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Toba B, Lagali N. Use of in vivo confocal microscopy in suspected Acanthamoeba keratitis: a 12-year real-world data study at a Swedish regional referral center. J Ophthalmic Inflamm Infect 2024; 14:43. [PMID: 39254750 PMCID: PMC11387576 DOI: 10.1186/s12348-024-00424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 08/22/2024] [Indexed: 09/11/2024] Open
Abstract
PURPOSE To report real-world data (RWD) on the use of in vivo confocal microscopy (IVCM) in handling cases of suspected Acanthamoeba keratitis (AK) cases at a regional referral center during a 12-year period. METHODS Retrospective study of patients with suspected AK presenting at a regional referral center for IVCM in Sweden from 2010 to 2022. Demographics, symptoms, outcomes, and clinical management were analyzed, and IVCM images were interpreted. RESULTS Of 74 included patients with suspected AK, 18 (24%) were IVCM-positive, 33 (44%) were IVCM-negative, 15 had inconclusive IVCM results (20.2%), and 8 (11%) were referred for a second opinion based on IVCM, 4 of which were IVCM-positive (5.5%), yielding an overall IVCM-positive rate of 29.5%. Cultures were taken in 38 cases (51%) with only 2 cases (2.7%) culture-positive for AK. Of IVCM-negative cases, cultures were taken in 22 (67%) of cases and 100% of these were AK-negative. IVCM-positive cases had more clinic visits (median 30, P = 0.018) and longer follow-up time (median 890 days, P = 0.009) than IVCM-negative patients, while visual acuity improvement did not differ (P > 0.05). Of IVCM-positive cases, 10 (56%) underwent surgery despite prior anti-amoebic treatment, and 14 (78%) had 3 or more IVCM examinations during follow-up, with cysts (100%), dendritic cells (89%) and inflammatory infiltrate (67%) as the most prevalent features. Longitudinal IVCM indicated improvement in cysts, dendritic cells and subbasal nerves with treatment, while clinical resolution was not always consistent with complete absence of cysts. CONCLUSIONS In a real-world setting, IVCM has a high reliability in classifying AK-negative cases, while IVCM detects AK-positive cases more frequently than the gold-standard culture method, leading to its preferential use over the culture method where time or resources are limited. Despite this, a subset of cases are IVCM-inconclusive, the clinical course of referred patients is long requiring many hospital visits, and visual acuity in most cases does not improve with medical treatment alone. Information sharing across centers and standardization of referral and diagnostic routines is needed to exploit the full potential of IVCM in AK patient management.
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Affiliation(s)
- Bogdana Toba
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, 581 83, Sweden
| | - Neil Lagali
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, 581 83, Sweden.
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
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Curro-Tafili K, Verbraak FD, de Vries R, van Nispen RMA, Ghyczy EAE. Diagnosing and monitoring the characteristics of Acanthamoeba keratitis using slit scanning and laser scanning in vivo confocal microscopy. Ophthalmic Physiol Opt 2024; 44:131-152. [PMID: 37916883 DOI: 10.1111/opo.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/09/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Acanthamoeba keratitis (AK) is a serious and potentially blinding ocular infection caused by the free-living amoeba, Acanthamoeba. In vivo confocal microscopy (IVCM) is a non-invasive device which has been proven of great use to diagnose Acanthamoeba infections immediately. The aim of this review was to establish different patterns and signs of AK that appear on the IVCM both before and after treatment. METHODS A systematic review of the literature from 1974 until September 2021 was performed using Embase and PubMed, following The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Twenty different signs of AK were observed using IVCM. The included studies used vastly different criteria to diagnose infections, ranging from just 1 to 13 of the signs, demonstrating the current lack of a standardised diagnosis of this infection using the IVCM. The appearance of double wall cysts, trophozoites, signet rings, target signs and clusters were shown to be pathognomonic to AK infections. Bright spots located in the corneal epithelium were demonstrated as non-reliable predictors of AK. The presence of cysts in clusters and single file can predict the need for corneal transplantation. The morphological changes in cysts using the IVCM following treatment were described as breaking down to hollow forms and occasionally surrounded by black cavities. Using this information, a visual guideline for identifying AK signs in diagnosis and follow-up using IVCM was created. CONCLUSION Increased awareness of the different signs and patterns of AK that appear on the IVCM is crucial in order to correctly identify an infection and increase the potential of this device. Our guidelines presented here can be used, but further studies are needed in order to determine the relationship and aetiology of these signs and cellular changes on the IVCM both before and after anti-amoeba treatment.
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Affiliation(s)
- K Curro-Tafili
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - F D Verbraak
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - R M A van Nispen
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - E A E Ghyczy
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Moshtaghion SM, Abolhosseini M, Yaseri M, Hosseini SB, Kanavi MR. Diagnostic accuracy of confocal scan in detecting acanthamoeba keratitis and fungal keratitis: a systematic review and meta-analysis. Int Ophthalmol 2023; 43:3011-3022. [PMID: 36977847 DOI: 10.1007/s10792-023-02689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Acanthamoeba keratitis (AK) and fungal keratitis (FK) are two microbial keratitis that cause serious damage and, without early accurate diagnosis and treatment, may lead to blindness. In vivo corneal confocal scan, as an emerging ocular diagnostic method in comparison with microbiological smears and cultures as the gold standard, may assist in accelerating appropriate diagnosis. OBJECTIVE To determine the diagnostic accuracy of confocal scan for the diagnosis of AK and FK. METHODS Data were collected via a comprehensive literature search of PubMed, Web of Science, Cochrane Library, Embase and Scopus using keywords related to diagnostic accuracy of confocal scan in AK and FK up to October 2022. Pooled data underwent meta-analysis in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic odds ratio (DOR) of confocal scan for the diagnosis of AK and FK. RESULTS The final 14 relevant studies were identified, including 1950 eyes. Meta-analysis in AK group revealed 94% sensitivity, 87% specificity, 89% PPV, 92% NPV, and DOR of 143.32, and in FK group disclosed 88% sensitivity, 85% specificity, 85% PPV, 88% NPV, and DOR of 75.98. CONCLUSION The accuracy of confocal scan for the diagnosis of AK was significantly more than that for detecting FK; despite the limitations such as limited numbers of available retrospective studies for the detection of FK, confocal scan had an acceptable performance in detecting FK eyes. The overall performance of NCS was similar with that of HRT-RCM for the detection of both types of keratitis.
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Affiliation(s)
- Seyed Mohamadmehdi Moshtaghion
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard St., Boostan 9 St., Pasdaran Ave., Tehran, 1666673111, Iran
- Department of Regeneration and Cell Therapy, Andalusian Molecular Biology and Regenerative Medicine Centre (CABIMER), Avda. Américo Vespucio 24, 41092, Seville, Spain
| | - Mohammad Abolhosseini
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard St., Boostan 9 St., Pasdaran Ave., Tehran, 1666673111, Iran
- Department of Confocal Scan, Central Eye Bank of Iran, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard St., Boostan 9 St., Pasdaran Ave., Tehran, 1666673111, Iran.
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Wojtkowiak-Giera A, Derda M, Łanocha-Arendarczyk N, Kolasa A, Kot K, Walczykiewicz J, Solarczyk P, Kosik-Bogacka D. The Immunological Changes in the Skin of BALC/c Mice with Disseminated Acanthamoebiasis. Pathogens 2023; 12:pathogens12050631. [PMID: 37242301 DOI: 10.3390/pathogens12050631] [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: 03/25/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Toll-like receptors (TLR) are involved in the recognition of numerous pathogens, including Acanthamoeba spp. Thanks to this, it is possible for immune cells to recognize microorganisms and trigger the body's innate immune response. The stimulation of TLRs also leads to the activation of specific immunity. The aim of the study was to determine the TLR2 and TLR4 gene expression in the skin of BALC/c mice infected with Acanthamoeba with AM22 strain isolated from a patient. Receptor expression was assessed by real-time polymerase chain reaction (qPCR) in the amoeba-infected host with normal (A) and reduced immunity (AS) as well as in the control host with normal immunity (C) and reduced immunity (CS). Statistical analysis of TLR2 gene expression in A and AS groups compared to C and CS groups, respectively, were statistically insignificant. In the A group, we found statistical upregulation of TLR4 gene expression at 8 dpi compared to the C group. While in AS group, TLR4 gene expression was at a similar level, such as in the CS group. Taking into account the host's immune status, the TLR4 gene expression was statistically higher in the skin of host from A group than in host from AS group at the beginning of the infection. Increased TLR4 gene expression in hosts with normal immunity infected with Acanthamoeba suggests the involvement of the studied receptor in the course of acanthamoebiasis. The above research results provide new data on the involvement of the studied receptor in the skin in the host's immune defense triggered during the Acanthamoeba infection.
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Affiliation(s)
- Agnieszka Wojtkowiak-Giera
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Monika Derda
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Agnieszka Kolasa
- Department of Histology and Embryology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Karolina Kot
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Joanna Walczykiewicz
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Piotr Solarczyk
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Danuta Kosik-Bogacka
- Independent of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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Zhang Y, Xu X, Wei Z, Cao K, Zhang Z, Liang Q. The global epidemiology and clinical diagnosis of Acanthamoeba keratitis. J Infect Public Health 2023; 16:841-852. [PMID: 37030037 DOI: 10.1016/j.jiph.2023.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/10/2023] Open
Abstract
Acanthamoeba keratitis is a rare parasitic infection of the cornea that can lead to permanent blindness if not diagnosed and treated promptly. We collected data on the incidences of Acanthamoeba keratitis from 20 countries and calculated an annual incidence of 23,561 cases, with the lowest rates in Tunisia and Belgium, and the highest in India. We analyzed 3755 Acanthamoeba sequences from the GenBank database across Asia, Europe, North America, South America, and Oceania and genotyped them into T1, T2, T3, T4, T5, T10, T11, T12, and T15. Many genotypes possess different characteristics, yet T4 is the most prevalent genotype. As efficient treatment against Acanthamoeba remains lacking, prevention from early diagnosis via staining, PCR, or in vivo confocal microscopy (IVCM) becomes significant for the condition's prognosis. IVCM is the most recommended approach for the early detection of Acanthamoeba. If IVCM is unavailable, PCR should be used as an alternative.
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Affiliation(s)
- Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China.
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Müller-Morales CA, Vera-Duarte GR, Oliva-Bienzobas V, Ramirez-Miranda A, Navas A, Graue-Hernandez EO. Use of Amniotic Membrane Transplant and Deep Anterior Keratoplasty in a Patient with Bilateral Acanthamoeba Infectious Keratitis: A Case Report. Case Rep Ophthalmol 2023; 14:568-575. [PMID: 37901622 PMCID: PMC10601850 DOI: 10.1159/000533988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/03/2023] [Indexed: 10/31/2023] Open
Abstract
The aim of this study was to report a case with the use of amniotic membrane transplant and deep anterior keratoplasty in a patient with bilateral Acanthamoeba infectious keratitis as a treatment. A 20-year-old male presented with bilateral Acanthamoeba keratitis (AK) who was initially diagnosed with herpetic keratitis receiving full antiviral and corticosteroid topical treatment without any improvement. Corneal biopsy was performed to confirm the suspected diagnosis, and Acanthamoeba stromal cysts were identified in the sample. Treatment was initiated with 0.02% chlorhexidine, 0.1% propamidine isethionate, neomycin, and tropicamide/phenylephrine. Symptoms and clinical improvement were achieved between the 8th and 10th weeks, so corticosteroids were initiated. Treatment was continued until we observed a poor response in the left eye; therefore, an epithelial scraping and amniotic membrane placement were performed. Lately, the right eye underwent a deep anterior lamellar keratoplasty. A challenging case of bilateral AK managed with topical medications, amniotic membrane, and corneal keratoplasty. The earlier the disease is diagnosed, the better the outcome. If the diagnosis is delayed, the amoebas have penetrated deep into the corneal stroma, and successful therapy becomes difficult. A surgical option can be an early solution with a good prognosis for these cases.
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Affiliation(s)
- Carlos A Müller-Morales
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Guillermo Raul Vera-Duarte
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Valeria Oliva-Bienzobas
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Alejandro Navas
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
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7
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Pastrana C, Guerreiro JRL, Elumalai M, Carpena-Torres C, Crooke A, Carracedo G, Prado M, Huete-Toral F. Dual-Mode Gold Nanoparticle-Based Method for Early Detection of Acanthamoeba. Int J Mol Sci 2022; 23:ijms232314877. [PMID: 36499204 PMCID: PMC9740238 DOI: 10.3390/ijms232314877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Acanthamoeba keratitis is an aggressive and rapidly progressing ocular pathology whose main risk factor is the use of contact lenses. An early and differential diagnosis is considered the main factor to prevent the progression and improve the prognosis of the pathology. However, current diagnosis techniques require time, complex and costly materials making an early diagnosis challenging. Thus, there is a need for fast, accessible, and accurate methods for Acanthamoeba detection by practitioners for timely and suitable treatment and even for contact lens user as preventive diagnosis. Here, we developed a dual-mode colorimetric-based method for fast, visual, and accurate detection of Acanthamoeba using gold nanoparticles (AuNPs). For this strategy, AuNPs were functionalized with thiolated probes and the presence of target Acanthamoeba genomic sequences, produce a colorimetric change from red to purple. This approach allows the detection of 0.02 and 0.009 μM of the unamplified Acanthamoeba genome by the naked eye in less than 20 min and by color analysis using a smartphone. Additionally, real samples were successfully analyzed showing the potential of the technology considering the lack of point-of-care tools that are mostly needed.
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Affiliation(s)
- Cristina Pastrana
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
- Correspondence: (C.P.); (J.R.L.G.)
| | - J. Rafaela L. Guerreiro
- Food Quality and Safety Group, International Iberian Nanotechnology Laboratory (INL), Av. Mestre José Veiga, 4715-330 Braga, Portugal
- BioMark@ISEP, School of Engineering of the Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal
- CEB/LABBELS, Center of Biological Engineering, Minho University, Campus de Gualtar, Rua da Universidade, 4710-057 Braga, Portugal
- Correspondence: (C.P.); (J.R.L.G.)
| | - Monisha Elumalai
- Food Quality and Safety Group, International Iberian Nanotechnology Laboratory (INL), Av. Mestre José Veiga, 4715-330 Braga, Portugal
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Carlos Carpena-Torres
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
| | - Almudena Crooke
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
| | - Gonzalo Carracedo
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
| | - Marta Prado
- Food Quality and Safety Group, International Iberian Nanotechnology Laboratory (INL), Av. Mestre José Veiga, 4715-330 Braga, Portugal
| | - Fernando Huete-Toral
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
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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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In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography Analysis of the Microcystic Keratitis. J Ophthalmol 2020; 2020:8871904. [PMID: 33489348 PMCID: PMC7803116 DOI: 10.1155/2020/8871904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of bilateral acute microcystic epitheliopathy after daily soft contact lens wear. Methods IVCM and AS-OCT were used in the course of the bilateral epitheliopathy of a 23-year-old patient at the acute stage of the disease and at recovery after four days of treatment. The images were analyzed and compared. Results On AS-OCT of the right eye, general hyperreflectivity and the increased thickness of the central corneal epithelium to 150 μm with numerous hyporeflective small, oval cysts were revealed and resolved completely at day 4 after diagnosis and treatment. AS-OCT scans of the left eye revealed oval shaped, hyperreflective material within the corneal epithelium. IVCM of both eyes showed numerous microcysts of different sizes filled with hyperreflective material mostly within superficial epithelial layers. Epithelial cells showed a polymorphism along with disruption of a cytoarchitecture. Basal epithelial cells and anterior stroma showed inflammatory changes. Posterior corneal stroma and endothelium presented normal morphology. Conclusions Microcystic keratitis appeared as localized microcystic inflammation of epithelium on AS-OCT, which was confirmed by IVCM. Both IVCM and AS-OCT are helpful diagnostic instruments in case of cystic inflammation of corneal epithelium.
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Chopra R, Mulholland PJ, Hau SC. In Vivo Confocal Microscopy Morphologic Features and Cyst Density in Acanthamoeba Keratitis. Am J Ophthalmol 2020; 217:38-48. [PMID: 32278770 DOI: 10.1016/j.ajo.2020.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To correlate in vivo confocal microscopy morphologic features (IVCM-MF) and Acanthamoeba cyst density (ACD) with final best-corrected visual acuity (BCVA) in Acanthamoeba keratitis (AK). DESIGN Retrospective cohort study. METHODS Patient demographics, treatment outcome, and corresponding IVCM-MF performed at the acute stage of infection were analyzed. Inclusion criteria were microbiological positive AK cases seen at Moorfields Eye Hospital between February 2013 and October 2017. Statistical significance was assessed by multinomial regression and multiple linear regression analysis. Main outcome measure was final BCVA. RESULTS A total of 157 eyes (157 patients) had AK. Absence of single-file round/ovoid objects was associated with a BCVA of 6/36 to 6/9 (odds ratio [OR] 8.13; 95% confidence interval [CI], 1.55-42.56, P = .013) and ≥6/6 (OR 10.50; 95% CI, 2.12-51.92, P = .004) when compared to no perception of light to 6/60. Absence of rod/spindle objects was associated with a BCVA of ≥6/6 (OR 4.55; 95% CI, 1.01-20.45, P = .048). Deep stromal/ring infiltrate was associated with single-file round/ovoid objects (OR 7.78; 95% CI, 2.69-22.35, P < .001), rod/spindle objects (OR 7.05; 95% CI, 2.11-23.59, P = .002), and binary round/ovoid objects (OR 3.45; 95% CI, 1.17-10.14, P = .024). There was a positive association between ACD and treatment duration (β = 0.14, P = .049), number of IVCM-MF (β = 0.34, P = .021), and clusters of round/ovoid objects (β = 0.29, P = .002). CONCLUSIONS Specific IVCM-MF correlate with ACD and clinical staging of disease, and are prognostic indicators for a poorer visual outcome.
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Patel DV, Zhang J, McGhee CN. In vivo confocal microscopy of the inflamed anterior segment: A review of clinical and research applications. Clin Exp Ophthalmol 2020; 47:334-345. [PMID: 30953391 DOI: 10.1111/ceo.13512] [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: 09/30/2018] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022]
Abstract
In vivo confocal microscopy (IVCM) allows non-invasive imaging of the living human cornea, specifically enabling the detection of immune cells in the healthy and diseased ocular anterior segment. Studies using IVCM have provided insight into the effects of contact lens wear on corneal Langerhans cell density and morphology, and the effects of eye drops on conjunctiva-associated lymphoid tissue. IVCM has also been shown to be a useful adjunctive diagnostic tool in distinguishing infective and non-infective uveitis and in diagnosing atypical infective keratitis. In the research setting, this technology has enhanced our understanding of the role of inflammatory cells in corneal neuropathy and angiogenesis. In vivo-ex vivo correlation using animal models has helped overcome some of the difficulties in identifying cell type on IVCM images. As highlighted in this review, currently there are multiple established, and emerging, clinical and research applications for IVCM in the inflamed anterior segment.
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Affiliation(s)
- Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Nj McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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12
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Kératites interstitielles : prise en charge diagnostique et thérapeutiques. J Fr Ophtalmol 2020; 43:80-89. [DOI: 10.1016/j.jfo.2018.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
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Li S, Bian J, Wang Y, Wang S, Wang X, Shi W. Clinical features and serial changes of Acanthamoeba keratitis: an in vivo confocal microscopy study. Eye (Lond) 2019; 34:327-334. [PMID: 31292523 DOI: 10.1038/s41433-019-0482-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/10/2018] [Accepted: 04/02/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To observe the clinical features and serial changes of Acanthamoeba keratitis (AK) during medical treatment by using confocal microscopy. METHODS Thirty-seven patients (37 eyes) diagnosed with AK were included in this study. Confocal microscopy was used to observe the morphology, distribution, and density of Acanthamoeba cysts before and after medication. The differences between cysts and inflammatory cells were identified. RESULTS Acanthamoeba cysts were detected at a rate of 94.6% (35/37) by repeated confocal microscopic examinations. The cysts consisting of a lowly light-reflective wall and a high-refractive nucleus, showed cluster or chain distribution in the corneal stroma, which was different from inflammatory cells. After medical therapy, the nucleus of cysts or peripheral corneal tissue gradually dissolved to a hollow configuration. Some of the hollow cysts existed for up to 6 months. The quantity of cysts increased after 1-2 weeks of medication in 23 patients (62.1%), and then began to decrease in 13 patients (35.1 %) who were responsive to anti-amoebic treatment. CONCLUSION Acanthamoeba cysts have many typical clinical features that can be identified by confocal microscopy, which may serve as a valuable tool to guide clinical evaluation and treatment of AK.
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Affiliation(s)
- Suxia Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China.,Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jiang Bian
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yuting Wang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Shuting Wang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xin Wang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Weiyun Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China. .,Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
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Kot K, Kosik-Bogacka D, Łanocha-Arendarczyk N, Wojtkowiak-Giera A, Kolasa-Wołosiuk A. Expression of Toll-Like Receptors (TLR2 and TLR4) in the Eyes of Mice with Disseminated Acanthamoebiasis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1401894. [PMID: 31309100 PMCID: PMC6594330 DOI: 10.1155/2019/1401894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Toll-like receptors (TLRs) play a key role in the innate immune response to numerous pathogens, including Acanthamoeba spp. The aim of this study was to determine the expression of TLR2 and TLR4 in the eyes of mice following intranasal infection with Acanthamoeba spp. in relation to the host's immunological status. Amoebae used in this study were isolated from the bronchial aspirate of a patient with acute myeloid leukemia (AML) and atypical symptoms of pneumonia. We found statistically significant differences in the expression of TLR2 and TLR4 in the eye of immunocompetent mice at 8, 16, and 24 days after Acanthamoeba spp. infection (dpi) compared to control group. Immunosuppressed mice showed significant differences in the expression of TLR2 at 16 and 24 dpi compared to uninfected animals. Our results indicate that TLR2 and TLR4 are upregulated in the eyes of mice in response to Acanthamoeba spp. We suggest that it is possible for trophozoites to migrate through the optic nerve from the brain to the eyes. The course of disseminated acanthamoebiasis may be influenced by the host's immunological status, and the observed changes in expression of TLR2 and TLR4 in the host's organs may indicate the role of these receptors in the pathomechanism of acanthamoebiasis.
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Affiliation(s)
- Karolina Kot
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Danuta Kosik-Bogacka
- Independent of Pharmaceutical Botany, Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Agnieszka Wojtkowiak-Giera
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Agnieszka Kolasa-Wołosiuk
- Department of Histology and Embryology, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
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Gauthier AS, Noureddine S, Delbosc B. Interstitial keratitis diagnosis and treatment. J Fr Ophtalmol 2019; 42:e229-e237. [PMID: 31103357 DOI: 10.1016/j.jfo.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/18/2019] [Accepted: 04/18/2019] [Indexed: 11/16/2022]
Abstract
Interstitial keratitis is a non-ulcerative, non-suppurative, more or less vascularized inflammation of the corneal stroma. The corneal lesions result from the host response to bacterial, viral (40% of cases) or parasitic antigens, or from an autoimmune response (1% of cases) without active corneal infection. The natural history of the disease is divided into two phases: acute and cicatricial. This type of keratitis is less common than ulcerative bacterial keratitis, but it is a non-negligible cause of visual loss. It is associated with systemic or infectious disease and requires early diagnosis and appropriate treatment to optimize visual prognosis and avoid other complications.
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Affiliation(s)
- A-S Gauthier
- Service d'ophtalmologie, CHU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon cedex, France.
| | - S Noureddine
- Service d'ophtalmologie, CHU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon cedex, France
| | - B Delbosc
- Service d'ophtalmologie, CHU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon cedex, France; Faculté de médecine et de pharmacie, 20, rue Ambroise-Paré, 25000 Besançon, France
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Chidambaram JD, Prajna NV, Palepu S, Lanjewar S, Shah M, Elakkiya S, Macleod D, Lalitha P, Burton MJ. In Vivo Confocal Microscopy Cellular Features of Host and Organism in Bacterial, Fungal, and Acanthamoeba Keratitis. Am J Ophthalmol 2018; 190:24-33. [PMID: 29550185 PMCID: PMC5972002 DOI: 10.1016/j.ajo.2018.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine cellular features of fungal (FK), Acanthamoeba (AK), and bacterial keratitis (BK) using HRT3 in vivo confocal microscopy (IVCM). DESIGN Prospective observational cross-sectional study. METHODS Eligible participants were adults with microbiologically positive FK, AK, or BK, of size ≥ 3 mm, attending Aravind Eye Hospital from February 2012 to February 2013. Exclusion criteria were descemetocele or perforation. At presentation, IVCM imaging was performed, then corneal scrapes were obtained for culture/light microscopy. An experienced grader (masked to microbiology/clinical features) assessed IVCM images for presence/absence of normal keratocyte-like morphology, stellate interconnected cells with/without visible nuclei, dendritiform cells (DFCs), inflammatory cells in a honeycomb distribution, and organism features. Statistical significance was assessed by logistic regression, adjusted for age, sex, ulcer size, and symptom duration. Main outcome measures were presence/absence of IVCM features in FK, AK, BK. RESULTS A total of 183 participants had FK, 18 AK, 17 BK. Acanthamoeba appeared as bright spots (16/18, 89%), double-walled cysts (15/18, 83%), or signet rings (3/18, 17%), and often formed clusters after topical steroid use (univariable odds ratio [OR] 9.98, 95% confidence interval [CI] 1.02-97.96, P = .048). BK was associated with bullae in anterior stroma (OR 9.99, 95% CI: 3.11-32.06, P < .001). Honeycomb distribution of anterior stromal inflammatory cells was associated with FK (univariable OR 2.74, 95% CI: 1.01-7.40, P = .047). Aspergillus ulcers were associated with stromal DFCs (OR 11.05, 95% CI: 1.49-82.13, P = .019) and Fusarium ulcers with stellate appearance of interconnected cell processes with nuclei (OR 0.24, 95% CI: 0.09-0.65, P = .005). CONCLUSION Specific cellular and structural features observed using IVCM in microbial keratitis may be associated with organism.
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Affiliation(s)
- Jaya D Chidambaram
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | | | | | - Manisha Shah
- Aravind Medical Research Foundation, Madurai, India
| | | | - David Macleod
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Prajna Lalitha
- Aravind Eye Hospital, Madurai, India; Aravind Medical Research Foundation, Madurai, India
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Cornea Department, Moorfields Eye Hospital, London, United Kingdom
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Factors Influencing the Diagnostic Accuracy of Laser-Scanning In Vivo Confocal Microscopy for Acanthamoeba Keratitis. Cornea 2018; 37:818-823. [DOI: 10.1097/ico.0000000000001507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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De Craene S, Knoeri J, Georgeon C, Kestelyn P, Borderie VM. Assessment of Confocal Microscopy for the Diagnosis of Polymerase Chain Reaction-Positive Acanthamoeba Keratitis: A Case-Control Study. Ophthalmology 2017; 125:161-168. [PMID: 28965660 DOI: 10.1016/j.ophtha.2017.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine in vivo confocal microscopy diagnostic criteria to diagnose Acanthamoeba keratitis (AK) using polymerase chain reaction (PCR) as the reference diagnostic technique. DESIGN Retrospective case-control study. Data were recorded prospectively and analyzed retrospectively. PARTICIPANTS Fifty patients with PCR-positive AK (study group) and 50 patients with bacterial, fungal, viral, or immune keratitis featuring negative Acanthamoeba PCR results (control group). METHODS In vivo confocal microscopy performed at the acute stage of keratitis. MAIN OUTCOME MEASURES Presence of in vivo confocal microscopy images suggestive of AK. Multivariate logistic regression was used to determine the relationship between types of images and presence of PCR-positive AK. RESULTS The following 4 types of images were associated significantly with PCR-positive AK (P < 0.05): bright spots (round or ovoid hyperreflective objects with no double wall; diameter, <30 μm); target images (hyperreflective objects with hyporeflective halo; diameter, <30 μm); clusters of hyperreflective objects (diameter, <30 μm); and trophozoite-like objects (diameter, >30 μm). Specificity of both target and trophozoite images was 100%. This figure was 98.2% for clusters and 48.2% for bright spots. If the diagnosis of AK was made on presence of target images, clusters or trophozoite images (at least 1 of the 3 features), the positive predictive value of confocal microscopy was 87.5% and the negative predictive value was 58.5%. CONCLUSIONS Acanthamoeba keratitis is a serious vision-threatening disease. In vivo confocal microscopy can help in this challenging diagnosis, especially when PCR is delayed, shows negative results, or is not available. Target images and trophozoite-like images are pathognomonic of AK. Clusters of hyperreflective objects are highly specific of AK. However, the overall sensitivity of in vivo confocal microscopy features of AK is low. In addition to the clinical features, microbiological tests (direct examination and cultures of corneal scrapings), and PCR, in vivo confocal microscopy allows for more rapid diagnosis and treatment initiation, potentially leading to an improved outcome.
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Affiliation(s)
| | - Juliette Knoeri
- Federation of Ocular Infectious Diseases, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France; Institut de la Vision, INSERM, University Paris, Paris, France
| | - Cristina Georgeon
- Federation of Ocular Infectious Diseases, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France; Institut de la Vision, INSERM, University Paris, Paris, France
| | | | - Vincent M Borderie
- Federation of Ocular Infectious Diseases, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France; Institut de la Vision, INSERM, University Paris, Paris, France.
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