Treatment of Acanthamoeba keratitis with chlorhexidine

Kosrirukvongs, Panida; Wanachiwanawin, Darawan; Visvesvara, Govinda S.

doi:10.1016/s0161-6420(99)90169-0

Cited by 83 publications

(57 citation statements)

References 41 publications

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“…Although previous studies have investigated the treatment of AK with CHG, 10,11 we believe this study to be one of the largest studies to investigate visual outcomes in Asia. We treated all patients with topical CHG following a standardised protocol, which was different from similarly designed studies.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Visual outcome in Japanese patients with Acanthamoeba keratitis

Yamazoe

Yamamoto

Shimazaki-Den

et al. 2012

Eye

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“…The current therapy for AK is mainly based on antimicrobial agents, including polyhexamethylene biguanide combined with propamidine isethionate or chlorhexidine digluconate (4,5). Chlorhexidine alone has also been successfully used (6). However, these regimens exhibit poor efficacy because under adverse conditions Acanthamoeba trophozoites can convert to a protective cyst form, which is resistant to antimicrobial agents.…”

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confidence: 99%

Artemether Exhibits Amoebicidal Activity against Acanthamoeba castellanii through Inhibition of the Serine Biosynthesis Pathway

Deng

Wei

Man

et al. 2015

Antimicrob Agents Chemother

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dAcanthamoeba sp. parasites are the causative agents of Acanthamoeba keratitis, fatal granulomatous amoebic encephalitis, and cutaneous infections. However, there are currently no effective drugs for these organisms. Here, we evaluated the activity of the antimalarial agent artemether against Acanthamoeba castellanii trophozoites and identified potential targets of this agent through a proteomic approach. Artemether exhibited in vitro amoebicidal activity in a time-and dose-dependent manner and induced ultrastructural modification and cell apoptosis. The iTRAQ quantitative proteomic analysis identified 707 proteins that were differentially expressed after artemether treatment. We focused on phosphoglycerate dehydrogenase and phosphoserine aminotransferase in the serine biosynthesis pathway because of their importance to the growth and proliferation of protozoan and cancer cells. The expression of these proteins in Acanthamoeba was validated using quantitative real-time PCR and Western blotting after artemether treatment. The changes in the expression levels of phosphoserine aminotransferase were consistent with those of phosphoglycerate dehydrogenase. Therefore, the downregulation of phosphoserine aminotransferase may be due to the downregulation of phosphoglycerate dehydrogenase. Furthermore, exogenous serine might antagonize the activity of artemether against Acanthamoeba trophozoites. These results indicate that the serine biosynthesis pathway is important to amoeba survival and that targeting these enzymes would improve the treatment of Acanthamoeba infections. Artemether may be used as a phosphoglycerate dehydrogenase inhibitor to control or block Acanthamoeba infections.

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“…A valid alternative to polyhexamethylene biguanide is chlorhexidine, which has also been combined with propamidine isethionate (8). More recently, chlorhexidine alone has also been applied successfully (15). All these therapies need to be applied hourly at least for several days and therefore usually require stationary treatment.…”

mentioning

confidence: 99%

Cytotoxic Activities of Alkylphosphocholines against Clinical Isolates of Acanthamoeba spp

Walochnik¹,

Duchêne

Seifert

et al. 2002

Antimicrob Agents Chemother

112

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Free-living amoebae of the genus Acanthamoeba are causing serious chronic conditions such as destructive keratitis in contact lens wearers or granulomatous amoebic encephalitis in individuals with compromised immune systems. Both are characterized by the lack of availability of sufficiently effective and uncomplicated, manageable treatments. Hexadecylphosphocholine (miltefosine) is licensed for use as a topical antineoplastic agent, but it is also active in vitro against several protozoan parasites, and it was applied very successfully for the treatment of human visceral leishmaniasis. The aim of our study was to evaluate the efficacy of hexadecylphosphocholine and other alkylphosphocholines (APCs) against Acanthamoeba spp. The in vitro activities of eight different APCs against three Acanthamoeba strains of various pathogenicities were determined. All substances showed at least amoebostatic effects, and some of them disrupted the amoebae, as shown by the release of cytoplasmic enzyme activity. Hexadecylphosphocholine exhibited the highest degree of cytotoxicity against trophozoites, resulting in complete cell death at a concentration as low as 40 M, and also displayed significant cysticidal activity. Hexadecylphosphocholine may be a promising new candidate for the topical treatment of Acanthamoeba keratitis and, conceivably, even for the oral treatment of granulomatous amoebic encephalitis.

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Treatment of Acanthamoeba keratitis with chlorhexidine

Cited by 83 publications

References 41 publications

Visual outcome in Japanese patients with Acanthamoeba keratitis

Visual outcome in Japanese patients with Acanthamoeba keratitis

Artemether Exhibits Amoebicidal Activity against Acanthamoeba castellanii through Inhibition of the Serine Biosynthesis Pathway

Cytotoxic Activities of Alkylphosphocholines against Clinical Isolates of Acanthamoeba spp

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