Acanthamoeba infection as a cause of severe keratitis in a soft contact lens wearer in Jamaica (original) (raw)
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Contact Lens-Associated Acanthamoeba Keratitis in Iran
Acanthamoeba keratitis is a vision-threatening infection caused by pathogenic species of the genus Acanthamoeba. In this study, 13 Acanthamoeba keratitis cases were diagnosed among 52 keratitis patients. To confirm the identity of Acanthamoeba at the genus level, a PCR-based method was used, and their pathogenic potential was determined using in vitro cytotoxicity assays on human corneal epithelial cells. Twelve (92.3%) of Acanthamoeba keratitis patients were contact lens wearers; among them eleven (91.7%) wore soft contact lenses. 11/13 (84.6%) isolates were axenised in liquid culture medium, of which 10 (90.9%) isolates disrupted corneal cells. Nine (69.2%) isolates showed Acanthamoeba sp. group II, and four (30.8%) showed group III morphology. To our knowledge this is the first report of determination of Acanthamoeba pathogenicity in Iran. This study confirms the importance of determination of pathogenic potential of Acanthamoeba isolates for clinical purposes.
Acanthamoeba Keratitis in Non-Contact Lens Wearers
Archives of Ophthalmology, 1991
Nine cases of Acanthamoeba keratitis not associated with contact lens wear were diagnosed between July 1987 and August 1989. Patients were treated with topical neomycin-polymyxin B-bacitracin (Neosporin) drops alone or in combination with either miconazole nitrate or ketoconazole drops. At the time of data collection four patients were available for follow-up for an average of 4 months; however, four patients were unavailable for follow-up and one is still undergoing treatment. In four patients corneal infiltrates cleared completely with topical medication (Neosporin, two patients; Neosporin plus miconazole, two patients). Simple laboratory methods were found to be adequate for the diagnosis of Acanthamoeba keratitis. Therapy with Neosporin drops can result in resolution of corneal infiltrates due to Acanthamoeba species.
Failure of chemotherapy in the first reported cases of Acanthamoeba keratitis in Pakistan
Pathogens and Global Health, 2013
Acanthamoeba keratitis is a painful and progressive infection of the cornea that can result in loss of vision. Here, for the first time in Pakistan, we report two cases of Acanthamoeba keratitis. The first patient was a 37-year-old female who presented with severe itching, redness, pain, along with loss of vision. The patient was a regular soft contact lens wearer. The second patient was a 25-year-old female who had been using soft contact lenses for the past two years. She presented with a burning sensation and extreme pain, along with loss of vision. Both patients were treated for a possible microbial keratitis with topical moxifloxacin hydrochloride drops, vancomycin drops, propamidine isethionate ointment, amphotericin B drops, and amikacin drops. However, the response was inadequate and both patients were referred for corneal transplant. Acanthamoeba castellanii was isolated by placing contact lenses and contact lens cases on non-nutrient agar plates containing a lawn of non-invasive Escherichia coli K-12 HB101 bacteria. The polymerase chain reaction (PCR) using genus-specific probes confirmed the identity of Acanthamoeba spp., whereas the morphological characteristics of trophozoites and cysts were suggestive of A. castellanii in both cases. With growing use of contact lenses for vision correction/ cosmetic use coupled with substandard lens care in this region and the possibility of non-contact lensassociated Acanthamoeba keratitis, a need for increased awareness of this sight-threatening infection is discussed further.
Diagnosis and management of Acanthamoeba keratitis
Current Opinion in Ophthalmology, 2006
Purpose of review This paper reviews the literature generated on Acanthamoeba keratitis since 1998. Recent findings Acanthamoeba infections may be on the rise. Contact lenses are the biggest risk factor for their development. Silicone hydrogel lenses are increasingly prescribed and may be 'more sticky' to Acanthamoeba organisms. Orthokeratology for the treatment of myopia has been associated with many new cases of Acanthamoeba keratitis. Daily disposable contact lenses are the safest form of soft contact lens. Patients continue to be misdiagnosed as having herpetic keratitis. Impression cytology and confocal microscopy are newer diagnostic modalities. Topical polyhexamethylene biguanide, chlorhexidine and propamidine are the mainstay of medical therapy. Amniotic membrane may be used for cases of persistent epithelial defect and to control inflammation. Penetrating keratoplasty in a medically treated eye affords a good chance of positive outcome. Summary Acanthamoeba keratitis continues to be a difficult infection to diagnose and manage. The frequency of these infections may be on the rise, most commonly associated with frequent replacement soft contact lenses. The best chance for a good outcome is based on early diagnosis, so it is important for ophthalmologists consider it in patients, especially in the contact lens wearer with suspected herpes simplex keratitis.
Acanthamoeba keratitis associated with cosmetic contact lens wear
The New Zealand medical journal, 2008
Cosmetic, or novelty, contact lenses are soft hydrogel lenses worn solely to change the colour or appearance of the eye. The popularity of these lenses is increasing worldwide, particularly amongst teenage adolescents. 1 Although possessing no optical power, these lenses pose the same physiological impact on the eye and carry the same risks as vision-correcting contact lenses.
PloS one, 2024
Introduction Infectious Keratitis is one of the most common ocular emergencies seen by ophthalmologists. Our aim is to identify the risk factors and clinical features of Acanthamoeba Keratitis (AK). Methods This retrospective chart review study was conducted at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and included all the microbial keratitis cases, male and female patients of all ages. The main outcome is the differentiation between various microbial keratitis types. Results We included 134 consecutive eyes of 126 persons. We had 24 cases of acanthamoeba keratitis, 22 bacterial keratitis, 24 fungal keratitis, 32 herpetic keratitis, and 32 bacterial co-infection. Contact lens wear was found in 33 eyes (24.6%). Among acanthamoeba keratitis patients, 73% were � 39 years of age, and 73% were females (P <0.001). Also, in AK cases, epithelial defect was found in all cases (100%), endothelial plaques were found in 18 eyes (69.2%), 12 cases had radial keratoneuritis (46.2%), and ring infiltrate was found in 53.8% of AK cases. Conclusions We determined the factors that increase the risk of acanthamoeba infection and the clinical characteristics that help distinguish it from other types of microbial keratitis. Our findings
Strategies for the prevention of contact lens-related Acanthamoeba keratitis: a review
Ophthalmic and Physiological Optics, 2015
Purpose: Acanthamoeba keratitis is a severe, often sight threatening, corneal infection which in Western countries is predominantly seen in daily wear of contact lenses. This review aims to summarise the pathobiology and epidemiology of contact lens-related Acanthamoeba keratitis, and to present strategies for prevention, particularly with respect to modifiable risk factors in contact lens wear. Recent Findings: The virulence of Acanthamoeba and resistance to treatment in keratitis appears to be linked with the production of a low molecular weight protease MIP133 by the organism, in response to binding to corneal epithelial cells through a mannose binding protein, and to the ability of the organism to convert from the trophozoite to the resistant cyst form. Recent epidemiological studies in contact lens relate disease have confirmed the link between solution topping up and Acanthamoeba keratitis and have reinforced the importance of avoidance of tap water, either as part of the care for the contact lens or storage case, handling lenses with wet hands or showering while wearing lenses. In the most recent analysis from the USA, there were no strong effects for solution type, water source or water disinfection process. Wearer age, lens wear time and history to appear to be linked with Acanthamoeba keratitis. Daily disposable contact lens use would be expected to reduce the prevalence of Acanthamoeba disease although this is unproven. Summary: While Acanthamoeba keratitis remains challenging to diagnose and manage, strategies to limit the disease severity in contact lens wearers should include attention to recently identified risk factors, particularly those related to water contact. Public health awareness measures, the use of daily disposable contact lenses, a better understanding of the contribution of the host immunity and the development of standardised methods for culture of amoeba and testing of contact lens care systems against Acanthamoeba in the licensing process may be of value. Alternative treatments for the future may include those which target the mannose binding protein or the genes which control conversion to the cyst form.
Contact Lens-Related Acanthamoeba Keratitis
Optometry and Vision Science, 2009
Acanthamoeba keratitis is a rare but severe disease, with more than 95% of cases occurring in contact lens wearers. With a worldwide resurgence of contact lens-related disease, this report illustrates the clinical characteristics and treatment challenges representative of this disease. This report describes Acanthamoeba keratitis in a 47-year-old female using extended wear silicone hydrogel contact lenses, with a history of swimming in a home pool and failure to subsequently disinfect the contact lenses. The diagnosis was based on clinical signs, disease course, and confocal microscopy results despite a negative result for corneal smear and culture. The corneal signs included an epithelial defect, epithelial irregularities, anterior stromal infiltrates, perineural infiltrates, an anterior stromal ring infiltrate, and hypopyon. The case was diagnosed as an infective keratitis and treated promptly using intensive topical administration of fortified gentamicin and cephalothin. The high likelihood Acanthamoeba prompted immediate use of polyhexamethylbiguanide and chlorhexidine, with propamide and adjunct treatment using atropine and oral diclofenac. Steroids were added on day 3, and the frequency of administration of antibacterial treatment was gradually reduced and ceased by day 10. The analgesia was stopped at 3 months. The frequency of administration of antiamoeba therapy and steroid treatment was slowly reduced and all treatment was ceased after 18 months. Despite considerable morbidity in terms of the treatment duration, hospitalization, outpatient appointments, and associated disease costs, the final visual outcome (6/6) was excellent.
This study aimed to detect Acanthamoeba infection in different specimens obtained from patients with keratitis and its correlation with various host and risk factors. The study was carried out on 110 patients who were clinically suspected to have Acanthamoeba keratitis. The patients were divided into 2 groups according to contact lens use as 63 contact lens wearers (CLW) and 47 non contact lens wearers (NCLW). Obtained samples, including 110 corneal scrapings, 32 contact lenses, 32 contact lens storage cases and solutions, were subjected to cultivation on non-nutrient agar overlaid with Escherichia coli, direct smear and staining methods using trichrome and Giemsa stains. The results showed that Acanthamoeba infection was detected in 21 (19.1%) of clinically suspected cases; 17 (81%) of them were CLW and the remaining 4 (19%) positive cases were NCLW. These results revealed a significant association between Acanthamoeba infection and wearing of contact lenses (P <0.05). By examining 32 contact lenses, 32 contact lens storage cases and 32 contact lens solutions, there were 4(12.5%), 3 (9.4%) , 3 (9.4%) positive samples respectively. The difference between sources of sampling and detection of Acanthamoeba was statistically highly significant (P =0.001). In addition, the results revealed that the correlation between host factors (age, sex and residence) and Acanthamoeba infection among keratitic patients was statistically insignificant. The highest Acanthamoeba infection occurred in female keratitic patients aging 20- 30 years (47.6%) as most of them were CLW. Regarding risk factors, there was a significant correlation between Acanthamoeba infection and ocular trauma, history of contact lens use, history of swimming in swimming pools or canals (P = 0.02). In conclusion, Acanthamoeba keratitis is firmly associated with the use of improperly sterilized contact lenses, trauma or washing eyes with contaminated water. Further studies will be needed to realize the actual association between them.
Cornea, 2020
Purpose: To compare the clinical profiles and outcomes of patients with Acanthamoeba keratitis with or without mixed bacterial infection. Methods: A retrospective analysis of microbiologically confirmed AK cases presenting to a tertiary care center over a 9-year period was conducted. Fourteen eyes in the coinfected group (group 1) and 24 eyes in the AK group (group 2) were analyzed to study the differences in these 2 groups of patients. The cases were diagnosed using a conventional microscopic analysis with staining techniques confirmed by cultural methods and were treated, which tailored to the microbiology report. Results: There was no difference in the demographic profile and presenting features in the 2 groups. Duration of symptoms and history of ocular trauma, contact lens wear, and previous steroid usage were also similar for both the groups. Dense central corneal infiltrate was the common presentation for both groups (7/14 vs. 16/24 in group 1 vs. group 2). Epithelial defect without dense stromal infiltrate was significantly more common in group 1 (42.9% vs. 4.2%, P = 0.003) as a presenting clinical feature. Hypopyon was present in 8/14 of group 1 versus 9/24 of group 2 eyes (P = 0.25). No significant difference was found in the final visual acuity in pure and mixed AK cases, and the need for surgical intervention was comparable. The most common bacterial pathogen isolated in the mixed group was the Staphylococcus species. Conclusions: Bacterial coinfection is common in patients with Acanthamoeba keratitis. Coinfection did not point toward a worse clinical disease at presentation or outcome.