Acanthamoeba Keratitis: Diagnosis and Treatment Update 2009

Dart, John; Saw, Valerie P J; Kilvington, Simon

doi:10.1016/j.ajo.2009.06.009

Cited by 429 publications

(542 citation statements)

References 71 publications

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“…The most effective topical agents currently used against Acanthamoeba trophozoites and cysts are the biguanides (polyhexamethylene biguanide (PHMB) 0.02-0.06% or chlorhexidine 0.02-0.2%) in combination with diamidine (propamidine isethionate 0.1% or hexamidine 0.1%) [36,90,106,211]. The former drugs are membrane-acting cationic biocides that interact with negatively charged surface proteins of Acanthamoeba resulting in leakage of the cellular components [146].…”

Section: Treatmentmentioning

confidence: 99%

“…The main risk factors for Acanthamoeba keratitis are contact lens wear for extended periods, corneal trauma, non-sterile contact lens rinsing, swimming while wearing contact lenses and biofilm formation on contact lens [111,198]. While contact lens wear is the leading risk factor, Acanthamoeba can cause keratitis in non-contact lens wearers as well [36]. However, it is often overlooked in non-CLs users as a causative agent of keratitis, where it is usually associated with trauma and/or exposure to contaminated water, soil and organic matter.…”

Section: Introductionmentioning

confidence: 99%

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Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

181

121

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Microbial keratitis is a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. Epithelial defects and injuries are key predisposing factors making the eye susceptible to corneal pathogens. Among bacterial pathogens, the most common agents responsible for keratitis include Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumonia and Serratia species. Fungal agents of corneal infections include both filamentous as well as yeast, including Fusarium, Aspergillus, Phaeohyphomycetes, Curvularia, Paecilomyces, Scedosporium and Candida species, while in protists, Acanthamoeba spp. are responsible for causing ocular disease. Clinical features include redness, pain, tearing, blur vision and inflammation but symptoms vary depending on the causative agent. The underlying molecular mechanisms associated with microbial pathogenesis include virulence factors as well as the host factors that aid in the progression of keratitis, resulting in damage to the ocular tissue. The treatment therefore should focus not only on the elimination of the culprit but also on the neutralization of virulence factors to minimize the damage, in addition to repairing the damaged tissue. A complete understanding of the pathogenesis of microbial keratitis will lead to the rational development of therapeutic interventions. This is a timely review of our current understanding of the advances made in this field in a comprehensible manner. Coupled with the recently available genome sequence information and high throughput genomics technology, and the availability of innovative approaches, this will stimulate interest in this field.

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Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

181

121

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“…1,4,[6][7][8] Biguanides such as CHG and PHMB are the most effective cysticidal antiamoebics, and are currently used as a firstline treatment for AK. 9 Lim et al 10 compared the therapeutic outcomes for PHMB and CHG treatment and reported that, although the results were non-significant, 78% of eyes receiving PHMB and 86% of eyes receiving CHG were successfully treated.…”

Section: Introductionmentioning

confidence: 99%

Visual outcome in Japanese patients with Acanthamoeba keratitis

Yamazoe

Yamamoto

Shimazaki-Den

et al. 2012

Eye

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Purpose To identify prognostic factors affecting visual outcome in Acanthamoeba keratitis (AK) treated with topical chlorhexidine gluconate (CHG). Methods A total of 35 eyes in 34 patients with AK were treated with 0.02% topical CHG. Patients were divided into two groups according to the final visual outcome: Group 1, final visual acuity (VA) of 20/25 or greater (22 eyes); Group 2, less than 20/25 (13 eyes). We compared these groups and evaluated the effectiveness of topical CHG compared with outcomes in previous reports. Results Ring infiltrate was observed more often in Group 2 (4.5% vs 61.5%, OR 33.6, 95% confidence interval (CI) 3.4-333.9, Po0.01). The duration between onset and diagnosis of AK was significantly longer (24.9 days vs 48.4 days, OR 1.03, 95% CI 1.00-1.06, P ¼ 0.04) and VA at initial examination (log MAR) significantly lower (0.47 vs 1.59, OR 25.5, 95% CI 3.4-186.7, Po0.01) in Group 2 (visual outcome o20/25). Multivariate analysis revealed that only VA at initial examination was independently associated with worse visual outcome (adjusted OR 24.5, 95% CI 1.9-312.6, P ¼ 0.01). Seventeen (85.0%) of the 20 eyes diagnosed within 1 month and 24 (82.8%) of 29 eyes diagnosed within 2 months achieved a VA of 20/40 or greater. Conclusion VA at initial examination was the most predictive factors for final visual outcome in AK. Topical CHG was comparably effective to other treatments, including polyhexamethyl biguanide and propamidine isethionate.

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“…Fortunately, success rates in treating Acanthamoebic keratitis are more promising, with cure rates in the literature generally greater than 75-85% 38,39 .…”

Section: Acanthamoeba Keratitismentioning

confidence: 99%

Free living amoebae and human disease

Bursle¹,

Robson²

2016

Microbiol. Aust.

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Pathogenic FLA are ubiquitous protozoans and despite frequent human contact remain a rare cause of often devastating infection with poor prognosis. Given changes in climate, human encroachment into the environment, increasing immunosuppression, and improving diagnostic capacity, it is likely we will see increased cases in the future. Early diagnosis is challenging but crucial to achieving a favourable outcome. It is best facilitated by improved awareness of FLA disease, appropriate clinical suspicion and early diagnostic testing.

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Acanthamoeba Keratitis: Diagnosis and Treatment Update 2009

Cited by 429 publications

References 71 publications

Pathogenesis of microbial keratitis

Pathogenesis of microbial keratitis

Visual outcome in Japanese patients with Acanthamoeba keratitis

Free living amoebae and human disease

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