Acanthamoeba Keratits Contact Lenses

Acanthamoeba Keratits Contact Lenses - June 27, 1986-} Vol....

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Unformatted text preview: June 27, 1986-} Vol. 35 I No. 25 40-5 Acanthemaeba Karatitis Assocwteri- with 5, ' ‘ Contact Lenses. — United States ‘ £08 Bacillus c‘ereus'. —— Maine , ORBl-DITY AND MORTAUW '95 -l?::::;:‘::';§:'“*‘“”“v Ham V g 417 Bacteremia Associated with Reuse 0’ '_ > ” ‘ g ‘_: _ _ j ’ ' f‘” . J}. g- . till i. 2 age v; - Disposable. Hollow-Fiber Hemodralyzers V . tel!“ v _ 7 ‘ ‘ 419 First NationaLConierence on Chrome Disease ‘ ' N ' 5*“ “ ‘ t= Prevention and Control ' . Printed and distributed by the Massachusetts Medicoi Society, publishers of The NewEnglond Journal of Medicine M Epidemiologic Notes and Reports . '“Zl'carrthamoeba Keratitis Associated with Contact Lenses -- _ r - Uni-ted States ' Twenty-four patients with Acanthamoeba keratitis- have been reported to CDC. from 14 _ states in the last 9 months (Table 1). Although onset of illness for some patients dates—to as early as 1982, most had onset of illness in 1985 or 1986'. in two patients, the infected eye was enucleated; 12 patients underwent corneal transplantation, ' _ ' I Twenty {83%) of the patients wore contact lenses. Of these, two wore hard lenses (one hard, the other rigid gas-permeable); four were extended-wear soft lenses)“ and ‘24 were dailyuwear soft lenses. Ten of these 20' patients cleaned their lenses with home—maee Saline solution prepared by mixing salt tablets with bottled, distilled, nonsteril'e water; tour used commercially available -lens«cleaning solutions followed by a tap water rinsei one used com- mercial bottled saline; and one cleaned lenses with tap water pumped from'a private well. No lens-care information was available for four'patients. ' ' Twenty-two {90%) of the 24 patients were initially diagnosed as having corneal herpes sim~ piex virus (HSV) infections; in the other two patients, corneal lesions were'attributed to auto- immune disease. Acanrhamoeba keratitis was diagnosed by ekamin-atio'n of stained corneal scrapings or tissues (67%) and/or tissue-indirect fluorescent antibody llFAl test {52%) using speciesvspecific antisera. Acan-thamoebae were isolated from the cemeal scrapings/biopsies of 1'! (71%) of the patients. Three of the 1'? patients' lens cases containing-homemeoe saline 7 solution were also cultured; all were positive for Acanthamoeba. Contact-lens cases from other patients werenot'culturad. Patients' ages ranged from 17 years toS-E: years; half were temalas. _ The right eye was attested in 13 (54%} patients and the left eye, in 1 1 LA castellani‘i was identi» I tied from nine (38%) ; A. .polyphaga, from eight (33%); A; rhyscm’ee, fromfeurgl‘l 7%}; A. career» _ som; from three (13%); and A. hatchettigir-“om one (4%).‘The species of Aeanthemaeea was not determined for six {25%) patients. More than .one species of Acanrnamoeba- was cultured from samples from four patients. ' ' I ' ' Reported by [1‘ Newton, MD, Louisville, Ken-malty," WT Elliebe. JeMD; University of Florida. Gaines villa} in Grader), MD, G Gem/err, MD, ~li‘i‘filnrrnseifi; PhD: University of south Florida, Tampa; AD Praia, Ma, GK _ Charm/arm,- MD, M Coho, MD, D Klein, RM), Duke: University Medical (ferries Durham, P Moe-ton. MD.’ ' Raleigh, North Carolina Dept of Human Resources; 7 Whit MD, University of flkiahoma, atria-name City,- 08 Jones, MD, Rt Font,~-MD,"M Osata, PhD, Baylor-College o-f‘Medi‘chne, Houston, MC Kincaid tini‘versiry- _ Health Science Center at San Antonio, M3 Moore; MD; R Silvanys University of Texas Health Science Center at Dallas, Texas: 3.! Epstein, MD, EA Wilson, MD, Emory University: Atlanta, Georgia: RA Mifl'fl'f, MD, P Gardnenslylfl, RC Tripathi, MD, DF'Sehm, PM). university'of- Chicago; Mirrors; .13 Woifsnn, MD, 3 Foster: MD, MA Mldrom, Massachusetts General Hospital and Harvard Universitn Boston; CF Benn, MD. Naval Hospital, Dept of the Navy, Bethesda, Maryland; 6 Rare, MD, 'FS‘ Nor/ta, PhD. University of " Juch 27, 1:986 . piana - , 406 Acanthamoeba Keratitis- 4h Continued ‘ . . 63.3 .22.. waxwommsoflom Rococo a 4.530 moo, «.uficou Bot «082.30% . . . . .oufifiufioo .u 0361323500 u... 5: do cauofiofiomfix u 9.1 .dooofifi .1 no.1...ouaoq3au .1 "1.1...Emoeeqfi H 22.1 “monotonon 5.31 $231.33» 21 n .11.... . . . . 63303 H ... 6223a n. + “3.03 8.: “0.2 "anon—woo. E3333: 3.3%,: a $5. .oozoEMoEm as an rug; :92; um 23$ "35... “mag, an“ n «.2; w 60:32:»: 35.33323.» min. 633:3,» «o: u <2 "Liam oumEoEo: u 22: £2.33 meow MowoooEEoo w. uwou Begum oofioo n. mmw 6x59 airs on no»... a 2 .35. .Euufzaooeu Eat a Jog. Eco. Eu; a 41 RE: :2 Eozéaucfiso I 63m 35“ so. Enzyéoun a. 435+ .0233, n .— 63 29.. u m. 952 $.26 2.1 .2 + . <2 «2s. m 2 .3. SN 11. oz + m2: $25 $18 .. .>.z o .2 3 . . . om o1 oz + . 55.0.6 625 32b . .3.» o .2. me . mm .91 . + oz . <2 . 252 $26 . .5» z. .2 mo in .....1 + + <2 . 2oz £28 £2. ._ .2 3 96m 8.1 oz + 55.30 $5 $20 .3. . ._ 2. g . 9 8.1 + oz 2 . . 63o c2225 .8 m 2 on . 9 21.1.1 .11 + . ... .2 . .526 8:0 . .2 .o. .2 , . mm . . C. . 91 + + m2: 626, 323 .3». m 2 mm. , . m: 11 .21 a + oxemiz $25 318 .3 o .2 2 f 3.1 oz + 92:. $25 $26 . .5 m ._2 on . . E 91 oz + m2: :3me 226.. .oz .. 2. t . .2 .. u1 . oz 3+. $52: 525 £12 . .552 .. .. u. mm . 5 . 9.1 + , oz 215 $25 memo .23 o o 3 S . 3.1 .+ oz 2. om>>o mom. .8 ._ . u. on 9 0.1 + oz mm . .526 .212 . .. oz 2 , n. on m 3.1 .. oz , 6 5550.6 42 . moxoo . .3. 2 , L. on . . m o1. oz . $+ m2: $25 .328 . .22. , m u. no i 2111 +. 3+ .92: .526 $36 .92. o . u. on . o 3.1 d1 oz + m2: 626 328 .5 o o E . m 1.1 + + Esp .06 $26 218 .22 m o mm o 3.1 oz + <2 952 on: .o .3.» x n .2 . 2% ....1 + .+ z. 526 £26 .5. o 2 mm . N 91 + + go #61 $1: .3 m u. .. t . z .bwnwofimfiauov. _r<m_ 2.3.230 mowcuiu moo.“ «35:0 0232»? ., ..o>o .. now and Eaton . .0 53025 2.5»; . 5:9... on 32% 33033 .5532. ozuocmfin one. 83:00 0.339..“ . 533m 33:: I. $23.9. nouoEntwcaoq ._ mood: Vol. 35mm. 25 7 _ 7 ' M'MWR _ ' _ 7 407 Acanthamoeba K eratitis 4— Continued ' I Rochester Medical Center: Rochester: New York," C Parlalo, MD,'JC Davis, PhD, Mountainside Hospital, Monte/air, New Jersey, E Cohen, MD, Wills Eye Hospital and Thomas Jefferson University. Philadelphia,_ ‘Penns ylvania; MJ Mannis, MD, CE Thirkili, PhD, University of California, 08 vis; Pro‘tozoai Disease Br, Div of Parasitic Diseases. Center for Infectious Diseases, CDC? . _ , ' . — ‘ - ' Editorial Note: Members of the genus Acanthamoeba are the most common freakliving ‘ amoebae in fresh water and soil. They have been isolated from brackish andsea water, air» borne dust, and hot tubs. Acanthamoebae have also been recdvered‘ from the nose and throat of humans with impaired respiratory function and from'apparently healthy Parsonsrsuggest- ing that these organisms are commonly inhaled'l I it it is, therefore. not surprising that acan- - thamoebae may contaminate contact lenses 0r lens-cleaning/soaking fluids. 7 The first caseuofAcanthamoeba keratitis in the United States was reported in 1973 in a South Texas r‘ancher‘with a history of trauma to his right eye U l. A. polyphaga was repeat- edly cultured from his cornea, and both trophozoite and cyst forms of the organism were demonstrated in the-corneal sectioos. Since then, 31 patients have been diagnosed in the United States (excluding those reported heroic Nineteen of these 31 cases have been pub- lished (2-12); seven occurred before 1981; four occmred in 1981; one, in 1982; five, in 1983; and two, in l984. The 24 Acanthamoeaa keratitis cases described here represent a striking increase over those reported in previous years. A similar increase has been observed in the use of contact lenses during the past 5 years, from 14.5 million in 1980 to 23.1 million in1985li3i . ' _ . ' ‘ ' Review of the 19 published cases indicates that nearly all infections were preceded by some degree of ocular trauma and/or exposure to contaminated water. Only recently has it been suggested that wearing contact lenses or using contaminated lens-'cleaningisoak’ing so- lution may pr'edipose the wearer to developing Acanthamoeba keratitis (770). AlthOugh infOr- ' mation on contact lens use was not specified in all the published reports, at least13 of the 19 patients were known users, and in the present report, 20 (83%) of 24 patients were contact ' lenses. ' i * - I. _ Acanthamoebae are resistant to killing by freezing, dessication, a variety of antimicrobial agents, and levels of chlorine that‘are routinelyused to disinfect municipal drinking water, swimming pools, and hot tubsl l4). Recent studies indicate that thermal disinfection sys- tems fer contact lenses are superior to cold chemical disinfection in preventing‘the growth of Acanthamoeba (25). Although 10 of the 20 patients who worecomact lensesiused home- made saline cleaning solutions, it is not known how many of themhea.t-sterilized thesolutions . before use; 7 ' ‘ _ _ Since the clinical characteristics- of Acanrhamoejoakeratitisfesp'ecially the irregular epithe- ' 'liral lesions, the stromal infiltrative keratitisfiandfliedema seen in 'most patients may resemble HSV karat-his, many patients are initially diagnosed and treated for thisinfection. Until recently, ' the correct diagnosis Was made only after detailed” histologic examination of comeal tissue to . ' moved at the timed transplantation-The following clinical features are suggestive of Acan— ‘ " tha—moeba keratitis: (1) severe ocular pain; (Zia characteristic 3.60~degree or partial paracem trailstromal ring infiltrate; l3! resonant cement-epithelialbreakdown;- and‘ ill) a conical lesion refractory to the usual medications, The diagnosis can be confirmed by vigorously scraping the cornea with a swab or platinum-tipped spatula. staining the material obtained with Giemsa or trichr-orne stain, and examining it at 400x with a standard light microscope. in addi- tion, some of the'corneal rapings Shauld be cultured on non-nutrient agar seeded with Es- cherichia cali l 7 i. ' 7 _ ' _ ' - Medical management of Acanthamoeba keratitis is complicated by the resistance of these organisms to most of the commonly used antibacterial, antifungal. antiprotozoal. and antiviral Jun027.1986 Continued g -. ‘ ‘ i _ . agents. Although some patients ' ' I ' . sfully using ket'oconazole. miconazole, and propamidine isethionate.iBrolene'); penetrating- keratoplasty usually has - ' eful vision‘i5, 7-1 1,). Further studies are needed'to better esti- ' been'neces'Sar-y to recover us mate the true risk of infection, to improv . ' - ‘ d-treatmentrzmethods, and to evaluate? the-ability of different lens cleaningjsoakin . ‘ ' h of Acanthamoeba. References _ "’ r I _. -. 1. Visvesvara GS. Free-diving pail-lagenic amoebae. in: Lennette EH,HBalOWS A, Hensler; -_ JP, eds. Manual of Clinical Microbiology. 3rd edition. 1980;704-8_ - I _ 2. Jones DB, Visvesvara GS. Robinson NM. Acanthamoeba polyphaga' keratitis and Acanthamaeba uveitis associated with fatai meningoencephalitis. Trans Ophtha-lrnol Soc UK 1975;95:221-132. ‘ 3. Key SN. Ill, Green WFl. ,Jr.Keratilis due to 'Acanthamoeba casteflam'fi _ e clinicopathoiogiccase report. Arch Oph‘thaimoi 1980;98:475-9. - _ ‘ -- 4.. Ma P, Willaen E, Juechter KB, Stevens AB. A case 0 _ ' ' _ A ' ew York, _‘ New York. and features of 10 cases. J infect Dis 1981';143:662-?. - ' 5. Hirst LW. Green-WE. Merz W, et al. Management of Acan-thamoeb review of the iiterature. Ophthalmology 1984;91 :1 105-1 1. ' 6. Blackrr’lan HJ. Flao NA, Lamp MA. Visyesvara GS. Acanthamoe penetrating keratoplasty: suggested imm-unogenic mechanisms ' 7.- Samples JR, Binder PS, Luibei FJ, Font RL, Visvesvara GS, Peter . - bly acquired from a hot tub. Arch Ophthalmol f» 984:1 0217074 0} _ -_ 8‘ Sculiy RE, Mark EJ, McNealy BN, et al. Case 10-19851“ Eng! J'Med 1985312263441. 97 Cohen EJ. Buchanan HW. Laughrea P. et al. Diagnosis and management ofAcanthamoeea kerafitis, ' Am J Ophthalmol 1985;100:389-95. - i _ I 10. Moore MB“, McCulley JP, Luckenbach M. et ai. Acanthameeba keratiiis associated with soft contact tenses. Am J Ophthalmol 1985;100:396-403. 11. Theodore FH. Jakobiec FA. Juechter KB.. et 31. T' moebic keratitis. Ophthaimology 1985;92:1471-9. _ r - _ _ _ _ ' 12. Naab T, Bican F, McMahon J, Meisler DM, Rutherford I, Langston RHS. Chronic'ulcerative keratitis caused by Acanthamoeba polyphaga {Abstract}. St. Louis, Missouri: American SOciety of Microbi- Jr; . .I ' - a keratitie. A case report and be keratitis successfully treated with", of action. Cornea 19842332560”. - CRV Acahthamoeba keratitis pessi- ’ he diagnostic vaiue .of a ring infiitrate in .acant'ha- . ‘ oiogy, 1984:289. I . 13'. Ormerod LD, Smith, RE. Contact lens-associated microbial keratitisi Arch Ophthalmol 1988:1042 79—83. ‘ ' ' on of cysts of' pathogenic and nonpa-' van de Voorde H. Differences in destructi- thogenic Naeglerr‘a and Acanrhamoeba by chlorine. App‘i Environ Microbial1976;31:294-7. ' 1'5. . Ludwig lH, Meisier DM. Rutherford i, Bican FE, Langston RH. Visvesvara GS; Susceptibiiity of Acam . tharnoe-ba to soft contact- lens disinfection Systemsi invest Ophthaimol V-is. Sci 1936;27:176-8. ._ 14._ DeJonckheere J, 'Use of trade names if for identification only and does not imply endorsement by the US. Public Health ' Service. ' ...
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Acanthamoeba Keratits Contact Lenses - June 27, 1986-} Vol....

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