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Chuang YH, Wang YC, Yen CY, Lin CC, Chen CC. Case Series: Unusual Presentation of Acanthamoeba Coinfection in the Cornea. Optom Vis Sci 2022; 99:605-611. [PMID: 35413026 PMCID: PMC9296050 DOI: 10.1097/opx.0000000000001906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE The cases illustrate Acanthamoeba coinfection with Pseudomonas aeruginosa or microsporidia in the cornea. PURPOSE This case series aimed to alert clinicians toward considering Acanthamoeba coinfection in the cornea when unusual presentation such as perineuritis or epitheliitis was observed in clinical images. Increased suspicion of Acanthamoeba coinfection may facilitate early diagnosis and prompt management, eventually leading to good vision outcomes. CASE SERIES An 11-year-old boy wearing orthokeratology lens for myopia control complained of pain in the right eye for 1 week. A paracentral corneal ulcer with perineuritis was observed. Culture from corneal tissue revealed P. aeruginosa , and an in vivo confocal microscopic examination showed highly reflective and oval-shaped structures indicating Acanthamoeba coinfection. Corneal lesions gradually improved under 0.02% polyhexamethylene biguanidine, 0.1% propamidine isethionate, and 0.3% ciprofloxacin. At 1 year, the final best-corrected visual acuity was 20/25 with residual paracentral corneal opacity. Another 20-year-old man complained of pain in the right eye for 2 weeks. Multiple raised corneal lesions associated with epitheliitis were found. Moreover, 1% acid-fast staining showed oval-shaped spores, and microsporidia infection was inferred. In addition, polymerase chain reaction results obtained after subjecting the patient to corneal debridement revealed positivity for Acanthamoeba . Polyhexamethylene biguanidine (0.02%) and 0.5% moxifloxacin were prescribed, and the lesions subsided. At a 2-year follow-up, the final best-corrected visual acuity was 20/25. CONCLUSIONS Perineuritis in orthokeratology lens wearers and epitheliitis without any predisposing factor are unusual presentations of Acanthamoeba coinfection in the cornea. These corneal findings should arouse the suspicion of coinfection and enable the clinicians to conduct the appropriate workup and initiate adequate treatment. This case series demonstrated that early diagnosis and prompt treatment can improve visual prognosis.
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Affiliation(s)
- Yu-Hsun Chuang
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Ying-Ching Wang
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chu-Yu Yen
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chih-Chung Lin
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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2
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Ruenchit P, Whangviboonkij N, Sawasdipokin H, Phumisantiphong U, Chaicumpa W. A Search for Anti- Naegleria fowleri Agents Based on Competitive Exclusion Behavior of Microorganisms in Natural Aquatic Environments. Pathogens 2021; 10:pathogens10020142. [PMID: 33535404 PMCID: PMC7911858 DOI: 10.3390/pathogens10020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Naegleria fowleri causes deadly primary amoebic meningoencephalitis (PAM) in humans. Humans obtain the infection by inhaling water or dust contaminated with amebae into the nostrils, wherefrom the pathogen migrates via the olfactory nerve to cause brain inflammation and necrosis. Current PAM treatment is ineffective and toxic. Seeking new effective and less toxic drugs for the environmental control of the amoeba population to reduce human exposure is logical for the management of N. fowleri infection. On the basis of the concept of competitive exclusion, where environmental microorganisms compete for resources by secreting factors detrimental to other organisms, we tested cell-free culture supernatants (CFSs) of three bacteria isolated from a fresh water canal, i.e., Pseudomonas aeruginosa, Pseudomonas otitidis, and Enterobacter cloacae, were tested against N. fowleri. The CFSs inhibited growth and caused morphological changes in N. fowleri. At low dose, N. fowleri trophozoites exposed to P. aeruginosa pyocyanin were seen to shrink and become rounded, while at high dose, the trophozoites were fragmented. While the precise molecular mechanisms of pyocyanin and products of P. otitidis and E. cloacae that also exert anti-N. fowleri activity await clarification. Our findings suggest that P. aeruginosa pyocyanin may have a role in the control of amphizoic N. fowleri in the environment.
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Affiliation(s)
- Pichet Ruenchit
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.W.); (H.S.)
- Correspondence: ; Tel.: +66-2-419-6484; Fax: +66-2-419-6470
| | - Narisara Whangviboonkij
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.W.); (H.S.)
| | - Hathai Sawasdipokin
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.W.); (H.S.)
| | - Uraporn Phumisantiphong
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
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Spagnolo AM, Sartini M, Cave DD, Casini B, Tuvo B, Cristina ML. Evaluation of Microbiological and Free-Living Protozoa Contamination in Dental Unit Waterlines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152648. [PMID: 31344972 PMCID: PMC6696308 DOI: 10.3390/ijerph16152648] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022]
Abstract
Studies conducted over the last 40 years have demonstrated that the water output from dental unit waterlines (DUWLs) is often contaminated with high densities of microorganisms. It has been monitored the microbiological quality of the water in 30 public dental facilities in northern Italy in order to assess the health risk for patients and dental staff. In each facility, samples of water both from taps and from DUWLs were analyzed in order to evaluate heterotrophic plate counts (HPCs) at 22 °C and 36 °C, and to detect coliform bacteria, Pseudomonas aeruginosa, Legionella pneumophila and amoebae. In 100% of the samples taken from the DUWLs, the concentration of HPCs was above the threshold as determined by the Ministère de la Santé et des Solidarités (2007). The concentration of P. aeruginosa was greater than the indicated threshold in 16.67% of the hand-pieces analyzed. A total of 78.33% of samples were contaminated by L. pneumophila, while in the samples taken from the DUWLs alone, this percentage rose to 86.67%. Amoebae were detected in 60% of the samples taken from hand-pieces; all belonging to the species V. vermiformis. This study documented the presence of various microorganisms, including Legionella spp., at considerably higher concentrations in water samples from DUWLs than in samples of tap water in the same facilities, confirming the role of the internal DUWLs in increasing microbial contamination, especially in the absence of proper management of waterborne health risks.
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Affiliation(s)
- Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy.
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Benedetta Tuvo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy
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4
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Hajialilo E, Rezaeian M, Niyyati M, Pourmand MR, Mohebali M, Norouzi M, Razavi Pashabeyg K, Rezaie S, Khodavaisy S. Molecular characterization of bacterial, viral and fungal endosymbionts of Acanthamoeba isolates in keratitis patients of Iran. Exp Parasitol 2019; 200:48-54. [PMID: 30917916 DOI: 10.1016/j.exppara.2019.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/18/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
Free-living amoebae belong to the genus Acanthamoeba; can feed on microbial population by phagocytosis, and with the capability to act as a reservoir and a vehicle of microorganisms to susceptible host. Therefore, the role of endosymbiosis in the pathogenesis of Acanthamoeba is complex and not fully understood. The aim of the present study was to identify bacterial, fungal, and human adenovirus (HADV) endosymbionts as well as evaluating the endosymbionts role of such organisms in the pathogenesis of Acanthamoeba in keratitis patients living in Iran. Fifteen Acanthamoeba (T4 genotype) isolates were recovered from corneal scrapes and contact lenses of patients with keratitis. Cloning and purification was performed for all isolate. Gram staining was performed to identify bacterial endosymbionts. DNA extraction, PCR, and nested PCR was set up to identify endosymbiont of amoeba. Evaluation of pathogenicity was conducted by osmo-tolerance and thermo-tolerance assays and cell culture, and then CPE (cytopathic effect) was survey. Statistical analysis was used between Acanthamoeba associated endosymbionts and Acanthamoeba without endosymbiont at 24, 48, 72, and 96 h. A p value < 0.05 was considered as significant, statistically. A total of 9 (60%) Acanthamoeba (T4 genotypes) isolates were successfully cloned for detecting microorganism endosymbionts. The only isolate negative for the presence of endosymbiont was ICS9. ICS7 (Pseudomonas aeruginosa, Aspergillus sp., and human adenovirus endosymbionts) and ICS2 (Escherichia coli endosymbiont) isolates were considered as Acanthamoeba associated endosymbionts. ICS7 and ICS2 isolates were highly pathogen whereas ICS9 isolate showed low pathogenicity in pathogenicity evaluated. Positive CPE for ICS7 and ICS2 isolates and negative CPE for ICS9 isolate were observed in cell culture. The average number of cells, trophozoites, and cysts among ICS7, ICS2, and ICS9 isolates at 24, 48, 72, and 96 h was significant. This is the first survey on microbial endosymbionts of Acanthamoeba in keratitis patients of Iran, and also the first report of Aspergillus sp, Achromobacter sp., Microbacterium sp., Brevibacillus sp, Brevundimonas sp and Mastadenovirus sp in Acanthamoeba as endosymbionts. Our study demonstrated that microbial endosymbionts can affect the pathogenicity of Acanthamoeba; however, further research is required to clarify the exact pattern of symbiosis, in order to modify treatment protocol.
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Affiliation(s)
- Elham Hajialilo
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaeian
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Niyyati
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Pourmand
- Department of Pathobiology, School of Public Health, Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Norouzi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kobra Razavi Pashabeyg
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sassan Rezaie
- Division of Molecular Biology & Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Division of Molecular Biology & Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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5
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Hsu CC. Dendrite-like anterior stromal keratitis coinfected with Acanthamoeba and Pseudomonas in an orthokeratology contact lens wearer. Taiwan J Ophthalmol 2019; 9:131-133. [PMID: 31198674 PMCID: PMC6557072 DOI: 10.4103/tjo.tjo_114_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Acanthamoeba species can cause a keratitis misdiagnosed as herpes keratitis or fungal keratitis. We report an unusual dendrite-like anterior stromal keratitis coinfected with Acanthamoeba and Pseudomonas aeruginosa in an orthokeratology contact lens wearer in Taiwan. Topical 1% voriconazole and 0.5% levofloxacin were prescribed because besides Acanthamoeba keratitis, fungal keratitis was also highly suspected initially. Topical 0.02% chlorhexidine was added after the culture of the scraped cornea showed positive results of Acanthamoeba and P. aeruginosa. The lesion subsided using this triple combination therapy for 1 week. Both Acanthamoeba and P. aeruginosa are potentially devastating causes of infectious keratitis. Our case highlights the importance of considering the possibility of a concurrent infection and atypical presentation in cases with contact lens-related keratitis. The use of topical levofloxacin combined with voriconazole should be considered as the first-line treatment in such patients.
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Affiliation(s)
- Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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6
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Juárez MM, Tártara LI, Cid AG, Real JP, Bermúdez JM, Rajal VB, Palma SD. Acanthamoeba in the eye, can the parasite hide even more? Latest developments on the disease. Cont Lens Anterior Eye 2017; 41:245-251. [PMID: 29273391 DOI: 10.1016/j.clae.2017.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
Acanthamoeba spp. is a free living protozoan in the environment, but can cause serious diseases. Acanthamoeba keratitis (AK), a severe and painful eye infection, must be treated as soon as possible to prevent ulceration of the cornea, loss of visual acuity, and eventually blindness or enucleation. Although the disease affects principally contact lens (CLs) wearers, it is recognized nowadays as a cause of keratitis also in non-CLs wearers. Although the number of infections caused by these amoebae is low, AK is an emerging disease presenting an extended number of cases each year worldwide mostly due to the increasing use of CLs, but also to better diagnostic methods and awareness. There are two principal causes that lead to severe outcomes: misdiagnosis or late diagnosis of the causal agent, and lack of a fully effective therapy due to the existence of a highly resistant cyst stage of Acanthamoeba. Recent studies have reported different genotypes that have not been previously associated with this disease. In addition, Acanthamoeba can act as a reservoir for phylogenetically diverse microorganisms. In this regard, recently giant viruses called Pandoravirus have been found within genotypes producing keratitis. What potential risk this poses is not yet known. This review focuses on an overview of the present status and future prospects of this re-emerging pathology, including features of the parasite, epidemiology, clinical aspects, diagnosis, and treatment.
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Affiliation(s)
- M M Juárez
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - L I Tártara
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina
| | - A G Cid
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - J P Real
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina
| | - J M Bermúdez
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - V B Rajal
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Singapore Centre on Environmental Life Sciences Engineering (SCELSE), School of Biological Sciences, Nanyang Technological University, Singapore
| | - S D Palma
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina.
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7
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Metabolic flux analyses of Pseudomonas aeruginosa cystic fibrosis isolates. Metab Eng 2016; 38:251-263. [PMID: 27637318 DOI: 10.1016/j.ymben.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/07/2016] [Accepted: 09/11/2016] [Indexed: 01/22/2023]
Abstract
Pseudomonas aeruginosa is a metabolically versatile wide-ranging opportunistic pathogen. In humans P. aeruginosa causes infections of the skin, urinary tract, blood, and the lungs of Cystic Fibrosis patients. In addition, P. aeruginosa's broad environmental distribution, relatedness to biotechnologically useful species, and ability to form biofilms have made it the focus of considerable interest. We used 13C metabolic flux analysis (MFA) and flux balance analysis to understand energy and redox production and consumption and to explore the metabolic phenotypes of one reference strain and five strains isolated from the lungs of cystic fibrosis patients. Our results highlight the importance of the oxidative pentose phosphate and Entner-Doudoroff pathways in P. aeruginosa growth. Among clinical strains we report two divergent metabolic strategies and identify changes between genetically related strains that have emerged during a chronic infection of the same patient. MFA revealed that the magnitude of fluxes through the glyoxylate cycle correlates with growth rates.
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Cateau E, Delafont V, Hechard Y, Rodier M. Free-living amoebae: what part do they play in healthcare-associated infections? J Hosp Infect 2014; 87:131-40. [DOI: 10.1016/j.jhin.2014.05.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 05/01/2014] [Indexed: 12/12/2022]
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Necrotizing painful skin lesion after a mosquito bite in healthy elderly woman: case report. Am J Emerg Med 2014; 32:1148.e3-4. [PMID: 24686027 DOI: 10.1016/j.ajem.2014.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 11/20/2022] Open
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Coinfection with Acanthamoeba and Pseudomonas in Contact Lens–Associated Keratitis. Optom Vis Sci 2013; 90:e53-5. [DOI: 10.1097/opx.0b013e31827f15b4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bialasiewicz AA, Breidenbach KA, Klauss V, Al-Saeidi RM, Shenoy R, Bischoff G. Clinical management of infectious contact lens complications: from antibiotics to quorum-sensing inhibitors. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Influence of Legionella pneumophila and other water bacteria on the survival and growth of Acanthamoeba polyphaga. Arch Microbiol 2010; 192:877-82. [DOI: 10.1007/s00203-010-0618-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 06/29/2010] [Accepted: 08/10/2010] [Indexed: 11/29/2022]
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13
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Iovieno A, Ledee DR, Miller D, Alfonso EC. Detection of bacterial endosymbionts in clinical acanthamoeba isolates. Ophthalmology 2010; 117:445-52, 452.e1-3. [PMID: 20031220 DOI: 10.1016/j.ophtha.2009.08.033] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 08/23/2009] [Accepted: 08/25/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the presence of 4 clinically relevant bacterial endosymbionts in Acanthamoeba isolates obtained from patients with Acanthamoeba keratitis (AK) and the possible contribution of endosymbionts to the pathogenesis of AK. DESIGN Experimental study. PARTICIPANTS Acanthamoeba isolates (N = 37) recovered from the cornea and contact lens paraphernalia of 23 patients with culture-proven AK and 1 environmental isolate. METHODS Acanthamoeba isolates were evaluated for the presence of microbial endosymbionts belonging to the bacterial genera Legionella, Pseudomonas, Mycobacterium, and Chlamydia using molecular techniques (polymerase chain reaction and sequence analysis, fluorescence in situ hybridization) and transmission electron microscopy. Corneal toxicity and virulence of Acanthamoeba isolates with and without endosymbionts were compared using a cytopathic effect (CPE) assay on human corneal epithelial cells in vitro. Initial visual acuity, location and characteristics of the infiltrate, time to detection of the infection, and symptom duration at presentation were evaluated in all patients. MAIN OUTCOME MEASURES Prevalence and potential pathobiology of bacterial endosymbionts detected in Acanthamoeba isolates recovered from AK. RESULTS Twenty-two (59.4%) of the 38 cultures examined contained at least 1 bacterial endosymbiont. One isolate contained 2 endosymbionts, Legionella and Chlamydia, confirmed by fluorescence in situ hybridization. Corneal toxicity (CPE) was significantly higher for Acanthamoeba-hosting endosymbionts compared with isolates without endosymbionts (P<0.05). Corneal pathogenic endosymbionts such as Pseudomonas and Mycobacterium enhanced Acanthamoeba CPE significantly more than Legionella (P<0.05). In the presence of bacterial endosymbionts, there was a trend toward worse initial visual acuity (P>0.05), central location (P<0.05), absence of radial perineuritis (P<0.05), delayed time to detection (P>0.05), and longer symptom duration at presentation (P>0.05). CONCLUSIONS Most Acanthamoeba isolates responsible for AK harbor 1 or more bacterial endosymbionts. The presence of endosymbionts enhances the corneal pathogenicity of Acanthamoeba isolates and may impact detection time and clinical features of AK.
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Affiliation(s)
- Alfonso Iovieno
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, Florida 33136, USA
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14
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Cateau E, Imbert C, Rodier MH. Hartmanella vermiformiscan be permissive forPseudomonas aeruginosa. Lett Appl Microbiol 2008; 47:475-7. [DOI: 10.1111/j.1472-765x.2008.02457.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Abd H, Wretlind B, Saeed A, Idsund E, Hultenby K, Sandström G. Pseudomonas aeruginosa utilises its type III secretion system to kill the free-living amoeba Acanthamoeba castellanii. J Eukaryot Microbiol 2008; 55:235-43. [PMID: 18460161 DOI: 10.1111/j.1550-7408.2008.00311.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pseudomonas aeruginosa is a free-living and common environmental bacterium. It is an opportunistic and nosocomial pathogen causing serious human health problems. To overcome its predators, such as macrophages and environmental phagocytes, it utilises different survival strategies, such as the formation of microcolonies and the production of toxins mediated by a type III secretion system (TTSS). The aim of this study was to examine interaction of TTSS effector proteins of P. aeruginosa PA103 with Acanthamoeba castellanii by co-cultivation, viable count, eosin staining, electron microscopy, apoptosis assay, and statistical analysis. The results showed that P. aeruginosa PA103 induced necrosis and apoptosis to kill A. castellanii by the effects of TTSS effector proteins ExoU, ExoS, ExoT, and ExoY. In comparison, Acanthamoeba cultured alone and co-cultured with P. aeruginosa PA103 lacking the known four TTSS effector proteins were not killed. The results are consistent with P. aeruginosa being a strict extracellular bacterium that needs TTSS to survive in the environment, because the TTSS effector proteins are able to kill its eukaryotic predators, such as Acanthamoeba.
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Affiliation(s)
- Hadi Abd
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute, Stockholm, Sweden
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Rahman M, Abd H, Romling U, Sandstrom G, Möllby R. Aeromonas-Acanthamoeba interaction and early shift to a viable but nonculturable state of Aeromonas by Acanthamoeba. J Appl Microbiol 2008; 104:1449-57. [PMID: 18194253 DOI: 10.1111/j.1365-2672.2007.03687.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the hypothesis that amoeba may comprise a significant environmental reservoir for Aeromonas, Acanthamoeba-Aeromonas interaction experiments were performed. METHODS AND RESULTS Acanthamoeba were grown in monoculture and co-cultures with three different species of Aeromonas. Survival, invasion and viable but nonculturable state experiments were performed. We showed that at a low initial bacterial cell density, growth of Aeromonas spp. was inhibited by Acanthamoeba castellanii, while A. castellanii growth was unaffected. In contrast, a high initial bacterial cell density, Aeromonas hydrophila AEW44 and Aeromonas veronii biovar sobria AEW104 suppressed the growth of A. castellanii. Fluorescent and phase-contrast microscopic observations of GFP tagged Aer. hydrophila AEW44 demonstrated that the bacterial cells aggregated on A. castellanii cells after 15 min of incubation and internalized. Aeromonas hydrophila AEW44 cells were found to be actively moving. Interestingly, Aer. hydrophila AEW44 cells shifted more rapidly to a viable but nonculturable form when co-cultured with A. castellanii than in monoculture. CONCLUSIONS We demonstrated that Aeromonas spp. are able to interact with and to infect the protozoan A. castellanii under laboratory conditions. SIGNIFICANCE AND IMPACT OF THE STUDY Free-living amoeba might play a role as reservoir for Aeromonas, and thus may increase the transmission of Aeromonas by acting as a vehicle.
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Affiliation(s)
- M Rahman
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
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17
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Pickup ZL, Pickup R, Parry JD. Effects of bacterial prey species and their concentration on growth of the amoebae Acanthamoeba castellanii and Hartmannella vermiformis. Appl Environ Microbiol 2007; 73:2631-4. [PMID: 17293529 PMCID: PMC1855622 DOI: 10.1128/aem.02061-06] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two amoebae were presented with six bacterial prey at a range of concentrations, and the growth parameters of the amoebae were deduced. All but one bacterium (Synechococcus) resulted in a positive growth response, but the gram-positive bacterium Staphylococcus aureus proved to be difficult to digest and the heavily pigmented bacterium Klebsiella ozaenae induced unusual amoebic behavior prior to ingestion.
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Affiliation(s)
- Zoë L Pickup
- Department of Biological Sciences, The Lancaster Environment Centre, Faculty of Science and Technology, Lancaster University, Lancaster, UK
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18
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Hwang MG, Katayama H, Ohgaki S. Effect of intracellular resuscitation of Legionella pneumophila in Acanthamoeba polyphage cells on the antimicrobial properties of silver and copper. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2006; 40:7434-9. [PMID: 17181000 DOI: 10.1021/es060412t] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The property of Legionella pneumophila entering into a viable but noncultivable (VBNC) state under drinking water conditions (50 mL, pH 7.0, and 25 degrees C) and the intracellular resuscitation in Acanthamoeba polyphage cells were investigated. Then, the survival profiles of L. pneumophila residing in the planktonic phase and the endosymbiosis phase against antimicrobial silver and copper reagents were differentially compared with the case of Pseudomonas aeruginosa. The number of L. pneumophila in a cultivable state was rapidly reduced to below the detection limit (5.0 log reduction) within 30 days of incubation in synthetic drinking water, while the number of L. pneumophila in a viable state varied in only 0.1 log reduction during the same period, and the levels were sustained constantly for 190 days; in contrast, P. aeruginosa multiplied even in drinking water and continuously maintained its cultivability and viabilityfor 190 days. Distinctively, the numbers of E. coli in both cultivable and viable states were simultaneously diminished as 3.0 log and 1.6 log reduction. The cultivability of L. pneumophila in the VBNC state was recovered and started to multiply after coincubation with A. polyphage in the same environment (initial population of inoculated amoeba was adjusted as 1.0 x 10(5) amoeba/ mL), and P. aeruginosa also multiplied in amoeba cells. Finally, the populations of L. pneumophila in the planktonic phase after 10 days coincubation were detected at 1.7 x 10(7) CFU/mL, and this population was considered to have originated from the release of bacteria residing inside amoeba caused by the destruction of amoeba cells. Bacteria in the planktonic phase that were exposed to silver and copper were completely inactivated (more than 7 log reduction) within 30 min, while bacteria in the endosymbiosis phase showed much higher resistance against the exposure to the same concentrations of silver and copper. L. pneumophila and P. aeruginosa in A. polyphage cells survived to levels of 5.6 x 10(1) and 1.1 x 10(1) CFU/mL at the silver exposure (0.1 mgAg/L) and 7.3 x 10(3) and 6.1 x 10(4) CFU/ mL at the copper exposure (1.0 mgCu/L), respectively, after 7 days.
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Affiliation(s)
- Myoung Goo Hwang
- Department of Urban Engineering, The University of Tokyo, 3-1-7 Hongo Bunkyo, Tokyo 133-8656, Japan.
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19
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Abstract
Free-living amoebae feed on bacteria, fungi, and algae. However, some microorganisms have evolved to become resistant to these protists. These amoeba-resistant microorganisms include established pathogens, such as Cryptococcus neoformans, Legionella spp., Chlamydophila pneumoniae, Mycobacterium avium, Listeria monocytogenes, Pseudomonas aeruginosa, and Francisella tularensis, and emerging pathogens, such as Bosea spp., Simkania negevensis, Parachlamydia acanthamoebae, and Legionella-like amoebal pathogens. Some of these amoeba-resistant bacteria (ARB) are lytic for their amoebal host, while others are considered endosymbionts, since a stable host-parasite ratio is maintained. Free-living amoebae represent an important reservoir of ARB and may, while encysted, protect the internalized bacteria from chlorine and other biocides. Free-living amoebae may act as a Trojan horse, bringing hidden ARB within the human "Troy," and may produce vesicles filled with ARB, increasing their transmission potential. Free-living amoebae may also play a role in the selection of virulence traits and in adaptation to survival in macrophages. Thus, intra-amoebal growth was found to enhance virulence, and similar mechanisms seem to be implicated in the survival of ARB in response to both amoebae and macrophages. Moreover, free-living amoebae represent a useful tool for the culture of some intracellular bacteria and new bacterial species that might be potential emerging pathogens.
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Affiliation(s)
- Gilbert Greub
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseille, France
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20
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Kinnear FB. Cytopathogenicity of acanthamoeba, vahlkampfia and hartmannella: quantative & qualitative in vitro studies on keratocytes. J Infect 2003; 46:228-37. [PMID: 12799148 DOI: 10.1053/jinf.2002.1116] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the cytopathogenicity of Vahlkampfia and Hartmannella clinical isolates with a type culture of Acanthamoeba castellanii. METHODS The cytopathic effect produced during 24 h co-incubation with cultured keratocytes was assessed at set time intervals. Formal quantative studies involved image analysis of the area of cells remaining after 6 h. The mechanism of cytopathogenicity was elucidated using time-lapse video, light and scanning electron microscopy. The ability to produce cell damage in the absence of physical contact was studied using the transwell apparatus. The role of apotosis was also investigated. RESULTS All three isolates produced near destruction of the keratocyte monolayer within 24 h, although initial cell destruction was more rapid with Acanthamoeba. For all three genera, the mechanism of cell damage involved physical attack and trogocytosis: cytopathic products were also implicated as cell damage was produced in the absence of physical contact, but apoptosis was not demonstrated. CONCLUSIONS While the results do not prove that Vahlkampfia and Hartmannella are pathogens, they provide important evidence supporting the thesis that they cause keratitis by demonstrating that their ability to produce a cytopathic effect on keratocytes in vitro is similar in magnitude and mechanism to that of the known pathogen Acanthamoeba castellanii. The mechanisms by which small free-living amoebae produce cell damage is poorly understood. The ability of genera of amoebae other than Acanthamoeba to produce corneal infection remains controversial. In this study, the cytopathogenicity of Vahlkampfia and Hartmannella isolated from a case human keratitis are compared both quantitatively and qualitatively with that to the known pathogen Acanthamoeba castellanii. The results suggest that representatives of each of the 3 genera produce a similar degree of cytopathic effect on keratocytes after 24h of co-incubation and that a combination of physical and chemical factors are responsible.
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Affiliation(s)
- F B Kinnear
- Department of Ophthalmic Pathology, University of Glasgow, Glasgow, G12 6NT, Scotland.
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Cengiz AM, Harmis N, Stapleton F. Co-incubation of Acanthamoeba castellanii with strains of Pseudomonas aeruginosa alters the survival of amoeba. Clin Exp Ophthalmol 2000; 28:191-3. [PMID: 10981796 DOI: 10.1046/j.1442-9071.2000.00291.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Enhanced survival of Acanthamoeba castellanii has previously been reported following co-incubation with a single strain of Pseudomonas aeruginosa. The aim of this study was to evaluate the impact of different strains of P. aeruginosa on amoebae survival. Four contact lens solutions were challenged with A. castellanii for between 6 and 24 h, and survival rates of amoeba were calculated. Subsequently, A. castellanii was co-incubated with different strains of P. aeruginosa (strain 6294, an invasive isolate; 6206, a cytotoxic isolate; and Paer 001, a null isolate). Differences in amoeba survival over time between solutions for each bacterial strain were analysed. Non-neutralized hydrogen peroxide was the most effective system against A. castellani at all time points (P<0.05). Survival rates were not different between multipurpose solutions and neutralized hydrogen peroxide. Co-incubation with P. aeruginosa altered amoeba survival, and maximum survival occurred in the presence of the invasive strain of P. aeruginosa. Enhanced amoeba survival may occur in the presence of certain strains of Gram-negative bacteria, and with certain types of contact lens disinfection systems.
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Affiliation(s)
- A M Cengiz
- Cooperative Research Centre for Eye Research and Technology, University of New South Wales, Sydney, Australia
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22
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Dini LA, Cockinos C, Frean JA, Niszl IA, Markus MB. Unusual case of Acanthamoeba polyphaga and Pseudomonas aeruginosa keratitis in a contact lens wearer from Gauteng, South Africa. J Clin Microbiol 2000; 38:826-9. [PMID: 10655392 PMCID: PMC86214 DOI: 10.1128/jcm.38.2.826-829.2000] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/1999] [Accepted: 11/19/1999] [Indexed: 11/20/2022] Open
Abstract
Acanthamoeba species can cause a chronic, progressive ulcerative keratitis of the eye which is not responsive to the usual antimicrobial therapy and is frequently mistaken for stromal herpes keratitis. An unusual case of coinfection with Acanthamoeba polyphaga and Pseudomonas aeruginosa as causes of corneal keratitis in a contact lens wearer from Gauteng, South Africa, is reported. These two pathogens have previously been assumed to be selectively exclusive. Cysts of the isolated acanthameba tolerated an incubation temperature of 40 degrees C, indicating a pathogenic species. This case highlights the importance of culture methods in the diagnosis of corneal infection and the choice of treatment regimen. The patient's history of careless contact lens-disinfecting habits emphasizes the need to adhere strictly to recommended methods of contact lens care.
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Affiliation(s)
- L A Dini
- Department of Clinical Microbiology and Infectious Diseases, South African Institute for Medical Research and University of the Witwatersrand, University of the Witwatersrand, Johannesburg, South Africa.
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Stapleton F, Harmis N, Deshpande R, Tran D. Preliminary studies on the amoebicidal efficacy of contact lens disinfection systems. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1998; 26 Suppl 1:S44-6. [PMID: 9685020 DOI: 10.1111/j.1442-9071.1998.tb01369.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This preliminary study evaluated the efficacy of contact lens disinfection systems against Acanthamoeba castellanii, tested with and without co-incubation with Pseudomonas aeruginosa. METHODS First, disinfection systems containing 3% hydrogen peroxide, 0.00005% polyaminopropyl biguanide or 0.001% polyquaternium were challenged with A. castellanii for 72 h. Surviving cells were enumerated. Second, A. castellanii were co-incubated with P. aeruginosa for 48 h, then exposed to the disinfectants for 6 h. RESULTS There was zero survival of A. castellanii in hydrogen peroxide and variable survival in multipurpose systems. Following co-incubation, A. castellanii survival increased significantly (P = 0.015). CONCLUSIONS Multipurpose systems have variable anti-amoeba activity and storage cases contaminated by bacteria may enhance amoeba survival.
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Affiliation(s)
- F Stapleton
- School of Optometry, University of New South Wales, Sydney, Australia.
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24
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Penland RL, Wilhelmus KR. Comparison of axenic and monoxenic media for isolation of Acanthamoeba. J Clin Microbiol 1997; 35:915-22. [PMID: 9157153 PMCID: PMC229701 DOI: 10.1128/jcm.35.4.915-922.1997] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Acanthamoeba is a genus of ubiquitous, free-living amebae that can be difficult to isolate by standard microbiologic techniques. We retrospectively reviewed the laboratory records of patients with ocular acanthamoebic infection for the period from January 1973 to June 1996 and found that Acanthamoeba isolates were recovered from 73, 71, and 70% of clinical specimens inoculated onto buffered charcoal-yeast extract agar (BCYE), nonnutrient agar with live or dead Escherichia coli, and tryptic soy agar (TSA) with horse or sheep blood, respectively. We then prospectively compared the recovery of a corneal isolate of Acanthamoeba on commercial media from Remel and BBL (TSA with 5% sheep blood, TSA with 5% horse blood, TSA with 5% rabbit blood, V agar, chocolate agar, BCYE, and selective BCYE with polymyxin B, anisomycin, and vancomycin) and on axenic and monoxenic media prepared with live or dead bacteria (Enterobacter aerogenes, E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, and Stenotrophomonas maltophilia). Good recovery of trophozoites was obtained on BCYE, TSA with rabbit blood, TSA with horse blood, and Remel TSA with sheep blood. BBL TSA with horse blood or rabbit blood provided good recovery of cysts. All species of live or dead bacteria yielded good recovery of trophozoites; however, only nonnutrient agar with live P. aeruginosa, live E. aerogenes, or live S. maltophilia gave good recovery of cysts. TSA with either rabbit blood or horse blood, BCYE, and nonnutrient agar prepared with live P. aeruginosa, E. aerogenes, or S. maltophilia offer optimal recovery of Acanthamoeba.
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Affiliation(s)
- R L Penland
- Sid W. Richardson Ocular Microbiology Laboratory, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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Ahearn DG, Gabriel MM. Contact lenses, disinfectants, and Acanthamoeba keratitis. ADVANCES IN APPLIED MICROBIOLOGY 1997; 43:35-56. [PMID: 9097411 DOI: 10.1016/s0065-2164(08)70222-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- D G Ahearn
- Department of Biology, Georgia State University, Atlanta 30302-4010, USA
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26
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Kelly LD, Xu L. The effect of concurrent Pseudomonas or Xanthomonas exposure on adherence of Acanthamoeba castellanii to soft contact lenses. Graefes Arch Clin Exp Ophthalmol 1996; 234:311-4. [PMID: 8740252 DOI: 10.1007/bf00220706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Approximately 85% of Acanthamoeba-contaminated contact lens systems in asymptomatic patients have concurrent bacterial contamination. Pseudomonas aeruginosa and Xanthomonas maltophilia are common contact lens contaminants; we investigated the effect of coincubation of Acanthamoeba adherence to contact lenses. METHODS A. castellanii, 1 x 10(5) organisms/ml, was coincubated with P. aeruginosa or X. maltophilia, 1 x 10(8) CFU/ml in phosphate-buffered saline. Sterile, unworn polymacon, etafilcon A or lidofilcon contact lens were investigated. The experimental groups were: (I) lenses exposed to bacteria for 1 h, then Acanthamoeba for 2 h; (II) lenses exposed concurrently to bacteria and Acanthamoeba for 2 h; (III) Acanthamoeba coincubated with bacteria for 24 h, then lenses exposed for 2 h; (IV) lenses exposed to Acanthamoeba for 2 h (control). RESULTS For all experimental groups, Acanthamoeba adherence was greater to lidofilcon than to polymacon and etafilcon. For both P. aeruginosa and X. maltophilia, neither group I nor group II displayed greater Acanthamoeba adherence than group IV. Group III exhibited significantly less adherence than group IV for lidofilcon and polymacon. The decrease in group III adherence reflected an overall decrease in Acanthamoeba trophozoite concentration. CONCLUSION Short bacteria/Acanthamoeba coincubation times did not result in increased Acanthamoeba adherence. Twenty-four-hour coincubation resulted in decreased adherence for Pseudomonas and unchanged adherence rates for Xanthomonas. This model suggests that Pseudomonas or Xanthomonas co-contamination does not necessarily facilitate quantitative Acanthamoeba contact lens adherence.
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Affiliation(s)
- L D Kelly
- Department of Ophthalmology, Stanford Medical School, CA 94305-5308, USA
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Gray TB, Cursons RT, Sherwan JF, Rose PR. Acanthamoeba, bacterial, and fungal contamination of contact lens storage cases. Br J Ophthalmol 1995; 79:601-5. [PMID: 7626578 PMCID: PMC505174 DOI: 10.1136/bjo.79.6.601] [Citation(s) in RCA: 174] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Microbial corneal infection is the most serious complication of contact lens wear. Contact lens cases are a recognised potential source of pathogens associated with corneal ulcers. METHODS This survey established the incidence of protozoal, bacterial, and fungal contact lens case contamination in 101 asymptomatic daily wear cosmetic contact lens wearers from a domiciliary contact lens practice. RESULTS Eighty two (81%) contact lens cases were found to be contaminated, with 19 (19%) sterile. Of all contact lens cases, 78 (77%) grew bacteria, 24 (24%) fungi, and 20 (20%) protozoa. Acanthamoeba spp were isolated from eight (8%) contact lens cases. Fifty six (55%) contact lens cases yielded mixed bacterial contamination. This is the first contact lens case survey in which hydrogen peroxide disinfection was the major method of contact lens disinfection (75% of subjects) and no home made saline was used. All the contaminating organisms were shown to possess the enzyme catalase that breaks down hydrogen peroxide to oxygen and water. The polymicrobial nature of the biofilms found in many contact lens cases is illustrated electron micrographically. CONCLUSION Based on data from this and previous studies, the authors conclude with recommendations for contact lens wearers: (1) regular scrubbing of contact lens case interior to disrupt biofilms; (2) exposure of contact lens case to very hot water (> or = 70 degrees C) will kill Acanthamoeba contaminants; (3) allow contact lens case to air dry between uses; (4) if hydrogen peroxide disinfection is preferred, use a two step system; (5) replace contact lens case regularly.
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Affiliation(s)
- T B Gray
- Department of Ophthalmology, Auckland Hospital, New Zealand
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