Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome
Por:
Omaña-Molina M., Vanzzini-Zago, Virginia, Hernandez-Martinez, Dolores, Reyes-Batlle, Maria, Castelan-Ramirez, Ismael, Hernandez-Olmos, Perla, Salazar-Villatoro, Lizbeth, Gonzalez-Robles, Arturo, Ramirez-Flores, Elizabeth, Servin-Flores, Christopher, Flores-Alvarado, Victor, Alcantara-Castro, Marino, Lorenzo-Morales, Jacob
Publicada:
1 ene 2019
Resumen:
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 degrees
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 x 10(6)/20 mu l 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.
Filiaciones:
Omaña-Molina M.:
Faculty of Superior Studies Iztacala, UNAM, Tlalnepantla, State of Mexico, Mexico
Vanzzini-Zago, Virginia:
Hospital Para Evitar la Ceguera en México, “Luis Sánchez Bulnes”, Mexico
Hosp Evitar Ceguera Mexico, Luis Sanchez Bulnes, Mexico
Hernandez-Martinez, Dolores:
Faculty of Superior Studies Iztacala, UNAM, Tlalnepantla, State of Mexico, Mexico
UNAM, Fac Super Studies Iztacala, Tlalnepantla, State Of Mexico, Mexico
Reyes-Batlle, Maria:
University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Tenerife, Canary Island, Spain
Univ La Laguna, Univ Inst Trop Dis & Publ Hlth Canary Isl, Tenerife, Canary Island, Spain
Castelan-Ramirez, Ismael:
Faculty of Superior Studies Iztacala, UNAM, Tlalnepantla, State of Mexico, Mexico
UNAM, Fac Super Studies Iztacala, Tlalnepantla, State Of Mexico, Mexico
Hernandez-Olmos, Perla:
Faculty of Superior Studies Iztacala, UNAM, Tlalnepantla, State of Mexico, Mexico
UNAM, Fac Super Studies Iztacala, Tlalnepantla, State Of Mexico, Mexico
Salazar-Villatoro, Lizbeth:
Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies, Mexico City, Mexico
Ctr Res & Adv Studies, Dept Infect & Mol Pathogenesis, Mexico City, DF, Mexico
Gonzalez-Robles, Arturo:
Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies, Mexico City, Mexico
Ctr Res & Adv Studies, Dept Infect & Mol Pathogenesis, Mexico City, DF, Mexico
Ramirez-Flores, Elizabeth:
Faculty of Superior Studies Iztacala, UNAM, Tlalnepantla, State of Mexico, Mexico
UNAM, Fac Super Studies Iztacala, Tlalnepantla, State Of Mexico, Mexico
Servin-Flores, Christopher:
Faculty of Superior Studies Iztacala, UNAM, Tlalnepantla, State of Mexico, Mexico
UNAM, Fac Super Studies Iztacala, Tlalnepantla, State Of Mexico, Mexico
Flores-Alvarado, Victor:
Hospital Para Evitar la Ceguera en México, “Luis Sánchez Bulnes”, Mexico
Hosp Evitar Ceguera Mexico, Luis Sanchez Bulnes, Mexico
Alcantara-Castro, Marino:
Hospital Para Evitar la Ceguera en México, “Luis Sánchez Bulnes”, Mexico
Hosp Evitar Ceguera Mexico, Luis Sanchez Bulnes, Mexico
Lorenzo-Morales, Jacob:
University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Tenerife, Canary Island, Spain
Univ La Laguna, Univ Inst Trop Dis & Publ Hlth Canary Isl, Tenerife, Canary Island, Spain
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