual outcomes, decreases the duration of treatment, and reduces the chances of needing surgical intervention. In clinical practice, AK diagnosis is often missed or delayed, leading to poorer final visual outcomes and a negative impact on patient morbidity and quality of life.
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Bonini S, Di Zazzo A, Varacalli G, Coassin M. Acanthamoeba Keratitis: Perspectives for Patients. Curr Eye Res 2020; 46:771-776. [PMID: 33151784 DOI: 10.1080/02713683.2020.1846753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To unveil the long-term prognosis of Acanthamoeba keratitis based on clinical presentation and timing of diagnosis to better inform patients since the first visit regarding their length of treatment, quality of life, and visual function.Methods: Retrospective observational study enrolling patients with Acanthamoeba keratitis from 1994 to 2019. Patients with a complete eye examination and medical records were analyzed. The severity of the disease, the time from onset of symptoms to the appropriate therapeutic regimen, the time until clinical resolution, visual function, and long term follow-up was evaluated. Quality of life was assessed at the last follow-up visit by means of the VFQ-25 questionnaire.Results: Thirty-five patients (40 eyes) were assessed. The overall healing time of patients with Acanthamoeba keratitis was 12.5 ± 3.5 months, while patients with a severe corneal ulcer (stage III) had a significant longer healing time (16.2 ± 3.7 months) compared to patients with stage II (7.04 ± 0.7 months) or I (7.7 ± 1.5 months; p < .05). Patients who received a prompt therapy (<30 days form symptoms onset) had a reduced healing time compared to patients with a delayed diagnosis (p < .01). Quality of life was assessed after a mean of 11.7 ± 4.7 years and it was mildly reduced (86.6 ± 17). Patients that were diagnosed early (<30 days from onset) showed a lower reduction in quality of life than in patients that were diagnosed >30 days from onset. After resolution, 59% of the patients considered unnecessary any further proposed surgical intervention.Conclusions: Delayed diagnosis of Acanthamoeba keratitis and disease severity significantly increases healing time and duration of treatment. The time to diagnosis and disease stage at diagnosis predicts the duration of treatment, the final outcome, quality of life, and the requirement of surgery. These data would allow us to promptly inform patients about long-term disease timeline, future outcomes, improving disease acceptance, and quality of life.
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Affiliation(s)
- Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Varacalli
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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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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Drug Discovery against Acanthamoeba Infections: Present Knowledge and Unmet Needs. Pathogens 2020; 9:pathogens9050405. [PMID: 32456110 PMCID: PMC7281112 DOI: 10.3390/pathogens9050405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
Although major strides have been made in developing and testing various anti-acanthamoebic drugs, recurrent infections, inadequate treatment outcomes, health complications, and side effects associated with the use of currently available drugs necessitate the development of more effective and safe therapeutic regimens. For any new anti-acanthamoebic drugs to be more effective, they must have either superior potency and safety or at least comparable potency and an improved safety profile compared to the existing drugs. The development of the so-called 'next-generation' anti-acanthamoebic agents to address this challenge is an active area of research. Here, we review the current status of anti-acanthamoebic drugs and discuss recent progress in identifying novel pharmacological targets and new approaches, such as drug repurposing, development of small interfering RNA (siRNA)-based therapies and testing natural products and their derivatives. Some of the discussed approaches have the potential to change the therapeutic landscape of Acanthamoeba infections.
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