Contact lens-related polymicrobial keratitis: Acanthamoeba spp. genotype T4 and Candida albicans

• Published in: Parasitology research (1987) 2018-11, Vol.117 (11), p.3431-3436
• Main Authors: Buchele, Maria Luiza Carneiro, Wopereis, Débora Borgert, Casara, Fabiana, de Macedo, Jefferson Peres, Rott, Marilise Brittes, Monteiro, Fabíola Branco Filippin, Bazzo, Maria Luiza, dos Reis Spada, Fernando, dos Santos, Jairo Ivo, Caumo, Karin Silva
• Format: Article
• Language: English
• Subjects: Acanthamoeba; Acanthamoeba - genetics; Acanthamoeba - isolation & purification; Acanthamoeba Keratitis - diagnosis; Acanthamoeba Keratitis - drug therapy; Acanthamoeba Keratitis - parasitology; Adult; Biguanides - therapeutic use; Biomedical and Life Sciences; Biomedicine; Candida albicans; Candida albicans - isolation & purification; Candidiasis - diagnosis; Candidiasis - drug therapy; Chlorhexidine; Chlorhexidine - therapeutic use; Concurrent infection; Contact Lenses; Cornea; Cornea - parasitology; Cornea - pathology; DNA, Ribosomal - genetics; Epithelium; Female; Fungi; Genotype; Genotypes; Humans; Hyperemia; Immunology; Irritation; Keratitis; Medical Microbiology; Microbiology; Original Paper; Pons; Ribosomal DNA; RNA, Ribosomal, 18S - genetics
• ISSN: 0932-0113; 1432-1955
• DOI: 10.1007/s00436-018-6037-x

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.