Advances in the Diagnosis and Treatment of Acanthamoeba Keratitis
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This paper aims to review the recent literature describing Acanthamoeba keratitis and outline current thoughts on pathogenesis, diagnosis, and treatment as well as currently emerging diagnostic and treatment modalities.Keywords:
Acanthamoeba keratitis
Treatment modality
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The aim of this article is to present a concise review of the literature regarding acanthamoeba keratitis by exploring the pathophysiology, diagnosis, examinations and management strategies of this ocular condition. Acanthamoeba keratitis is a sight-threatening condition which progress rapidly if left untreated and is a real emergency that requires immediate and intensive assessment and treatment. As there is a potential increase in the number of cases of acanthamoeba keratitis among young contact lens wearers and the possibility to confuse the symptoms of acanthamoeba keratitis with those of other corneal diseases, there is a need to understand the pathophysiology of the acanthamoeba. This article will stress the necessity and create awareness about the importance of early diagnosis and treatment of acanthamoeba keratitis. The main focus is contact len-related acanthamoeba keratitis where the author will present two cases that attended the eye emergency department where they were diagnosed with acanthamoeba keratitis. This article will also send a message to all healthcare practitioners to suspect acanthamoeba keratitis in those patients with contact lenses and severe microbial keratitis or herpes simplex keratitis.
Acanthamoeba keratitis
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The free-living amebae of genus Acanthamoeba are an important cause of microbial keratitis. The clinical appearance of Acanthamoeba keratitis (AK) usually mimics viral or fungal keratitis. Thus, microbiological workup plays a significant role in the diagnosis and timely treatment of such cases. We report a retrospective case series of seven culture-confirmed AK cases from a tertiary eye care center in North India. Various risk factors and triggers of infection, clinical presentations, microbiological findings, and management of AK are elucidated.
Acanthamoeba keratitis
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Abstract 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 MIP 133 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.
Acanthamoeba keratitis
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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 suggest that younger females and patients who wear contact lenses are more likely to develop acanthamoeba keratitis. The occurrence of epitheliopathy, ring infiltrate, radial keratoneuritis, and endothelial plaques indicate the possibility of acanthamoeba infection. Promoting education on wearing contact lenses is essential to reduce the risk of acanthamoeba infection, as it is the most significant risk factor for this infection.
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When presented with an animal exhibiting signs of keratitis (inflammation of the cornea), such as impaired vision, mucoid discharges, redness, swelling, and corneal oedema, most veterinarians would think of bacteria, viruses, or fungi as the potential causative agent(s). However, evidence has arisen in recent years of a possible connection between the protozoan Acanthamoeba and keratitis in animals. Acanthamoeba infection is underdiagnosed, but potentially common, in animals. In view of the paucity of evidence regarding Acanthamoeba keratitis (AK) in animals, this review has been written to increase awareness of veterinary professionals of the potential threat associated with AK and to stimulate more studies into the extent of occurrence and clinical impact of AK in animals.
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Objective: To report three cases of bilateral Acanthamoeba keratitis in association with Synergeyes hybrid contact lens wear. Methods: Retrospective case series of six eyes of three patients that developed Acanthamoeba keratitis with Synergeyes hybrid contact lens wear. Results: Acanthamoeba keratitis was diagnosed in six eyes with a previous misdiagnosis of Herpes simplex keratitis in two patients and a misdiagnosis of corneal graft rejection in the third patient. Misdiagnosis in all three patients led to inappropriate topical corticosteroid use. All cases were diagnosed with Acanthamoeba castellanii by culture on nonnutrient agar, corneal scraping, and/or confocal microscopy. The infection ultimately cleared in all eyes with topical therapy using chlorhexidine, propamidine, and antibiotic ointment with neomycin. Cornea transplantation was required in two of six eyes for dense central corneal scarring. Conclusions: Acanthamoeba keratitis can occur in association with SynergEyes contact lens wear. Eye care professionals must take care to avoid potential misdiagnosis of Herpes simplex keratitis, avoid topical corticosteroids in contact lens wearers with an unknown keratitis, and pay special attention to the fellow eye for potential bilateral infection when Acanthamoeba has been diagnosed in one eye.
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Acanthamoeba keratitis
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Acanthamoeba keratitis
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Introduction: Infectious keratitis is one of the main causes of visual impairment. The incidence of acanthamoeba keratitis is relatively rare, while the prevalence is around 1 to 9 cases per 100.000. One of the factors supporting the occurrence of acanthamoeba keratitis is the increasing use of contact lenses around the world.
Content: When there is microtrauma to the cornea, it can cause the expression of the mannose on the surface. With the emergence of mannose in the form of glycoproteins, it will be a requirement for the attachment of Acanthamoeba spp.
Conclusion: Keratitis Acanthamoeba is an infectious disease of the cornea due to the use of contact lenses that are too long exposed to water which causes the entry of Acanthamoeba. This disease has a good prognosis with immediate drug administration within the first 3 weeks after the onset of symptoms.
Acanthamoeba keratitis
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