Results of a trial of combined propamidine isethionate and neomycin therapy for acanthamoeba keratitis

Hargrave, Sylvia L.; McCulley, James P.; Husseini, Ziad M.

doi:10.1016/s0161-6420(99)00515-1

Cited by 67 publications

(46 citation statements)

References 24 publications

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“…Although not licensed for therapeutic use, it has been employed as a successful experimental treatment for AK by Larkin et al (250). A combination of chlorhexidine digluconate (a bisbiguanide) with PHMB (a polymeric biguanide) or with aromatic diamidines such as hexamidine, pentamidine, and propamidine isethionate or PHMB and hexamidine with debridement has been reported for the treatment of AK (124,161,171,175,195,196,250,260,323,365,405,447,454,482). PHMB alone does not appear to be associated with toxicity, but other compounds used in combination with PHMB may exert untoward effects (195).…”

Section: Amebic Keratitismentioning

confidence: 99%

Acanthamoebaspp. as Agents of Disease in Humans

2003

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Acanthamoeba spp. are free-living amebae that inhabit a variety of air, soil, and water environments. However, these amebae can also act as opportunistic as well as nonopportunistic pathogens. They are the causative agents of granulomatous amebic encephalitis and amebic keratitis and have been associated with cutaneous lesions and sinusitis. Immuno compromised individuals, including AIDS patients, are particularly susceptible to infections with Acanthamoeba. The immune defense mechanisms that operate against Acanthamoeba have not been well characterized, but it has been proposed that both innate and acquired immunity play a role. The ameba's life cycle includes an active feeding trophozoite stage and a dormant cyst stage. Trophozoites feed on bacteria, yeast, and algae. However, both trophozoites and cysts can retain viable bacteria and may serve as reservoirs for bacteria with human pathogenic potential. Diagnosis of infection includes direct microscopy of wet mounts of cerebrospinal fluid or stained smears of cerebrospinal fluid sediment, light or electron microscopy of tissues, in vitro cultivation of Acanthamoeba, and histological assessment of frozen or paraffin-embedded sections of brain or cutaneous lesion biopsy material. Immunocytochemistry, chemifluorescent dye staining, PCR, and analysis of DNA sequence variation also have been employed for laboratory diagnosis. Treatment of Acanthamoeba infections has met with mixed results. However, chlorhexidine gluconate, alone or in combination with propamidene isethionate, is effective in some patients. Furthermore, effective treatment is complicated since patients may present with underlying disease and Acanthamoeba infection may not be recognized. Since an increase in the number of cases of Acanthamoeba infections has occurred worldwide, these protozoa have become increasingly important as agents of human disease

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Section: Amebic Keratitismentioning

confidence: 99%

Acanthamoebaspp. as Agents of Disease in Humans

2003

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“…From a series of clinical reports, identification of the signs and symptoms associated with a poor prognosis [22][23][24] is a starting point. In addition, analysis of differential therapeutic responses among individual case descriptions, retrospective or prospective epidemiological surveys and clinical trials can contribute to direct the management of disease and decide about the treatments with the greatest chance of success in different situations [2,[25][26][27]. In corneal diseases by microbial infection, such as AK-for which there is no consensus therapythese studies, are particularly important.…”

Section: Reverse Translational Researchmentioning

confidence: 99%

Translational and Reverse Translational Research Supporting Precision Medicine: Acanthamoeba Keratitis as a Model of Linkage between Clinical and Basic Research Focused on Personalized Ophthalmology

Carvalho¹

2014

OCR

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Translational Research is defined as Scientific Research conducted in order to apply discoveries from basic sciences for developing new applications to improve clinical practice and patient's welfare, including rapid, specific and sensitive diagnostic methods, and safely effective therapeutic agents. The translational approach "from bench to bedside" has limited success if there is not a reverse path. Reverse translational research ensures the feedback "from bedside to bench" and helps identifying specific subjects that demand laboratory investigation or establishing inferences between laboratory findings and clinical observations. Precision medicine employs scientific advances and discoveries from basic sciences on the clinical research to provide an accurate diagnosis followed by a personalized care for each patient, selecting the most suitable therapy pattern for a specific etiology. In the genomic era, a full and integrative cycle between these three areas of translation is now possible. Management of knowledge concerning the application of molecular biology, biochemistry and cellular technologies can offer personalized application of basic sciences' tools within a specific sub-specialty of ophthalmology. Advanced basic science supported by current omics technologies provides a potential linkage between the standardized experimental data-from in vitro and in vivo assays under controlled laboratorial environment and the applied science used in clinical routine. The linkage between both basic and applied sciences focuses on the improvement of human health. The three main aspects of cyclic interaction constituted by the two-way approaches between bench top and bedside with main focus on the application of precision medicine to provide knowledge about human diseases are illustrated here with examples in the context of Acanthamoeba keratitis. This paper presents translational approaches in the ophthalmology field and visual sciences, available technologies, and promising issues to be investigated through reverse translational research, such as searching for specific biomarkers, setting up prognostic factors and recognizing differential profiles of host resistance and pathogen virulence. These advances may render benefits for the practice of personalized medicine. Fábio Ramos de Souza Carvalho*, Linda Christian Carrijo-Carvalho and Denise de Freitas

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“…Topical therapy with cysticidal agents remains the mainstay of therapy (18,19). Polyhexamethylene biguanide has been demonstrated to be effective, especially if applied in conjunction with other agents.…”

Section: Case Presentationmentioning

confidence: 99%

Acanthamoeba Species Keratitis in a Soft Contact Lens Wearer Molecularly Linked to Well Water

Mubareka

Alfa

Harding

et al. 2006

Canadian Journal of Infectious Diseases and Medical Microbiolog

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An otherwise-healthy 14-year-old female soft contact lens wearer, who lived in a rural area where the tap water source for the home was a well, presented to a community hospital with a four-week history of progressive redness, swelling and blurred vision of her left eye despite treatment with topical neomycin and corticosteroids. A dendritiform corneal epithelial lesion, corneal edema and inflammation in the anterior chamber were noted on initial examination, and treatment for herpes simplex keratouveitis with oral valacyclovir and topical trifluridine 1% was initiated. There was no clinical improvement, and six weeks after the onset of symptoms she was referred to a corneal specialist for evaluation and further management. The patient's visual acuity was 20/80 and her corneal sensation was intact; slit-lamp examination revealed diffuse corneal edema, areas of punctate epithelial staining, poorly defined subepithelial and anterior stromal infiltrates, a partial ring infiltrate and 2+ cell and flare in the anterior chamber (Figure 1). The patient underwent corneal debridement, and scrapings were sent for viral, bacterial and Acanthameoba culture. She was admitted to the hospital, and polyhexamethalene biguanide 0.02% and diamidine propamidine isothianate eye drops were added to antiviral therapy and topical neomycin. Over the next few days, her visual acuity decreased to hand movement only, the corneal edema intensified, and midstromal peripheral vascularization developed. Her corneal epithelium healed promptly following debridement. Treatment with oral itraconazole, topical chlorhexidine 0.02% and topical ciprofloxacin were added after Acanthameoba species were isolated from corneal scrapings. Over the next few months, the patient improved markedly (her left visual acuity was 20/50) despite significant corneal vascularization and persisting central stromal opacity.Clinical samples, including corneal scrapings, contact lenses, contact lens solution, tap water and well water, were inoculated directly onto non-nutrient agar with Escherichia coli overlay (1), as well as sheep's blood agar, MacConkey agar and chocolate agar. The non-nutrient agar with E coli overlay was incubated at room temperature. The agar surface of the plates was examined daily with an inverted microscope at 10× magnification. On day 5 after planting, the plates inoculated by corneal scrapings were positive for both the cyst (Figure 2) and trophozoite forms of Acanthamoeba species. In addition, Serratia marcescens and Stenotrophomonas maltophilia were isolated from corneal scrapings that were inoculated onto sheep's blood agar, MacConkey agar and chocolate agar. Environmental samples consisting of well water and tap water from the patient's home, in addition to samples from the contact lens case, were also positive for Acanthamoeba species. Acanthamoeba species isolates were forwarded to the Ohio State University Department of Molecular Genetics (Columbus, Ohio, USA), where molecular epidemiological analysis was undertaken. This consisted of amp...

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Results of a trial of combined propamidine isethionate and neomycin therapy for acanthamoeba keratitis

Cited by 67 publications

References 24 publications

Acanthamoebaspp. as Agents of Disease in Humans

Acanthamoebaspp. as Agents of Disease in Humans

Translational and Reverse Translational Research Supporting Precision Medicine: Acanthamoeba Keratitis as a Model of Linkage between Clinical and Basic Research Focused on Personalized Ophthalmology

Acanthamoeba Species Keratitis in a Soft Contact Lens Wearer Molecularly Linked to Well Water

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