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
ISSN: 00144894
Editorial
Academic Press Inc., 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA, Estados Unidos America
Tipo de documento: Article
Volumen: 196 Número:
Páginas: 22-27
WOS Id: 000456355000003
ID de PubMed: 30472333

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