Rapid resolution of stromal keratitis with the assistance of oral voriconazole in resistant acanthamoeba keratitis

Hou, Tzu-Yu; Chen, Yun-Chen; Hsu, Chih Chien

doi:10.4103/tjo.tjo_73_17

Cited by 9 publications

(4 citation statements)

References 9 publications

(14 reference statements)

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“…Voriconazole is an antifungal agent with reported effectiveness against refractory AK in both topical and oral formulations. 29,30 In vitro studies have shown that voriconazole has amoebicidal activity against both the trophozoite and cystic forms. 31,32 A 2014 in vitro study of potentially pathogenic strains of AK in Peru found that voriconazole had higher activity than chlorhexidine.…”

Section: ' Voriconazolementioning

confidence: 99%

“…Voriconazole is an antifungal agent with reported effectiveness against refractory AK in both topical and oral formulations 29,30. In vitro studies have shown that voriconazole has amoebicidal activity against both the trophozoite and cystic forms 31,32.…”

Section: Voriconazolementioning

confidence: 99%

“…It is usually dosed at 200 mg by mouth twice daily for at least 1 to 2 months. Liver function should be assessed at baseline and checked periodically throughout the course of treatment 30,37,38. Systemic voriconazole might be considered as part of initial therapy for cases that are advanced at time of diagnosis.…”

Section: Voriconazolementioning

confidence: 99%

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An Update on the Initial Treatment of Acanthamoeba Keratitis

Wang¹,

Jacobs²

2022

International Ophthalmology Clinics

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Acanthamoeba keratitis (AK) is an infectious disease of the ocular surface that can be challenging to diagnose and treat and can lead to permanent loss of vision. It is most common in contact lens wearers, with reported rates of 1 to 33 cases per million contact lens wearers. 1,2 Acanthamoebae are protozoans ranging 25 to 50 um in size that can exist in either an active trophozoite or dormant cyst form. Several species of Acanthamoeba have been reported to cause AK, including A. castellanii and A. polyphaga. The cyst form can survive low temperatures and is resistant to biocides, chlorination, and antibiotics. 3 Patients can present with a variety of symptoms and signs that may be initially misdiagnosed as bacterial or viral keratitis. AK should be included in the differential diagnosis of any case presenting with unilateral keratitis, especially in the setting of contact lens wear, trauma, or contamination with soil or water. Patients typically present with pain, photophobia, and decreased visual acuity (VA). 4 Early findings include epitheliitis, with punctate keratopathy and pseudodendrites, often leading to a presumptive diagnosis of Herpes simplex keratitis. Patients may progress and develop perineural infiltrates, anterior stromal disease, deep stromal keratitis, or a ring infiltrate. 5 Although a ring infiltrate and perineural infiltrates are conventionally thought to be pathognomic for AK, they only occur in about 50% and 63% of cases, respectively, 4,6 and are findings that develop later in the disease course. Since the likelihood of medical cure is greater if diagnosis is made while the infection remains superficial, prompt recognition of the disease before the development of these later pathognomic signs is important. 5 Clinicians must consider risk factors, clinical course, and response to therapy in arriving at a preliminary

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Section: ' Voriconazolementioning

confidence: 99%

Section: Voriconazolementioning

confidence: 99%

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An Update on the Initial Treatment of Acanthamoeba Keratitis

Wang¹,

Jacobs²

2022

International Ophthalmology Clinics

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“…Moreover, oral voriconazole combined with topical PHMB was shown clinically to be a successful treatment [9]. If AK is not detected early and treated appropriately, it can lead to loss of vision [10].…”

Section: Introductionmentioning

confidence: 99%

Atypical Presentation of Acanthamoeba Keratitis in a Contact Lens Wearer

Al-Yousuf¹,

Sindi²,

Hashem³

et al. 2020

OJOph

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Acanthamoeba keratitis is a serious infection that can lead to loss of vision. It is highly challenging and often poses a diagnostic dilemma, causing delay in diagnosis and treatment. We report herewith the clinical and histopathology findings of a patient with an atypical presentation of acanthamoeba keratitis in Bahrain. The patient is a 16-year-old Bahraini teenager who was a cosmetic contact lens wearer. She presented with clinical signs and symptoms of microbial keratitis, which was initially misdiagnosed elsewhere as a case of herpetic corneal infection. Her corneal biopsy confirmed the clinical diagnosis as acanthamoeba keratitis. The patient was started on anti amoebic treatment. The infection got eradicated. The cornea healed with a central scar. Eventually, she underwent penetrating keratoplasty. This case report serves to raise awareness of this rare condition. Clinicians should have a high index of suspicion when diagnosing such cases among contact lens wearers. Early diagnosis and treatment are crucial to prevent serious complications.

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