TY - JOUR
T1 - Acanthamoeba keratitis in Mexico
T2 - 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
N1 - Publisher Copyright:
© 2018
PY - 2019/1
Y1 - 2019/1
N2 - 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 - 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.
KW - Acanthamoeba keratitis case
KW - Acanthamoeba polyphaga
KW - Chemotherapy assays
KW - Chlorhexidine
KW - Mexico
KW - Netilmicin
KW - Voriconazole
UR - http://www.scopus.com/inward/record.url?scp=85057244918&partnerID=8YFLogxK
U2 - 10.1016/j.exppara.2018.11.005
DO - 10.1016/j.exppara.2018.11.005
M3 - Artículo
C2 - 30472333
SN - 0014-4894
VL - 196
SP - 22
EP - 27
JO - Experimental Parasitology
JF - Experimental Parasitology
ER -