Acanthameba Keratitis

Transcription

1 Acanthameba Keratitis CHARALAMBOS S. SIGANOS, MD, PHD ASSOC. PROFESSOR OF OPHTHALMOLOGY UNIVERSITY OF CRETE DEPARTMENT OF OPHTHALMOLOGY HERAKLION UNIVERSITY HOSPITAL CRETE GREECE

2 I declare no conflict of interest

3 Acanthameba Protozoon Pathogenic microorganism living in soil, in water, sewage systems, air condition systems. Resistant to medications Common in CL users

4 Life cycle 2 stages Trophozoites Metabolically actice Under extreme temperature and conditions or lack of nutrition develop cysts. Cysts In suitable enviromental conditions change to trophozoites within 3 days

5 Acanthameba species Castellani Polyphaga Hatsetti Culbertsoni Rhysodes Lugdunesis Quina Griffini

6 Acanthameba Keratitis (AK) 1. How can CL users be protected? Other factors? Is it rare? 2. When do you suspect AK? Can it be confused with other clinical entities? 3. How do you culture? Difficulties and other methods of diagnosis? 4. Management and treatment options? For how long? Is it effective? What is the role of Steroids? 5. What are the sign and symptoms of improvement or deterioration? How do you follow progress? 6. When would you proceed to transplantation? Are there any special considerations?

7 How can CL users be protected? Avoid contact with water (tap water, swimming pool, see water) Thorough use of soft contact lenses (daily wear) Other factors? Low levels of IgA in tears in CL users with AK. Is it rare? Usually CL users (80%) Soft lenses: 78%, RGP: 22% 5% of contact lens related infections

8 Acanthameba Keratitis (AK) 1. How can CL users be protected? Other factors? Is it rare? 2. When do you suspect AK? Can it be confused with other clinical entities? 3. How do you culture? Difficulties and other methods of diagnosis? 4. Management and treatment options? For how long? Is it effective? What is the role of Steroids? 5. What are the sign and symptoms of improvement or deterioration? How do you follow progress? 6. When would you proceed to transplantation? Are there any special considerations?

9 2. When do you suspect AK? Can it be confused with other clinical entities? At the beginning it mimics Herpetic Keratitis At later stage it resembles Bacterial or fungal keratitis Courtesy Dr. Miltsakakis

10 Acanthameba Keratitis (AK) 1. How can CL users be protected? Other factors? Is it rare? 2. When do you suspect AK? Can it be confused with other clinical entities? 3. How do you culture? Difficulties and other methods of diagnosis? 4. Management and treatment options? For how long? Is it effective? What is the role of Steroids? 5. What are the sign and symptoms of improvement or deterioration? How do you follow progress? 6. When would you proceed to transplantation? Are there any special considerations?

11 1. How do you culture? Difficulties and other methods of diagnosis? Corneal scraping and culture for bacteria fungi acanthameba in NNA PCR for HSV and acanthameba Confocal microscopy Corneal biopsy Confocal microscopy Biopsy

12 Infectious Keratitis Acanthamoeba Cysts μm Double Walled Structure Trophozoites μm Winchester et al (1995), Pfister et al (1996), Nakano et al (2004) Fungal Fusarium Solani (Fungal hyphae) Linear structures up to 300 μm length, 5 μm width, branching patterns 90 degrees Candida (pseudofilament) structures 10 to 40 μm length and 5 to 10 μm width Brasnu et al (2007) Bacterial Langerhans cells and leucocytes at the nerve plexus, increased oedema and scattering Difficult differential diagnosis

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14 Acanthameba Keratitis (AK) 1. How can CL users be protected? Other factors? Is it rare? 2. When do you suspect AK? Can it be confused with other clinical entities? 3. How do you culture? Difficulties and other methods of diagnosis? 4. Management and treatment options? For how long? Is it effective? What is the role of Steroids? 5. What are the sign and symptoms of improvement or deterioration? How do you follow progress? 6. When would you proceed to transplantation? Are there any special considerations?

15 1. Management and treatment options? For how long? Is it effective? Diamidines(hexamidine -propamidine) and Biguanides (PHMB 0.02%-0.06%- Chlorhexidine 0.02%) Voriconazole topical and systemic 6-12 months What is the role of Steroids? Controversial role In vitro και in vivo increase the number of trophozoites Increase cell disruption of corneal epithelium Indicated for sustained inflammation after at least 2 weeks of acanthamebic treatment Severe pain

16 Acanthameba Keratitis (AK) 1. How can CL users be protected? Other factors? Is it rare? 2. When do you suspect AK? Can it be confused with other clinical entities? 3. How do you culture? Difficulties and other methods of diagnosis? 4. Management and treatment options? For how long? Is it effective? What is the role of Steroids? 5. What are the sign and symptoms of improvement or deterioration? How do you follow progress? 6. When would you proceed to transplantation? Are there any special considerations?

17 Improvement Deteriotration 1. What are the sign and symptoms of improvement or deterioration? How do you follow progress?

18 Acanthameba Keratitis (AK) 1. How can CL users be protected? Other factors? Is it rare? 2. When do you suspect AK? Can it be confused with other clinical entities? 3. How do you culture? Difficulties and other methods of diagnosis? 4. Management and treatment options? For how long? Is it effective? What is the role of Steroids? 5. What are the sign and symptoms of improvement or deterioration? How do you follow progress? 6. When would you proceed to transplantation? Are there any special considerations?

19 When would you proceed to transplantation? Are there any special considerations? Intractable disease Persistence of inflammation Corneal thinning and pending perforation Corneal scarring to restore vision Αρχείο Δ. Μιλτσακάκη

20 Bilateral Disease

21 Other treatment modalities? Corneal Cross Linking

22 Thank you for your kind attention