Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome

Maritza Omaña-Molina, Virginia Vanzzini-Zago, Dolores Hernández-Martínez, María Reyes-Batlle, Ismael Castelan-Ramírez, Perla Hernández-Olmos, Lizbeth Salazar-Villatoro, Arturo González-Robles, Elizabeth Ramírez-Flores, Christopher Servín-Flores, Víctor Flores-Alvarado, Marino Alcántara-Castro, Jacob Lorenzo-Morales

Research output: Contribution to journalArticleResearchpeer-review

Abstract

© 2018 Acanthamoeba keratitis (AK) is a sight-threatening corneal infection. The early symptoms include redness, pain, photophobia and intense tearing. Chronic infection usually progresses to stromal inflammation, ring ulcers, corneal opacification and hypopyon. Here we document an AK case in a high myopic 38-year-old woman from Mexico City, with a history of wearing contact lenses while swimming. Corneal scrapes cultures were positive only for amoebae, consequently a treatment including netilmicin 0.3% and oral itraconazole 100 mg/12 h was prescribed. The infection was resolved after 8 months, leaving a slight leucoma outside the visual axis, with a visual acuity of 20/150. In the laboratory, the amoebic isolate was axenized in PYG medium, with an optimal growth at 30 °C, and was identified morphologically as Acanthamoeba polyphaga according to the taxonomic criteria of Page (1988) and placed in the T4 group by genotyping. The virulence of this strain (40%) was determined by intranasal inoculation of 1 × 106/20 μl trophozoites in BALB/c mice recovering from brain, proving their invasion ability and by the interaction with monolayers of epithelial cells of the established MDCK line of canine kidney origin (1:2 ratio of interaction), at 1, 3, 6, 8 and 24 h; trophozoites migrated to cell junctions inducing few lytic zones. In addition to the biological characterization, in vitro drug sensitivity tests were performed using chlorhexidine, itraconazole, netilmicin and voriconazole. Results revealed that voriconazole was the most effective compound. A. polyphaga remains as one of the most frequently isolated species producing AK. The treatment of AK case using netilmicin and oral itraconazole solved the disease, but the healing process was wide-ranging (8 months). The use of voriconazole and chlorhexidine may be an alternative treatment of future AK cases in Mexico.
Original languageAmerican English
Pages (from-to)22-27
Number of pages19
JournalExperimental Parasitology
DOIs
StatePublished - 1 Jan 2019
Externally publishedYes

Fingerprint

Acanthamoeba Keratitis
Mexico
Netilmicin
Itraconazole
Trophozoites
Chlorhexidine
Infection
Acanthamoeba
Corneal Opacity
Corneal Ulcer
Photophobia
Amoeba
Aptitude
Intercellular Junctions
Contact Lenses
Visual Acuity
Virulence
Canidae
Epithelial Cells
Inflammation

Cite this

Omaña-Molina, M., Vanzzini-Zago, V., Hernández-Martínez, D., Reyes-Batlle, M., Castelan-Ramírez, I., Hernández-Olmos, P., ... Lorenzo-Morales, J. (2019). Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome. Experimental Parasitology, 22-27. https://doi.org/10.1016/j.exppara.2018.11.005
Omaña-Molina, Maritza ; Vanzzini-Zago, Virginia ; Hernández-Martínez, Dolores ; Reyes-Batlle, María ; Castelan-Ramírez, Ismael ; Hernández-Olmos, Perla ; Salazar-Villatoro, Lizbeth ; González-Robles, Arturo ; Ramírez-Flores, Elizabeth ; Servín-Flores, Christopher ; Flores-Alvarado, Víctor ; Alcántara-Castro, Marino ; Lorenzo-Morales, Jacob. / Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome. In: Experimental Parasitology. 2019 ; pp. 22-27.
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title = "Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome",
abstract = "{\circledC} 2018 Acanthamoeba keratitis (AK) is a sight-threatening corneal infection. The early symptoms include redness, pain, photophobia and intense tearing. Chronic infection usually progresses to stromal inflammation, ring ulcers, corneal opacification and hypopyon. Here we document an AK case in a high myopic 38-year-old woman from Mexico City, with a history of wearing contact lenses while swimming. Corneal scrapes cultures were positive only for amoebae, consequently a treatment including netilmicin 0.3{\%} and oral itraconazole 100 mg/12 h was prescribed. The infection was resolved after 8 months, leaving a slight leucoma outside the visual axis, with a visual acuity of 20/150. In the laboratory, the amoebic isolate was axenized in PYG medium, with an optimal growth at 30 °C, and was identified morphologically as Acanthamoeba polyphaga according to the taxonomic criteria of Page (1988) and placed in the T4 group by genotyping. The virulence of this strain (40{\%}) was determined by intranasal inoculation of 1 × 106/20 μl trophozoites in BALB/c mice recovering from brain, proving their invasion ability and by the interaction with monolayers of epithelial cells of the established MDCK line of canine kidney origin (1:2 ratio of interaction), at 1, 3, 6, 8 and 24 h; trophozoites migrated to cell junctions inducing few lytic zones. In addition to the biological characterization, in vitro drug sensitivity tests were performed using chlorhexidine, itraconazole, netilmicin and voriconazole. Results revealed that voriconazole was the most effective compound. A. polyphaga remains as one of the most frequently isolated species producing AK. The treatment of AK case using netilmicin and oral itraconazole solved the disease, but the healing process was wide-ranging (8 months). The use of voriconazole and chlorhexidine may be an alternative treatment of future AK cases in Mexico.",
author = "Maritza Oma{\~n}a-Molina and Virginia Vanzzini-Zago and Dolores Hern{\'a}ndez-Mart{\'i}nez and Mar{\'i}a Reyes-Batlle and Ismael Castelan-Ram{\'i}rez and Perla Hern{\'a}ndez-Olmos and Lizbeth Salazar-Villatoro and Arturo Gonz{\'a}lez-Robles and Elizabeth Ram{\'i}rez-Flores and Christopher Serv{\'i}n-Flores and V{\'i}ctor Flores-Alvarado and Marino Alc{\'a}ntara-Castro and Jacob Lorenzo-Morales",
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Omaña-Molina, M, Vanzzini-Zago, V, Hernández-Martínez, D, Reyes-Batlle, M, Castelan-Ramírez, I, Hernández-Olmos, P, Salazar-Villatoro, L, González-Robles, A, Ramírez-Flores, E, Servín-Flores, C, Flores-Alvarado, V, Alcántara-Castro, M & Lorenzo-Morales, J 2019, 'Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome' Experimental Parasitology, pp. 22-27. https://doi.org/10.1016/j.exppara.2018.11.005

Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome. / Omaña-Molina, Maritza; Vanzzini-Zago, Virginia; Hernández-Martínez, Dolores; Reyes-Batlle, María; Castelan-Ramírez, Ismael; Hernández-Olmos, Perla; Salazar-Villatoro, Lizbeth; González-Robles, Arturo; Ramírez-Flores, Elizabeth; Servín-Flores, Christopher; Flores-Alvarado, Víctor; Alcántara-Castro, Marino; Lorenzo-Morales, Jacob.

In: Experimental Parasitology, 01.01.2019, p. 22-27.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome

AU - Omaña-Molina, Maritza

AU - Vanzzini-Zago, Virginia

AU - Hernández-Martínez, Dolores

AU - Reyes-Batlle, María

AU - Castelan-Ramírez, Ismael

AU - Hernández-Olmos, Perla

AU - Salazar-Villatoro, Lizbeth

AU - González-Robles, Arturo

AU - Ramírez-Flores, Elizabeth

AU - Servín-Flores, Christopher

AU - Flores-Alvarado, Víctor

AU - Alcántara-Castro, Marino

AU - Lorenzo-Morales, Jacob

PY - 2019/1/1

Y1 - 2019/1/1

N2 - © 2018 Acanthamoeba keratitis (AK) is a sight-threatening corneal infection. The early symptoms include redness, pain, photophobia and intense tearing. Chronic infection usually progresses to stromal inflammation, ring ulcers, corneal opacification and hypopyon. Here we document an AK case in a high myopic 38-year-old woman from Mexico City, with a history of wearing contact lenses while swimming. Corneal scrapes cultures were positive only for amoebae, consequently a treatment including netilmicin 0.3% and oral itraconazole 100 mg/12 h was prescribed. The infection was resolved after 8 months, leaving a slight leucoma outside the visual axis, with a visual acuity of 20/150. In the laboratory, the amoebic isolate was axenized in PYG medium, with an optimal growth at 30 °C, and was identified morphologically as Acanthamoeba polyphaga according to the taxonomic criteria of Page (1988) and placed in the T4 group by genotyping. The virulence of this strain (40%) was determined by intranasal inoculation of 1 × 106/20 μl trophozoites in BALB/c mice recovering from brain, proving their invasion ability and by the interaction with monolayers of epithelial cells of the established MDCK line of canine kidney origin (1:2 ratio of interaction), at 1, 3, 6, 8 and 24 h; trophozoites migrated to cell junctions inducing few lytic zones. In addition to the biological characterization, in vitro drug sensitivity tests were performed using chlorhexidine, itraconazole, netilmicin and voriconazole. Results revealed that voriconazole was the most effective compound. A. polyphaga remains as one of the most frequently isolated species producing AK. The treatment of AK case using netilmicin and oral itraconazole solved the disease, but the healing process was wide-ranging (8 months). The use of voriconazole and chlorhexidine may be an alternative treatment of future AK cases in Mexico.

AB - © 2018 Acanthamoeba keratitis (AK) is a sight-threatening corneal infection. The early symptoms include redness, pain, photophobia and intense tearing. Chronic infection usually progresses to stromal inflammation, ring ulcers, corneal opacification and hypopyon. Here we document an AK case in a high myopic 38-year-old woman from Mexico City, with a history of wearing contact lenses while swimming. Corneal scrapes cultures were positive only for amoebae, consequently a treatment including netilmicin 0.3% and oral itraconazole 100 mg/12 h was prescribed. The infection was resolved after 8 months, leaving a slight leucoma outside the visual axis, with a visual acuity of 20/150. In the laboratory, the amoebic isolate was axenized in PYG medium, with an optimal growth at 30 °C, and was identified morphologically as Acanthamoeba polyphaga according to the taxonomic criteria of Page (1988) and placed in the T4 group by genotyping. The virulence of this strain (40%) was determined by intranasal inoculation of 1 × 106/20 μl trophozoites in BALB/c mice recovering from brain, proving their invasion ability and by the interaction with monolayers of epithelial cells of the established MDCK line of canine kidney origin (1:2 ratio of interaction), at 1, 3, 6, 8 and 24 h; trophozoites migrated to cell junctions inducing few lytic zones. In addition to the biological characterization, in vitro drug sensitivity tests were performed using chlorhexidine, itraconazole, netilmicin and voriconazole. Results revealed that voriconazole was the most effective compound. A. polyphaga remains as one of the most frequently isolated species producing AK. The treatment of AK case using netilmicin and oral itraconazole solved the disease, but the healing process was wide-ranging (8 months). The use of voriconazole and chlorhexidine may be an alternative treatment of future AK cases in Mexico.

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