[Keratitis caused by Acanthamoeba spp.: presentation of 10 cases]

Abstract

Objective: To describe the clinical and microbiological characteristics of ten patients with Acanthamoeba spp. keratitis.

Methods: A retrospective review was made of the clinical charts of ten patients with both clinical keratitis and positive culture for Acanthamoeba spp. from 1992 (date of first diagnosed case in our hospital) on. Corneal tissue was cultured in Page media and also the contact lenses and maintenance or cleaning fluids used by each patient.

Results: The earliest clinical symptom observed in 60% of cases was foreign-body sensation. Before the parasitologic studies all the patients received different treatments for 4 days minimum to a maximum of 3 months. On ophthalmological examination the findings were: radial perineuritis in 4 cases, anular infiltrate in two, keratitis punctata in two and pseudodendritic ulcer in two more. Treatment employed was the following: propamidine and neomycin in 8 patients (four of them also received ketoconazole); biguanides in two. After a mean observation time of 7 months (minimum 4, maximum 10) the clinical status was favorable in 70% of cases. In three patients with delayed diagnosis of 2 to 3 months a keratoplasty was needed.

Comments: Acanthamoeba spp. keratitis is a process of difficult diagnosis and treatment. For early detection of this disease a narrow collaboration with the microbiologist is mandatory because the prognosis in this patients depends on the precocity of treatment.