Acanthamoeba infections

Notes
  • Amoeba commonly found in the environment; rarely causes diseases but lethal when it does.
  • It is more prevalent in persons wearing contact lenses than the general population.
  • Since it is a rare diseases it poses challenges in diagnosis.
  • Statistics: prevalence of Acanthamoeba keratitis in USA: 33 in a million of the contact lens wearer.
Symptoms
  • Symptoms depend on tissue/organ that is affected.
  • For Acanthamoeba keratitis the symptoms include: painful eye, redness of the eye, blurred vision, photophobia, foreign body sensation and excessive tearing.
  • For Granulomatous amoebic encephalitis (GAE) the symptoms include: focal paralysis, seizures, brainstem symptoms, and other neurological symptoms.
Diagnosis
  • Clinical diagnosis
  • Scraping of the eye, culture, and then confocal microscopy
Differential

For Acanthamoeba keratitis:

  • Contact lens associated keratitis
  • Keratoconjunctivitis sicca (dry eye)
  • Herpes simplex virus keratitis
  • Infection related keratitis
  • Recurrent corneal erosion

For others:

  • Tuberculosis
  • Aspergillosis
  • Herpes Simplex
  • Toxoplasmosis
Prevention
  • Proper storage of and handling of lenses
  • Proper disinfection of lenses
Management
  • Rx of skin infections with amphotericin B, voriconazole, ketoconazole, fluconazole, albendazole, co-otrimoxazole and sulphadiazine.
  • For eye infections, cationic antiseptics such as chlorhexidine that destroy hard-to-kill spores are used though generally not very effective.
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