The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7‐year review of presentation, diagnosis and outcomes (2009–2016)

McKelvie, James; Alshiakhi, Moaz; Ziaei, Mohammed; Patel, Dipika V.; McGhee, Charles N J

doi:10.1111/ceo.13166

Cited by 42 publications

(38 citation statements)

References 45 publications

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“…It is widely known that contact lens wear is the main risk factor for the development of AK in developed countries. The percentage of patients wearing contact lenses in our series was 95, comparable to 93.5–96% and 96–100% in recent studies from the United Kingdom and New Zealand [11,14]. Soft contact lens wearers were slightly overrepresented in our study population: 74% versus 67% of the contact lens wearers in the general Dutch population [15].…”

Section: Discussionsupporting

confidence: 82%

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The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes

et al. 2019

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Purpose To evaluate the incidence of Acanthamoeba keratitis in the Netherlands between 2009 and 2015 and to analyse predicting factors for treatment outcome. Methods Patient characteristics, diagnostic methods, diagnostic delay, therapy prior to and after diagnosis, and visual outcome were obtained from medical files of all patients diagnosed with Acanthamoeba keratitis in the Netherlands between 2009 and 2015. A logistic regression analysis on treatment failure, defined as a best corrected visual acuity of less than 20/40 Snellen decimals (i.e. >0.3 logMAR or an approximate loss of three lines of visual acuity) and/or the need for keratoplasty, was performed to determine predicting factors. Results Two hundred and twenty-four eyes of 224 patients were included. Ninety-five percent of the patients were contact lens wearers, of whom 74% wore soft contact lenses. The number of cases increased from 16 in 2009 to 49 in 2015. This resulted in an estimated incidence of 1 in 21,000 for soft contact lens wearers in 2015. Eighty-seven eyes (39%) met the criteria for treatment failure. In a multivariable regression analysis, higher age at presentation, a higher severity stage and corticosteroid use before diagnosis were positively correlated with treatment failure. Early referral to a cornea specialist was associated with better clinical outcomes. Conclusions Although Acanthamoeba keratitis is still a relatively uncommon disease, the incidence in soft contact lens wearers has increased to reach 1 in 21,000 in 2015. Treatment failure occurred in 39% of cases, with age, higher severity stage, corticosteroid use before diagnosis and indirect referral to a cornea specialist as important risks factors.

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Section: Discussionsupporting

confidence: 82%

“…Most cases occurred in summer and autumn, as is shown in Fig 2. A high AK incidence in summer and autumn was also found in studies from Canada and New Zealand [10,11]. An American study reported high incidences in June and November, which correlated to the number of amoebae found in surface water [12].…”

Section: Discussionmentioning

confidence: 64%

The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes

et al. 2019

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“…AK is an emerging disease with an increasing number of cases presenting each year worldwide, mostly due to the increasing use of contact lens 2. Several papers showed that the incidence of AK was recently increasing in UK, India, and New Zealand 3–5. Additionally, recent AK cases (2013–2015) were reported to be more severe than previous (2009–2012) cases 6.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and clinical signs of severe <em>Acanthamoeba</em> keratitis

Shimmura-Tomita

Takano

Kinoshita

et al. 2018

OPTH

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PurposeTo determine risk factors and clinical signs for severe Acanthamoeba keratitis (AK) by comparing severe cases with mild cases with good prognosis.Patients and methodsWe reviewed medical records of ten cases of AK (five males and five females) referred to our hospital and classified cases into two groups. One eye that required therapeutic keratoplasty and three eyes with a poor visual acuity (<0.2) on last visit were included in the severe group. Six eyes that had good prognosis with a visual acuity of 1.2 on last visit were classified as mild group. We compared patients’ age, the time required for diagnosis, visual acuity on first visit, the history of steroid eye drops use, and other clinical findings.ResultsThe average age of the severe group was older than the mild group (P=0.04). The duration between onset and diagnosis of AK and visual acuity on first visit was not statistically different. A history of steroid eye drop use was found in four eyes of the severe group (100%) and four eyes of the mild group (67%). Keratoprecipitates were found in all severe group eyes and one mild group eye during follow-up (P=0.01). One case in the severe group was diagnosed with diabetes mellitus at initial examination. We detected Staphylococcus epidermis by palpebral conjunctival culture in one case of the severe group.ConclusionAging may be a possible risk factor for severe AK. The presence of keratoprecipitates is a possible sign of severe AK. Attention is also required in patients with comorbidities such as diabetes mellitus and bacterial infection.

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“…Indeed, some cultures may take days to weeks to become positive. For example, a recent study showed positive microscopy or culture results for acanthamoeba in 27.1% of laboratory samples, with positive results reported at a mean of 9.4 days . The diagnostic sensitivity of corneal scrape culture in acanthamoeba keratitis is also low (33% [95% CI, 9.9%‐65.1%]) …”

Section: Diagnosing Infective Keratitismentioning

confidence: 99%

In vivo confocal microscopy of the inflamed anterior segment: A review of clinical and research applications

Patel

Zhang

McGhee

2019

Clinical Exper Ophthalmology

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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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The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7‐year review of presentation, diagnosis and outcomes (2009–2016)

Abstract: AK is a rare vision-threatening protozoal infection with rapidly-increasing incidence in New Zealand, predominantly affecting CL users. Diagnosis is often challenging and when delayed is associated with worse outcomes. IVCM offers rapid diagnosis with high sensitivity.

Cited by 42 publications

References 45 publications

The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes

The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes

Risk factors and clinical signs of severe <em>Acanthamoeba</em> keratitis

In vivo confocal microscopy of the inflamed anterior segment: A review of clinical and research applications

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