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Parasitology Research

, Volume 110, Issue 5, pp 1945–1950 | Cite as

Effect of combined chlorhexidine gluconate and Neosporin on experimental keratitis with two pathogenic strains of Acanthamoeba

  • Zubeyde Akin PolatEmail author
  • Ayse Vural
Original Paper

Abstract

Acanthamoeba keratitis (AK) is a painful, sight-threatening, and difficult-to-treat corneal infection caused by the ubiquitous free-living amoebae Acanthamoeba species. The aim of the present study was to compare the severity of keratitis, caused by Acanthamoeba hatchetii and Acanthamoeba castellanii infections, and to assess the therapeutic effects of combined chlorhexidine (CHX) and Neosporin® treatment in rats. The rats were first divided into two groups, in which the eyes of the animals were infected with A. hatchetii or A. castellanii trophozoites. On day 5, all corneas were examined in order to determine the degree of infection (grade 0 to 3), and animals were divided into two new groups, treatment and infected control groups. The treatment was continued for 28 days, followed by excision and histological evaluation of the corneas. In conclusion, the clinical picture progressed more rapidly and severely in eyes infected by A. castellanii, while it was non-invasive and slower to progress with A. hatchetii. Moreover, eyes infected by A. hatchetii responded quicker and more positively to therapy, consistent with its clinical course, while a longer recovery was seen with A. castellanii. Histological examinations revealed the presence of A. castellanii and A. hatchetii trophozoites in the stroma of eyes of the treatment and control groups. As a result, our findings suggest that a combination of Neosporin with lower doses of CHX may be beneficial to treat patients with early diagnosis of AK.

Keywords

Keratitis Chlorhexidine Corneal Opacity Chlorhexidine Gluconate Acanthamoeba Keratitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank Prof. Ali Fazil Yenidünya for his invaluable contribution in the preparation of the manuscript.

References

  1. Chong EM, Dana MR (2007) Acanthamoeba keratitis. Int Ophthalmol Clin 47:33–46PubMedCrossRefGoogle Scholar
  2. Cohen EJ (2006) Fusarium keratitis associated with soft contact lens wear. Arch Ophthalmol 124:1183–1184PubMedCrossRefGoogle Scholar
  3. Cohen EJ, Fulton JC, Hoffman CJ, Rapuano CJ, Laibson PR (1996) Trends in contact lens-associated corneal ulcers. Cornea 15:566–570PubMedGoogle Scholar
  4. Duguid IG, Dart JKG, Morlet N, Allan BD, Matheson M, Ficker L, Tuft S (1997) Outcome of Acanthamoeba keratitis treated with polyhexamethyl biguanide and propamidine. Ophthalmology 104:1587–1592PubMedGoogle Scholar
  5. Elder MJ, Kilvington S, Dart JK (1994) A clinicopathologic study of in vitro sensitivity testing and Acanthamoeba keratitis. Invest Ophthalmol Vis Sci 35:1059–1064PubMedGoogle Scholar
  6. Hamill MB, Osato MS, Wilhelmus KR (1984) Experimental evaluation of chlorhexidine gluconate for ocular antisepsis. Antimicrob Agents Chemother 26:793–796PubMedGoogle Scholar
  7. Hammersmith KM (2006) Diagnosis and management of Acanthamoeba keratitis. Curr Opin Ophthalmol 17:327–331PubMedCrossRefGoogle Scholar
  8. Hay J, Kirkness CM, Seal DV, Wright P (1994) Drug resistance and Acanthamoeba keratitis: the quest for alternative antiprotozoal chemotherapy. Eye 8:555–563PubMedCrossRefGoogle Scholar
  9. Joslin CE, Tu EY, McMahon TT, Passaro DJ, Stayner LT, Sugar J (2006) Epidemiological characteristics of a Chicago-area Acanthamoeba keratitis outbreak. Am J Ophthalmol 142:212–217PubMedCrossRefGoogle Scholar
  10. Khan NA (2003) Pathogenesis of Acanthamoeba infections. Microb Pathog 34:277–285PubMedCrossRefGoogle Scholar
  11. Kitagawa K, Nakamura T, Takahashi N (2003) A novel combination treatment of chlorhexidine gluconate, natamycin (pimaricin) and debridement for a Acanthamoeba keratitis. Jpn J Ophthalmol 47:616–617PubMedCrossRefGoogle Scholar
  12. Kosrirukvongs P, Wanachiwanawin D, Visvesvara GS (1999) Treatment of Acanthamoeba keratitis with chlorhexidine. Ophthalmology 106:798–802PubMedCrossRefGoogle Scholar
  13. Kumar R, Lloyd D (2002) Recent advances in the treatment of Acanthamoeba keratitis. Clin Infect Dis 35:434–441PubMedCrossRefGoogle Scholar
  14. Lee GA, Gray TB, Dart JK, Pavesio CE, Ficker LA, Larkin DF et al (2002) Acanthamoeba sclerokeratitis: treatment with systemic immunosuppression. Ophthalmology 109:1178–1182PubMedCrossRefGoogle Scholar
  15. Lorenzo-Morales J, Martínez-Carretero E, Batista N, Alvarez-Marín J, Bahaya Y, Walochnik J, Valladares B (2007) Early diagnosis of amoebic keratitis due to a mixed infection with Acanthamoeba and Hartmannella. Parasitol Res 102:167–169PubMedCrossRefGoogle Scholar
  16. Mathers W (2006) Use of higher medication concentrations in the treatment of Acanthamoeba keratitis. Arch Ophthalmol 124:923PubMedCrossRefGoogle Scholar
  17. Narasimhan S, Madhavan HN, Therese L (2002) Development and application of an in vitro susceptibility test for Acanthamoeba species isolated from keratitis to polyhexamthylene biguanide and chlorhexidine. Cornea 21:203–205PubMedCrossRefGoogle Scholar
  18. Pens CJ, Costa M, Fadanelli C, Caumo K, Rott M (2008) Acanthamoeba spp. and bacterial contamination in contact lens storage cases and the relationship to user profiles. Parasitol Res 103:1241–1245PubMedCrossRefGoogle Scholar
  19. Polat ZA, Ozcelik S, Vural A, Cetin A (2007) Clinical and histologic evaluations of experimental Acanthamoeba keratitis. Parasitol Res 101:1621–1625PubMedCrossRefGoogle Scholar
  20. Rahman MR, Minassian DC, Srinivasan M, Martin MJ, Johnson GJ (1997) Trial of chlorhexidine gluconate for fungal corneal ulcers. Ophthalmic Epidemiol 4:141–149PubMedCrossRefGoogle Scholar
  21. Schuster FL, Visvesvara GS (2004) Opportunistic amoebae: challenges in prophylaxis and treatment. Drug Resist Updat 7:41–51PubMedCrossRefGoogle Scholar
  22. Seal DV (2003) Acanthamoeba keratitis update—incidence, molecular epidemiology and new drugs for treatment. Eye 17:893–905PubMedCrossRefGoogle Scholar
  23. Sharma S, Srinivasan M, George C (1990) Acanthamoeba keratitis in non-contact lens wearers. Arch Ophthalmol 108:676–678PubMedCrossRefGoogle Scholar
  24. Thebpatiphat N, Hammersmith KM, Rocha FN, Rapuano CJ, Ayres BD, Laibson PR, Eagle RC, Cohen EJ (2007) Acanthamoeba keratitis: a parasite on the rise. Cornea 26:701–706PubMedCrossRefGoogle Scholar
  25. Visvesvara GS (2010) Amebic meningoencephalitides and keratitis: challenges in diagnosis and treatment. Curr Opin Infect Dis 23:590–594PubMedCrossRefGoogle Scholar
  26. Walochnik J, Obwaller A, Aspöck H (2000) Correlations between morphological, molecular biological, and physiological characteristics in clinical and nonclinical isolates of Acanthamoeba spp. Appl Environ Microbiol 66:4408–4413PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Medical ParasitologyCumhuriyet University School of MedicineSivasTurkey
  2. 2.Department of OphthalmologyCumhuriyet UniversitySivasTurkey

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