Contact lens-related polymicrobial keratitis: Acanthamoeba spp. genotype T4 and Candida albicans
A 31-year-old female daily user of contact lenses sought medical attention, reporting blurred vision and irritation of the left eye. Slit-lamp examination revealed hyperemia and an irregular corneal epithelium surface, and empirical treatment was started. A corneal scrape was obtained and examined for the presence of fungi, bacteria, and Acanthamoeba spp. The results of the microbial culture revealed growth of Acanthamoeba spp. and Candida albicans. The Acanthamoeba isolate was characterized by cyst morphology as belonging to group II according to Pussard and Pons. Sequencing of the diagnostic fragment 3 (DF3) region located on the 18S ribosomal DNA identified the isolate as genotype T4. The patient was treated with chlorhexidine 0.02% and polyhexamethylene biguanide (PHMB) 0.02% drops for 5 months until the infection resolved. Lately, rare cases of polymicrobial keratitis associated with Acanthamoeba and Candida albicans have been reported. Cases of co-infection are more difficult to treat, since the specific treatment depends on precise identification of the agents involved.
KeywordsInfectious keratitis Acanthamoeba spp. Candida albicans Contact lenses
The authors thank the Clinical analysis Department of the Federal University of Santa Catarina, Brazil, and Dr. Janet W. Reid who revised the English text.
This study received financial support from CAPES and CNPq.
Compliance with ethical standards
We obtained approval for this study from the Committee for Human Research at the University of Santa Catarina, Florianópolis (CAAE No. 32938014.5.0000.0121).
Conflict of interest
The authors declare that they have no conflict of interest.
- Cope JR, Collier SA, Rao MM, Chalmers R, Mitchell GL, Richdale K, Wagner H, Kinoshita BT, Lam DY, Sorbara L, Zimmerman A, Yoder JS, Beach MJ (2015) Contact lens wearer demographics and risk behaviors for contact lens-related eye infections--United States, 2014. MMWR Morb Mortal Wkly Rep 64:865–870CrossRefGoogle Scholar
- Corsaro D, Köhsler M, Montalbano di Filippo M, Venditti D, Monno R, di Cave D, Berrilli F, Walochnik J (2017) Update on Acanthamoeba Jacobsi genotype T15, including full-length 18s RDNA molecular phylogeny. Parasitol Res 116:1273–1284. https://doi.org/10.1007/s00436-017-5406-1 CrossRefPubMedGoogle Scholar
- Dudley R, Matin A, Alsam S, Sissons J, Maghsood AH, Khan NA (2005) Acanthamoeba isolates belonging to T1, T2, T3, T4 but not T7 encyst in response to increased osmolarity and cysts do not bind to human corneal epithelial cells. Acta Trop 95:100–108. https://doi.org/10.1016/j.actatropica.2005.05.004 CrossRefPubMedGoogle Scholar
- Karsten E, Watson SL, Foster LJ (2012) Diversity of microbial species implicated in keratitis: a review. In Open Ophthalmol J 6: 110-24. NetherlandsGoogle Scholar
- Lorenzo-Morales J, Martínez-Carretero E, Batista N, Álvarez-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 102:167–169. https://doi.org/10.1007/s00436-007-0754-x CrossRefPubMedGoogle Scholar
- Page FC (1988) A new key to freshwater and soil gymnamoebae: with instructions for culture. Freshwater Biological Association, AmblesideGoogle Scholar
- Pussard M, Pons R (1977) Morphologie de la paroi kystiqueet taxonomie du genre Acanthamoeba (Protozoa, Amoebida). Protistologica 8:557–598Google Scholar
- Raqqad NA, Fgara NA (2015) Management of Acanthamoeba and Candida Keratitis in a young female: our experience at Princess Haya Military Hospital. Int J Keratoconus Ectatic Corneal Dis 4:120–122Google Scholar
- Said DG et al (2011) The challenge of fungal keratitis. In Br J Ophthalmol 95: 1623-4. EnglandGoogle Scholar
- Schroeder JM, Booton GC, Hay J, Niszl IA, Seal DV, Markus MB, Fuerst PA, Byers TJ (2001) Use of subgenic 18s ribosomal DNA PCR and sequencing for genus and genotype identification of Acanthamoebae from humans with keratitis and from sewage sludge. J Clin Microbiol 39:1903–1911. https://doi.org/10.1128/JCM.39.5.1903-1911.2001 CrossRefPubMedPubMedCentralGoogle Scholar
- Tice AK, Shadwick LL, Fiore-Donno AM, Geisen S, Kang S, Schuler GA, Spiegel FW, Wilkinson KA, Bonkowski M, Dumack K, Lahr DJG, Voelcker E, Clauß S, Zhang J, Brown MW (2016) Expansion of the molecular and morphological diversity of Acanthamoebidae (Centramoebida, Amoebozoa) and identification of a novel life cycle type within the group. Biol Direct 11:69. https://doi.org/10.1186/s13062-016-0171-0 CrossRefPubMedPubMedCentralGoogle Scholar
- Vieira A, Ramesh A, Seddon AM, Karlyshev AV (2017) CmeABC multidrug efflux pump contributes to antibiotic resistance and promotes campylobacter Jejuni survival and multiplication in Acanthamoeba polyphaga. Appl Environ Microbiol 83(Sep 15). https://doi.org/10.1128/aem.01600-17
- Visvesvara GS (2013) Infections with free-living amebae. Handb Clin Neurol 114:153–168. https://doi.org/10.1016/b978-0-444-53490-3.00010-8 CrossRefPubMedGoogle Scholar