Concurrent Acanthamoeba and Fusarium Keratitis With Silicone Hydrogel Contact Lens Use

Abstract

Coexisting infection with Acanthamoeba and Fusarium species can occur in contact lens wear. Atypical infection must be considered in patients with corneal ulcers demonstrating poor therapeutic response in the setting of contact lens wear. Corticosteroids should be used with extreme caution in contact lens–related corneal infections, especially when the diagnosis remains unknown because they can lead to acceleration of active infection and keratolysis.

Investigation of the Role of Bacteria in the Development of Acanthamoeba Keratitis

“…In fact, coinfections with other microorganisms have been reported in patients with AK. [21][22][23] AK sometimes develops in eyes with bacterial and bacteria-associated keratitis. Most Acanthamoeba isolates from patients with AK harbor one or more bacterial symbionts.…”

Case Report: Corneal Coinfection with Fungus and Amoeba: Report of Two Patients and Literature Review

“…Literature search revealed 13 cases with concurrent Acanthamoeba and Fusarium keratitis ( Table 1); all were initially misdiagnosed as bacterial or viral keratitis. [4][5][6][7][8][13][14][15][16] Of these cases, five had a history of use of contact lens 4-8 whereas injury by foreign body was seen in two cases, 5 including one from our series. Corneal trauma allows the microorganisms access to the stroma and deep epithelial layers.…”

“…3 So far, 13 cases of coinfection of cornea with Acanthamoeba and fungus have been reported, and the use of contact lenses was involved in five of them. [4][5][6][7] Treatment regimens have varied from the biguanides, polyhexamethylene biguanide (PHMB) and chlorhexidine, to the diamide propamidine, the aminoglycoside neomycin, and the antifungal clotrimazole. The drugs have been used in different combinations, with varying degrees of success.…”

Bilateral Acanthamoeba Keratitis in Synergeyes Contact Lens Wear: Clinical and Confocal Microscopy Findings

“…While our series is small, it does corroborate other published reports that depict the danger of corticosteroids in worsening the prognosis and outcomes of AK before antiamoeba therapy. 17,18 Corticosteroids have been shown to promote excystment of Acanthamoeba from cyst to trophozoite form and accelerate trophozoite proliferation with a 4-to 10-fold increase in Bilateral Acanthamoeba Keratitis trophozoite number in the laboratory, thereby increasing the pathogenicity of the organism. 19 These results suggest that continued exposure to topical or oral corticosteroids in the absence of antiamoeba therapy creates a potential exponential increase in the number of Acanthamoeba trophozoites in the cornea by two methods: excystment and accelerated multiplication of trophozoites.…”