Diagnosis and Management of Acanthamoeba Keratitis: A Continental Approach

Abstract

Acanthamoeba keratitis (AK) is a potentially blinding infection caused by protozoa found worldwide. The topical application of biguanides and diamidines is the most common anti-amoebic treatment for AK. In this study, we hypothesized that geographical location and socioeconomic status influence the management and treatment of AK. To test this hypothesis, we analyzed case reports and series of Acanthamoeba eye infections from different geographic regions to evaluate the association between diagnosis, treatment, and outcome worldwide. This study looked specifically at case reports of patients with diagnosed AK using bibliographic databases such as PubMed, BioMed Central, and Google Scholar, which were searched between 30 April 1990 and 1 May 2022. The search identified 38 eligible studies that provided data for 60 clinical cases of AK. The results indicated that current standard treatments are effective if the infection is identified early and that delays can lead to clinical symptoms, including permanent visual opacities. There was evidence suggesting an association between the treatment regimen practiced in certain geographic regions and treatment outcome. Patient access to medical facilities and economic background also had an influence on the treatment and outcome of AK. Further analysis of more case reports can expand our understanding of the influence of specific demographic and individual patient characteristics on the effectiveness and accessibility of AK medicines. Additionally, using a living systematic review approach to incorporate emerging evidence will reveal the relative merits of different treatment regimens for AK and outcomes.

Successive Acanthamoeba Corneal Isolates Identified in Poland Monitored in Terms of In Vitro Dynamics

“…The progressive, devastating, sight-threatening Acanthamoeba keratitis is still considered a rare eye disease but is an emerging public health threat worldwide, including in Poland; during the last decades, incidents of human infections caused by pathogenic Acanthamoeba strains have been detected and reported in a constantly increasing frequency [ 24 , 26 , 30 , 31 , 38 , 39 , 40 , 54 , 55 , 61 , 62 , 63 , 64 ].…”

A Review Article: Clean Water Contamination as a Risk Factor for Acanthamoeba Keratitis

“…The combination of Polyhexamethylene biguanide (PHMB) with 0.02% chlorhexidine is a first-line therapy for KA which is quite effective to treat Acanthamoeba spp in trophpzite and cyst. Other combinations that can be chosen are the combination of chlorhexidine with natamicin or the combination of chlorhexidine with aromatic diamidines such as propamidine isethionate Brolene 0.1%, dibromopropamidine 0.15%, or hexamidine 0.1% 6 . During the first 3 days after corneal debridement, the selected combination of topical therapy was applied every hour.…”

A detailed dissection of the expression, localization, structure, and diagnostic potential of cyst wall proteins of the eye pathogen Acanthamoeba

“…The cyst wall also makes Acanthamoebae resistant to disinfectants used to clean surfaces, alcohol-based hand sanitizers, sterilizing agents in contact lens solutions, and/or antibiotics applied to the eye (23)(24)(25)(26)(27). While trophozoites cause damage to corneal epithelial cells, AK is most often diagnosed by microscopic identification of cysts in corneal scrapings (1,2,28). Acanthamoeba cysts are detected using calcofluor white (CFW) or wheat germ agglutinin (WGA), which bind to cellulose and chitin, respectively, in their walls (29,30).…”

“…Acanthamoeba keratitis (AK), which leads to scarring and blindness, if not successfully treated, is caused by free-living amoebae, named for acanthopods (spikes) on the surface of trophozoites [1][2][3]. In immunocompromised patients, Acanthamoebae may cause encephalitis, which is frequently fatal [4].…”

“…The cyst wall also makes Acanthamoebae resistant to disinfectants used to clean surfaces, alcohol-based hand sanitizers, sterilizing agents in contact lens solutions, and/or antibiotics applied to the eye [23][24][25][26][27]. While trophozoites cause damage to corneal epithelial cells, AK is most often diagnosed by microscopic identification of cysts in corneal scrapings [1,2,28].…”