Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years

List, Wolfgang; Glatz, Wilfried; Riedl, Regina; Mossboeck, Georg; Steinwender, Gernot; Wedrich, Andreas

doi:10.1038/s41598-020-80222-3

Cited by 22 publications

(32 citation statements)

References 51 publications

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“…The incidence of AK is steadily increasing worldwide with approximately 90% of cases associated with contact lenses in developed countries [49]. Although contact lens wear is not commonly associated with AK in India and other developing nations, [45,51] the global surge of myopia and the use of contact lens for preventing myopia, cosmetic purposes and sport activities have increased the risk of AK, especially among youths [1]. As observed in the current study, ocular trauma and contact with contaminated soil or water are the major predisposing risk factors of AK infection not linked with contact lens wear [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

“…Acanthamoeba keratitis (AK) is a rare eye disease accounting for 2% of global corneal infections [ 1 ]. However, perhaps due to increase in contact lens use and increasing prevalence of Acanthamoeba species in different water resources including man-made swimming pools and even treated domestic water supplies [ 2 ], AK cases are increasing globally.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of genotypes, endosymbionts and clinical characteristics of Acanthamoeba recovered from ocular infection

et al. 2022

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Introduction Acanthamoeba is an emerging pathogen, infamous for its resilience against antiprotozoal compounds, disinfectants and harsh environments. It is known to cause keratitis, a sight-threatening, painful and difficult to treat corneal infection which is often reported among contact lens wearers and patients with ocular trauma. Acanthamoeba comprises over 24 species and currently 23 genotypes (T1-T23) have been identified. Aims This retrospective study was designed to examine the Acanthamoeba species and genotypes recovered from patients with Acanthamoeba keratitis (AK), determine the presence of endosymbionts in ocular isolates of Acanthamoeba and review the clinical presentations. Methodology Thirteen culture-confirmed AK patients treated in a tertiary eye care facility in Hyderabad, India from February to October 2020 were included in this study. The clinical manifestations, medications and visual outcomes of all patients were obtained from medical records. The Acanthamoeba isolates were identified by sequencing the ribosomal nuclear subunit (rns) gene. Acanthamoeba isolates were assessed for the presence of bacterial or fungal endosymbionts using molecular assays, PCR and fluorescence in situ hybridization (FISH). Results The mean age of the patients was 33 years (SD ± 17.4; 95% CI 22.5 to 43.5 years). Six (46.2%) cases had AK associated risk factors; four patients had ocular trauma and two were contact lens wearers. A. culbertsoni (6/13, 46.2%) was the most common species, followed by A. polyphaga and A. triangularis. Most of the isolates (12/13) belonged to genotype T4 and one was a T12; three sub-clusters T4A, T4B, and T4F were identified within the T4 genotype. There was no significant association between Acanthamoeba types and clinical outcomes. Eight (61.5%) isolates harboured intracellular bacteria and one contained Malassezia restricta. The presence of intracellular microbes was associated with a higher proportion of stromal infiltrates (88.9%, 8/9), epithelial defect (55.6%, 5/9) and hypopyon (55.6%, 5/9) compared to 50% (2/4), 25% (1/4) and 25% (1/4) AK cases without intracellular microbes, respectively. Conclusions Genotype T4 was the predominant isolate in southern India. This is the second report of T12 genotype identified from AK patient in India, which is rarely reported worldwide. The majority of the Acanthamoeba clinical isolates in this study harboured intracellular microbes, which may impact clinical characteristics of AK.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of genotypes, endosymbionts and clinical characteristics of Acanthamoeba recovered from ocular infection

et al. 2022

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“…Medical management is generally attempted prior to surgery unless there is immediate threat to central nervous system penetration. Procedures such as penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK), which were originally performed with the intention of debriding diseased tissue and debulking disease, are now generally reserved for either cases refractory to medical management or for restoration of vision due to structural damage [6,19,20].…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Smith¹,

Ashraf²,

Haghnegahdar³

et al. 2022

Cureus

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Acanthamoeba species are free-living protozoa found pervasively in water and soil, which can cause infections of the central nervous system, skin, and eye. Amoebic keratitis (AK) is a vision-threatening, often chronic infection that is associated with the use of soft contact lenses due to corneal microtrauma and improper cleaning and storage. Although AK infections are rare, they cause significant morbidity including vision loss due to the diagnostic and therapeutic challenges they pose.The clinical course is determined by the organism's inherent pathogenicity, delay of diagnosis, and the paucity of data on effective therapeutic regimens. The case series and review of literature that follows examine current latest best practices in AK diagnosis including in vivo confocal microscopy (IVCM) and therapeutic interventions including miltefosine.

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“…Case series of AK tend to show worse visual acuity outcomes in India compared with those from high-income nations. [2][3][4][5][6]18 We sought to determine in this study whether Acanthamoeba susceptibility could play a role in the poorer outcomes in Indian patients with AK. We did not find evidence of a difference in antiamoebic susceptibility between South India and Northern California, which argues against antiamoebic resistance as a chief driver of differential outcomes in India.…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of Acanthamoeba keratitis (AK) is believed to be poorer in low-income and middle-income countries, such as India, relative to high-income countries. [2][3][4][5][6] Variability in outcomes may be explained by the same factors that make most diseases worse in resource-limited settings, such as delays in diagnosis and treatment and lack of medicines or surgery. However, it is also possible that Acanthamoeba susceptibility could differ based on geographic region, especially because varying resistance profiles have been reported from clinical and environmental isolates.…”

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confidence: 99%

Antiamoebic Susceptibility in Acanthamoeba Keratitis: Comparison of Isolates From South India and Northern California

Richardson

Lalitha

Elakkiya

et al. 2022

Cornea

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Purpose:Outcomes of Acanthamoeba keratitis are often worse in India than in the United States. The goal of this study was to determine whether antiamoebic susceptibility patterns were different when comparing Acanthamoeba isolates from India with those of the United States.Methods:Acanthamoeba isolates were obtained from corneal scrapings of 43 patients with infectious keratitis seen at the Francis I. Proctor Foundation (N = 23) and Aravind Eye Hospital (N = 20) from 2008 through 2012 and plated on growth media. A previously described minimum cysticidal concentration (MCC) assay was performed by a single laboratory technician to assess susceptibility to 5 antiamoebic agents for all isolates. Testing was conducted in triplicate, with the median MCC chosen for analyses.Results:The MCC (μg/mL) of polyhexamethylene biguanide was 6.25 [IQR 5.47–12.5] for Aravind isolates and 6.25 [IQR 6.25–9.375] for Proctor isolates (P = 0.75), corresponding values were 6.25 [IQR 3.125–6.25] and 3.125 [IQR 3.125–9.375] for chlorhexidine (P = 0.81), 2500 [IQR 2500–5000] and 5000 [IQR 1250–20,000] for voriconazole (P = 0.25), 15.6 [IQR 15.6–39.0625] and 15.6 [IQR 15.6–31.25] for hexamidine (P = 0.92), and 15.6 [IQR 7.81–15.6] and 15.6 [IQR 7.81–31.25] for propamidine (P = 0.42).Conclusions:This study found no statistically significant differences in antiamoebic susceptibility of Indian versus US samples from Acanthamoeba keratitis clinical isolates. These findings suggest that differences in antiamoebic susceptibility are likely not responsible for differential outcomes in Acanthamoeba keratitis between the 2 locations.

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Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years

Cited by 22 publications

References 51 publications

Assessment of genotypes, endosymbionts and clinical characteristics of Acanthamoeba recovered from ocular infection

Assessment of genotypes, endosymbionts and clinical characteristics of Acanthamoeba recovered from ocular infection

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Antiamoebic Susceptibility in Acanthamoeba Keratitis: Comparison of Isolates From South India and Northern California

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