Acanthamoeba keratitis: clinical presentation, diagnosis, treatment and outcome
Abstract number: P1390
Tzanetou K., Miltsakakis D., Ziva K., Tsianou E., Strigari S., Petrou E., Marda E., Goula A., Ganteris G., Malamou-Lada E.
Acanthamoeba keratitis is a sight-threatening infection of the cornea caused by the ubiquitous free-living Acanthamoeba spp. The main risk factor for acquisition of this serious parasitic infection is the use of soft contact lenses.
Purpose: To review the clinical presentation, diagnosis, treatment, and outcome of patients with Acanthamoeba keratitis during a five year period.
Patients and Methods: All the patients, contact lens wearers, who presented with symptoms and signs of keratitis during the study period (from January, 2005 to October, 2009), underwent corneal scraping. The scrapings from the infected cornea were inoculated on 1.5% non-nutrient agar plates overlaid with E. coli, sheep blood agar, chocolate and sabouraud dextrose agar for isolation of Acanthamoeba, bacteria and fungi.
Results: Culture-proven Acanthamoeba keratitis was diagnosed in 25 patients. Seventeen of the 25 (68%) patients presented with symptoms and signs of early stage of the disease (pain, photophobia, epithelial and subepithelial opacities, dendritiform epithelial lesions, and radial keratoneuritis). Fourteen (82%) and six (35%) of early cases presented with pseudodendritic epitheliopathy (dendritiform epithelial lesions can mimic herpes simplex keratitis) and radial keratoneuritis (a nearly pathognomonic sign) respectively. Eight of the 25 (32%) patients presented with signs of late stage of the disease (annular and disciform stromal infiltration). The patients received topical treatment with polyhexamethylene biguanide (PHMB) 0.02% and hexamidine (desomedine or ophtamedine) 0.1% in combination or neosporine combined with desomedine or ophtamedine (duration of treatment was 6 to 12 months). The outcome of the early cases was clinical resolution and cure, while the advanced cases underwent therapeutic penetrating keratoplasty (one case complicated by scleritis, corneal ulceration and cataract).
Conclusions: The clinical presentation of Acanthamoeba keratitis may be pathognomonic (radial keratoneuritis), characteristic (ring-shaped stromal infiltrate) or non-specific. The early diagnosis and treatment with combined antiacanthamoeba agents are critical for a good outcome and vision maintenance.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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