TY - JOUR
T1 - Polymicrobial Keratitis
T2 - Acanthamoeba and Infectious Crystalline Keratopathy
AU - Tu, Elmer Y.
AU - Joslin, Charlotte E.
AU - Nijm, Lisa M.
AU - Feder, Robert S.
AU - Jain, Sandeep
AU - Shoff, Megan E.
N1 - Funding Information:
This study was supported by Grants 15689 (Dr Joslin) and 09073 (Dr Shoff) from the National Eye Institute, National Institutes of Health, Bethesda, Maryland; Prevent Blindness America, Chicago, Illinois; Midwest Eye-Banks, Ann Arbor, Michigan; UIC Campus Research Board, Chicago, Illinois; AOF AAO William C. Ezell Fellowship, Rockville, Maryland; and the Karl Cless Foundation, Northbrook, Illinois. Dr Tu reports receiving honoraria of less than $10,000 for speaking at the invitation of Alcon and Allergan and holds an equity interest in Genentech of less than $10,000. Dr Feder reports book royalties and provision of expert legal testimony. Dr Jain reports receiving less than $10,000 as a member of the Alcon Dry Eye Advisory Board and research funding by the Warren and Clara Cole Foundation. Involved in design of study (E.Y.T., C.E.J., L.M.N.); analysis and interpretation (E.Y.T., C.E.J., R.S.F.); writing the article; (E.Y.T., L.M.N.); critical revision of the article (E.Y.T., C.E.J., L.M.N., R.S.F., S.J., M.E.S.); final approval of the manuscript (E.Y.T., C.E.J., L.M.N., R.S.F., S.J., M.E.S.); data collection (E.Y.T., L.M.N.); provision of materials (E.Y.T., R.S.F., S.J.); obtaining funding (E.Y.T., C.E.J.); literature search (E.Y.T., C.E.J.); and administrative or technical support (E.Y.T., C.E.J., M.E.S.). This research was approved by the Institutional Review Board of the University of Illinois at Chicago.
PY - 2009/7
Y1 - 2009/7
N2 - Purpose: To report the early presentation, cause, and successful medical management of combined Acanthamoeba keratitis (AK) and infectious crystalline keratopathy (ICK). Design: Interventional case series. Methods: Retrospective review of 111 AK patients diagnosed and managed at the University of Illinois Eye and Ear Infirmary between June 1, 2003 and November 30, 2008 for an additional diagnosis of infectious keratitis. Results: Of 5 AK patients with microbiologic evidence of an additional bacterial keratitis during their active AK treatment, concomitant ICK developed in 3 patients. All patients were examined within 3 weeks of their AK diagnosis and were found to have characteristic signs and symptoms consistent with ICK. Bacterial culture results at the time of AK diagnosis were negative in 2 patients, but subsequent culture results were positive for Streptococcus oralis. Initial culture results demonstrated light growth of methicillin-sensitive Staphylococcus aureus in the remaining patient, who had received partial antibiotic treatment. Topical corticosteroids were used before diagnosis in 2 patients and were in use in only 1 patient after AK diagnosis. All infections resolved with medical therapy alone. One patient later required penetrating keratoplasty for visual rehabilitation. Conclusions: In patients with AK, ICK can develop early and without either the use of corticosteroids or a preexisting epithelial defect, inconsistent with previously suggested mechanisms and major risk factors for secondary infection. Combined AK and ICK may exhibit increased pathogenicity with the onset of severe, often new, pain and acceleration of localized tissue loss and resultant scarring. Although early recognition and aggressive medical treatment were successful in resolving the combined infections in our cases, Acanthamoeba coinfection, and perhaps endosymbiosis, should be considered in the evaluation and clinical management of AK, especially in those cases progressing atypically. Further research is needed to understand the precise mechanism of the introduction of coinfectious pathogens and their role in the pathogenicity of AK.
AB - Purpose: To report the early presentation, cause, and successful medical management of combined Acanthamoeba keratitis (AK) and infectious crystalline keratopathy (ICK). Design: Interventional case series. Methods: Retrospective review of 111 AK patients diagnosed and managed at the University of Illinois Eye and Ear Infirmary between June 1, 2003 and November 30, 2008 for an additional diagnosis of infectious keratitis. Results: Of 5 AK patients with microbiologic evidence of an additional bacterial keratitis during their active AK treatment, concomitant ICK developed in 3 patients. All patients were examined within 3 weeks of their AK diagnosis and were found to have characteristic signs and symptoms consistent with ICK. Bacterial culture results at the time of AK diagnosis were negative in 2 patients, but subsequent culture results were positive for Streptococcus oralis. Initial culture results demonstrated light growth of methicillin-sensitive Staphylococcus aureus in the remaining patient, who had received partial antibiotic treatment. Topical corticosteroids were used before diagnosis in 2 patients and were in use in only 1 patient after AK diagnosis. All infections resolved with medical therapy alone. One patient later required penetrating keratoplasty for visual rehabilitation. Conclusions: In patients with AK, ICK can develop early and without either the use of corticosteroids or a preexisting epithelial defect, inconsistent with previously suggested mechanisms and major risk factors for secondary infection. Combined AK and ICK may exhibit increased pathogenicity with the onset of severe, often new, pain and acceleration of localized tissue loss and resultant scarring. Although early recognition and aggressive medical treatment were successful in resolving the combined infections in our cases, Acanthamoeba coinfection, and perhaps endosymbiosis, should be considered in the evaluation and clinical management of AK, especially in those cases progressing atypically. Further research is needed to understand the precise mechanism of the introduction of coinfectious pathogens and their role in the pathogenicity of AK.
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U2 - 10.1016/j.ajo.2009.01.020
DO - 10.1016/j.ajo.2009.01.020
M3 - Article
C2 - 19327742
AN - SCOPUS:67349192637
SN - 0002-9394
VL - 148
SP - 13-19.e2
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
IS - 1
ER -