Diagnosis and Successful Medical Treatment of Acanthamoeba Keratitis

D'Aversa, Gerard; Stern, George A.; Driebe, William T.

doi:10.1001/archopht.1995.01100090046021

Cited by 68 publications

(28 citation statements)

References 22 publications

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“…Corneal or conjunctival swabs are generally not suitable for isolation of Acanthamoeba (482). Corneal scrapes or corneal biopsy specimens are used for culture or for identification of cysts or trophozoites in stained tissue sections (108). For culture, material from a corneal scrape can be placed onto nonnutrient agar containing E. coli or inoculated into liquid medium (174,220).…”

Section: Amebic Keratitismentioning

confidence: 99%

“…Kosrirukvongs et al (236) reported that four of five culture-proven AK patients were treated successfully with 0.006% chlorhexidine solution alone. Imidazoles such as miconazole, itraconazole, and ketoconazole have been used with limited success (32,108,186,198,261,315,482). Topical treatment with miconazole, however, has lead to epithelial toxicity.…”

Section: Amebic Keratitismentioning

confidence: 99%

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Acanthamoebaspp. as Agents of Disease in Humans

2003

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Acanthamoeba spp. are free-living amebae that inhabit a variety of air, soil, and water environments. However, these amebae can also act as opportunistic as well as nonopportunistic pathogens. They are the causative agents of granulomatous amebic encephalitis and amebic keratitis and have been associated with cutaneous lesions and sinusitis. Immuno compromised individuals, including AIDS patients, are particularly susceptible to infections with Acanthamoeba. The immune defense mechanisms that operate against Acanthamoeba have not been well characterized, but it has been proposed that both innate and acquired immunity play a role. The ameba's life cycle includes an active feeding trophozoite stage and a dormant cyst stage. Trophozoites feed on bacteria, yeast, and algae. However, both trophozoites and cysts can retain viable bacteria and may serve as reservoirs for bacteria with human pathogenic potential. Diagnosis of infection includes direct microscopy of wet mounts of cerebrospinal fluid or stained smears of cerebrospinal fluid sediment, light or electron microscopy of tissues, in vitro cultivation of Acanthamoeba, and histological assessment of frozen or paraffin-embedded sections of brain or cutaneous lesion biopsy material. Immunocytochemistry, chemifluorescent dye staining, PCR, and analysis of DNA sequence variation also have been employed for laboratory diagnosis. Treatment of Acanthamoeba infections has met with mixed results. However, chlorhexidine gluconate, alone or in combination with propamidene isethionate, is effective in some patients. Furthermore, effective treatment is complicated since patients may present with underlying disease and Acanthamoeba infection may not be recognized. Since an increase in the number of cases of Acanthamoeba infections has occurred worldwide, these protozoa have become increasingly important as agents of human disease

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Section: Amebic Keratitismentioning

confidence: 99%

Section: Amebic Keratitismentioning

confidence: 99%

Acanthamoebaspp. as Agents of Disease in Humans

2003

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“…D'Aversa et al 96 reviewed the medical records of 12 patients and found that substandard lens-care methods were used in 13 out of 14 (92.9%) eyes infected with Acanthamoeba. The use of tap water for the care of contact lenses was widely accepted as the main risk factor in Acanthamoeba infection.…”

Section: Non-compliant Contact Lens Usersmentioning

confidence: 99%

How Could Contact Lens Wearers Be at Risk of Acanthamoeba Infection? A Review

Ibrahim

Boase

Cree

2009

Journal of Optometry

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Contact lens wear is highly influential on the incidence of ulcerative keratitis worldwide, particularly in developed countries. The association between Acanthamoeba keratitis and contact lens wear is firmly established; it may account for up to 95% of the reported cases. Before the popularisation of soft contact lens wear, Acanthamoeba keratitis was extremely rare. In 2000 it was estimated that the number of contact lens wearers worldwide was about 80 million, out of whom 33 million were in the United States and 90% of them wore hydrogel soft lenses. Contact lens-related problems depend on many factors, such as lens material, wearing modality, lens hygiene, type of lens-caring solution, the degree of compliance of the lens user with lens wear and care procedures, lens overwear, sleeping in lenses, rate of changing lenses, and lens case hygiene. This paper is a thorough review of the literature aiming to highlight the role of one of the main risk factors of infectious keratitis, contact lens wear, and also to show the responsibility of lens users in aggravating this risk. RESUMENLa utilización de lentes de contacto es un factor que influye sumamente en la incidencia de la queratitis ulcerosa, en particular en los países desarrollados. La asociación entre queratitis por Acanthamoeba y el uso de lentes de contacto está firmemente establecida; podría representar aproximadamente hasta un 95% de los casos registrados. Antes de la popularización del uso de lentes de contacto, la queratitis por Acanthamoeba era muy poco frecuente. En el año 2000 se estimó que, a nivel mundial, había unos 80 millones de usuarios de lentes de contacto, de los cuales 33 millones residían en los Estados Unidos y, de ellos, el 90% utilizaban lentes de contacto blandas de hidrogel. Los problemas derivados del uso de lentes de contacto dependen de otros muchos factores, como el material del que está hecha la lente, la modalidad de uso, las medidas de higiene empleadas, el tipo de solución utilizada para la limpieza y el mantenimiento de la lente, el grado de cumplimiento terapéutico del usuario de las lentes respecto a su utilización y a su limpieza/mantenimiento, el uso de las lentes durante periodos excesivamente prolongados, el dormir con las lentes de contacto puestas, la frecuencia con la que el usuario se cambia de lentes y la limpieza de la funda de las lentes de contacto. Este artículo presenta una revisión minuciosa de la literatura, con el objetivo de resaltar el papel de uno de los principales factores de riesgo de desarrollo de queratitis infeccionsa, como es el uso de lentes de contacto, y con el fin de poner de relieve que el propio usuario de las lentes es, en ocasiones, el responsable de agravar este riesgo. (J Optom 2009;2:60-66 ©2009 Consejo General de Colegios de Ópticos-Optometristas de España) PALABRAS CLAVE: Acanthamoeba; queratitis; lentes de contacto; usuario de lentes de contacto; uso excesivo de las lentes de contacto.

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“…Pineda and Dohlman 25 have recently concluded that the role of steroids in Acanthamoeba infection is ambiguous, while D' Aversa et al 26 have advised against their use in acute infection, because of the risk of compromis ing the host inflammatory response against Acantha moeba; these workers reserve steroids for later complications. Our experience suggests that steroids have a role in controlling late immuno-inflammatory responses, when the amoebae have been killed and antigen remains bound to the corneal stroma, but this aspect clearly requires further elucidation.…”

Section: Not Active Agamst Cant Amoe a Cysts Tn Vltro 'mentioning

confidence: 99%