Delayed diagnoses of <i>Acanthamoeba</i> keratitis at a tertiary care medical centre

Shah, Yesha; Stroh, Inna G.; Zafar, Sidra; Zhang, Nancy R.; Sriparna, Manjari; Shekhawat, Nakul; Ghos, Zara; Srikumaran, Divya; Woreta, Fasika A.

doi:10.1111/aos.14792

Cited by 12 publications

(13 citation statements)

References 33 publications

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“…In the PCR group, we found a significantly higher rate of suspected "bacterial infection." In the pre-PCR group, "herpetic keratitis" was the predominant initial diagnosis (48.3%), which is in line with the results of the literature [1,3,18,26,27].…”

Section: Clinical Findings and Initial Diagnosissupporting

confidence: 88%

“…Maybe it was not regularly available yet, as the included cases were from 2008 to 2011. Shah et al only included culture-proven AK cases and reported a mean time of 53 days from onset of symptoms to culture collection [18]. Data from the German Acanthamoeba Keratitis Registry indicate an exceptionally long delay until correct diagnosis of 2.8 months by a selection bias towards more difficult cases by tertiary referral centers which may also explain the high rate of corneal transplantations and thus histological confirmation (55%) in the registry [1].…”

Section: Duration Until Correct Diagnosismentioning

confidence: 99%

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Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis

Roth

Balasiu

Daas

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose Acanthamoeba keratitis (AK) is a painful and possibly sight-threatening ocular infection. While the correct diagnosis and specific treatment in the early stages significantly improve the prognosis, the disease is often misdiagnosed and in clinical examination confused with other forms of keratitis. Polymerase chain reaction (PCR) for the detection of AK was first introduced in our institution in December 2013 to improve the timely diagnosis of AK. The aim of this study was to assess the impact of implementation of Acanthamoeba PCR on the diagnosis and treatment of the disease in a German tertiary referral center. Patients and methods Patients treated for Acanthamoeba keratitis between 1st of January 1993 and 31st of December 2021 in the Department of Ophthalmology of the University Hospital Duesseldorf were identified retrospectively via in-house registries. Evaluated parameters include age, sex, initial diagnosis, method of correct diagnosis, duration of symptoms until correct diagnosis, contact lens use, visual acuity, and clinical findings as well as medical and surgical therapy by keratoplasty (pKP). In order to assess the impact of implementation of Acanthamoeba PCR, the cases were divided into two groups (before (pre-PCR group) and after PCR implementation (PCR group). Results Seventy-five patients with Acanthamoeba keratitis were included (69.3% female, median age 37 years). Eighty-four percent (63/75) of all patients were contact lens wearers. Until PCR was available, 58 patients with Acanthamoeba keratitis were diagnosed either clinically (n = 28), by histology (n = 21), culture (n = 6), or confocal microscopy (n = 2) with a median duration until diagnosis of 68 (18; 109) days. After PCR implementation, in 17 patients, the diagnosis was established with PCR in 94% (n = 16) and median duration until diagnosis was significantly shorter with 15 (10; 30.5) days. A longer duration until correct diagnosis correlated with a worse initial visual acuity (p = 0.0019, r = 0.363). The number of pKP performed was significantly lower in the PCR group (5/17; 29.4%) than in the pre-PCR group (35/58; 60.3%) (p = 0.025). Conclusions The choice of diagnostic method and especially the application of PCR have a significant impact on the time to diagnosis and on the clinical findings at the time of confirmation of diagnosis and the need for penetrating keratoplasty. In contact lens–associated keratitis, the first crucial step is to take AK into consideration and perform a PCR test as timely confirmation of diagnosis of AK is imperative to prevent long-term ocular morbidity.

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Section: Clinical Findings and Initial Diagnosissupporting

confidence: 88%

Section: Duration Until Correct Diagnosismentioning

confidence: 99%

Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis

Roth

Balasiu

Daas

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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“…To the Editor, We read with interest the article by Shah YS et al "Delayed diagnoses of Acanthamoeba keratitis at a tertiary care medical center" [1].…”

mentioning

confidence: 99%

“…The article well describes difficulties to diagnose microbial keratitis. As reported in Table 1 , Acanthamoeba keratitis (AK) is usually misdiagnosed with herpetic keratitis [ 1 ]. We have had same and similar issues [ 2 , 3 ].…”

mentioning

confidence: 99%

Metagenome techniques to reduce diagnostic delay in Acanthamoeba keratitis

Borroni¹,

Rachwani-Anil²,

Sánchez‐González³

et al. 2021

rjo

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“…5,12 These variable clinical presentations can result in misdiagnosis as herpetic keratitis in 38% to 48%, fungal corneal ulcer in 25.2%, and bacterial corneal ulcer in 3.9% of patients. 12,14…”

Section: Discussionmentioning

confidence: 99%

Lately Diagnosed Acanthamoeba Keratitis Manifesting as an Intrastromal Corneal Abscess: A Case Report

Feizi,

Karjou,

Esfandiari

2023

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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A 42-year-old female contact lens wearer presented to a local emergency department with a 3-day history of decreased vision and ocular discomfort in her right eye. She was started on topical fluorometholone and oral acyclovir with initial diagnosis of herpes simplex keratitis. After 3 weeks of worsening symptoms, she was diagnosed with bacterial corneal ulcer and treated with levofloxacin eye drops every 2 hr. After 14 days of no improvement, she was referred to our clinic for further workup. Slitlamp examination demonstrated a solitary dense 3×3-mm infiltration involving anterior and central corneal stroma. The overlying epithelium was intact, and there was no subepithelial infiltration, radial perineuritis, keratic precipitates, or anterior chamber reaction. Corneal sensation was normal. Confocal microscopy and corneal biopsy were definitive for Acanthamoeba infection. The patient received polyhexamethylene biguanide 0.02% every 2 hr and oral ketoconazole 200 mg twice a day, which resulted in improvement in her signs and symptoms within 10 days. The medications were gradually tapered off over 5 months per clinical response. At the 9-month follow-up visit, the best-corrected visual acuity was 5/10 with a superficial central stromal scar at slitlamp examination. Acanthamoeba infection should be considered in contact lens wearers who present with intrastromal corneal abscess.

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Delayed diagnoses of Acanthamoeba keratitis at a tertiary care medical centre

Cited by 12 publications

References 33 publications

Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis

Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis

Metagenome techniques to reduce diagnostic delay in Acanthamoeba keratitis

Lately Diagnosed Acanthamoeba Keratitis Manifesting as an Intrastromal Corneal Abscess: A Case Report

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