Oral Miltefosine as Adjunctive Treatment for Recalcitrant Acanthamoeba Keratitis
Conclusions: This case shows resolution of recalcitrant Acanthamoeba keratitis with oral miltefosine in an immunocompetent patient. Further clinical evidence would be needed to possibly incorporate this medication in the antiamoebic armamentarium.
To report a case series of patients with treatment-resistant Acanthamoeba keratitis (AK) using oral miltefosine, often as salvage therapy.
by Christopher A. Rice, Beatrice L. Colon, Emily Chen, Mitchell V. Hull, Dennis E. Kyle Diseases caused by pathogenic free-living amoebae include primary amoebic meningoencephalitis (Naegleria fowleri), granulomatous amoebic encephalitis (Acanthamoeba spp.),Acanthamoeba keratitis, andBalamuthia amoebic encephalitis (Balamuthia mandrillaris). Each of these are difficult to treat and have high morbidity and mortality rates due to lack of effective therapeutics. Since repurposing drugs is an ideal strategy for orphan diseases, we conducted a high throughput phenotypic screen of 12,000 compounds from the Calibr ReFRAME librar...
Publication date: Available online 22 September 2020Source: The Journal of Molecular DiagnosticsAuthor(s): Danièle Maubon, Claire Richarme, Lucie Post, Marie Gladys Robert, Diane Bernheim, Cécile Garnaud
Abstract Acanthamoeba sp. is a free living amoeba that causes severe, painful and fatal infections, viz. Acanthamoeba keratitis and granulomatous amoebic encephalitis among humans. Antimicrobial chemotherapy used against Acanthamoeba is toxic to human cells and show side effects as well. Infections due to Acanthamoeba also pose challenges towards currently used antimicrobial treatment including resistance and transformation of trophozoites to resistant cyst forms that can lead to recurrence of infection. Therapeutic agents targeting central nervous system infections caused by Acanthamoeba should be able to cross b...
In this study, we adapted a previous in-house AK-PCR, on the BDMAX, a full-integrated automated platform for molecular biology (Becton Dickinson, Heidelberg, Germany), for the rapid routine diagnosis of Acanthamoeba keratitis.
In this study, the effects of HDACi such as MPK472 and KSK64 on A. castellanii trophozoites and cysts were observed. MPK472 and KSK64 showed at least 60% amoebicidal activity against Acanthamoeba trophozoite at a concentration of 10 μM upon 8 h. Neither of the two HDACi affected mature cysts, but significant amoebicidal activities (36.4% and 33.9%) were observed against encysting Acanthamoeba following treatment with 5 and 10 μM HDACi for 24 h. Light microscopy and transmission electron microscopy results confirmed that the encystation of Acanthamoeba was inhibited by the two HDACi. In addition to this, low cytopathi...
Conclusions: Corneal endotheliitis, although uncommon, may be a manifestation of AK. We must have high-index suspicion for AK in all contact lens users, particularly before making a diagnosis of HSV keratitis. Accurate diagnosis and prompt treatment can result in a favorable prognosis for AK.
Conclusion: Epipremnum aureum toxicity is a rare cause of keratitis. It can mimic acanthamoeba keratitis or anesthetic abuse and should be considered in cases of culture negative nonhealing corneal ulcerations. Eliciting a history of plant sap exposure can facilitate appropriate supportive care for this toxic keratitis.
Conclusions: Bacterial coinfection is common in patients with Acanthamoeba keratitis. Coinfection did not point toward a worse clinical disease at presentation or outcome.
Conclusions: Topical voriconazole 1% combined with first-line therapy composed of polyhexamethylene biguanide 0.02% and propamidine isethionate 0.1% appears to be an effective option with minor side effects for the treatment of AK.