PDF herunterladen
Klin Monbl Augenheilkd 2006; 223(6): 485-492
DOI: 10.1055/s-2005-859014
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Antiinfektiöse medikamentöse Therapie in der Augenheilkunde - Teil 4: Akanthamöben

Anti-Infective Drug Therapy in Ophthalmology - Part 4: Acanthamoeba KeratitisT. Reinhard1 , W. Behrens-Baumann2
  • 1Augenklinik des Universitätsklinikums, Killianstr. 5, 79106 Freiburg
  • 2Augenklinik des Universitätsklinikums, Leipziger Str. 44, 39120 Magdeburg
Weitere Informationen

Publikationsverlauf

Eingegangen: 16.9.2005

Angenommen: 24.11.2005

Publikationsdatum:
28. Juni 2006 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Gezielte Anamneseerhebung und Spaltlampenmikroskopie erlauben in aller Regel die Diagnose einer Akanthamöbenkeratitis bereits im Frühstadium. In Zweifelsfällen können konfokale Mikroskopie, mikrobiologische und histopathologische Untersuchungen zur Sicherung der Diagnose beitragen. Mit konservativen Maßnahmen (lokale Kombinationstherapie mit Aminoglykosiden, Polyhexamethylenbiguanid 0,02 %, Propamidinisoethionat 0,1 %) kann im Frühstadium eine vollständige Visusrehabilitierung erreicht werden. Im Spätstadium ist jedoch eine perforierende Keratoplastik oft unumgänglich.

Abstract

An early diagnosis of an acanthamoeba keratitis can usually be made on the basis of the patient’s history and slit-lamp examination. Further helpful diagnostic steps are confocal microscopy, microbiological, and histopathological examination. In the early stages topical application of antimicrobials (combined application of aminoglycosides, polyhexamethylene biguanide 0.02 %, propamidine isoethionate 0.1 %) is effective. In the late stages a penetrating keratoplasty is often necessary.

Schlüsselwörter

Akanthamöben - Keratitis - Hornhautinfiltrat - Hornhautulkus - Keratoplastik

Key words

Acanthamoeba - keratitis - corneal infiltrate - corneal ulcer - keratoplasty

Literatur

  • 1 Allan B DS, Dart J KG. Strategies for the management of microbial keratitis.  Br J Ophthalmol. 1995;  79 777-786
    PubMedSuche in Google Scholar
  • 2 Auran J D, Starr M B, Koester C J. et al . In vivo scanning slit confocal microscopy of Acanthamoeba Keratitis.  Cornea. 1994;  13 183-185
    CrossrefPubMedSuche in Google Scholar
  • 3 Bacon A S, Frazer D G, Dart J KG. et al . A review of 72 consecutive cases of Acanthamoeba keratitis, 1984 - 1992.  Eye. 1993;  7 719-725
    PubMedSuche in Google Scholar
  • 4 Behrens-Baumann W. Acanthamoeba-Keratitis. Ferdinand Enke Das äußere Auge Stuttgart; Kampik A, Grehn F 1996: 145-155
    Suche in Google Scholar
  • 5 Behrens-Baumann W. Mycosis of the Eye and Its Adnexa. Developments in Ophthalmology (with a contribution by Rüchel R). Karger AG Basel; 1999 32
    Suche in Google Scholar
  • 6 Behrens-Baumann W, Kramer A. Anti-Infectives against Amebic Keratitis. Karger Antiseptic Prophylaxis and Therapy in Ocular Infections Basel; Kramer A, Behrens-Baumann W 2002: 297-303
    Suche in Google Scholar
  • 7 Behrens-Baumann W. Antiinfektive medikamentöse Therapie in der Augenheilkunde - Teil 1: Bakterielle Infektionen.  Klin Monatsbl Augenheilkd. 2004;  221 539-545
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 Behrens-Baumann W. Antiinfektive medikamentöse Therapie am Auge - Teil 3: Mykotische Infektionen. Klin Monatsbl Augenheilkd 2005 222: 605-611
    Suche in Google Scholar
  • 9 Berger S T, Mondino B J, Hoft R H. et al . Successful medical management of Acanthamoeba keratitis.  Am J Ophthalmol. 1990;  110 395-403
    PubMedSuche in Google Scholar
  • 10 Blackman H J, Rao N A, Lemp M A. et al . Acanthamoeba keratitis successfully treated with penetrating keratoplasty: Suggested immunogenic mechanism of action.  Cornea. 1984;  3 125-130
    PubMedSuche in Google Scholar
  • 11 Brasseur G, Favennec L, Perrine D. et al . Successful treatment of acanthamoeba keratitis by hexamidine.  Cornea. 1994;  13 459-462
    PubMedSuche in Google Scholar
  • 12 Brooks J G, Coster D J, Badenoch P R. Acanthamoeba keratitis. Resolution after epithelial debridement. Cornea 1994 13: 186-189
    Suche in Google Scholar
  • 13 Brown T J, Cursons R TM, Keys E A. Amoebae from antarctic soil and waters.  Appl Environ Microbiol. 1982;  44 491-493
    PubMedSuche in Google Scholar
  • 14 Butler T KH, Males J J, Robinson L P. et al . Six-year review of Acanthamoeba keratitis in New South Wales, Australia: 1997 - 2002.  Clinical and Experimental Ophthalmology. 2005;  33 41-46
    CrossrefPubMedSuche in Google Scholar
  • 15 Cavanagh H D, Petroll W M, Alizadeh H A. Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease.  Ophthalmology. 1993;  100 1444-1453
    PubMedSuche in Google Scholar
  • 16 Cerva L, Serbus C, Skocil V. Isolation of limax amoebae from the nasal mucosa of man.  Folia Parasitol. 1973;  20 97-103
    PubMedSuche in Google Scholar
  • 17 Chang P CT, Soong H K, Arbor A. Acanthamoeba keratitis in non-contact lens wearers.  Arch Ophthalmol. 1991;  109 463-464
    PubMedSuche in Google Scholar
  • 18 Chew S J, Beuerman R W, Assouline M. et al . Early diagnosis of infectious keratitis with in vivo real time confocal microscopy.  CLAO. 1992;  J 18 197-201
    PubMedSuche in Google Scholar
  • 19 Chynn E W, Lopez M A, Pavan-Langston D. et al .Acanthamoeba keratitis. Contact lens and non-contact lens characteristics. Ophthalmology 1995 102: 1369-1373
    Suche in Google Scholar
  • 20 Cohen E J, Parlato C J, Arentsen J J. et al . Medical and surgical treatment of Acanthamoeba keratitis.  Am J Ophthalmol. 1987;  103 615-625
    PubMedSuche in Google Scholar
  • 21 Cursons R TM, Brown T J, Keys E A. et al . Immunity to pathogenic freeliving amoeba: Role of humoral antibody.  Infect Immun. 1980;  29 401-407
    PubMedSuche in Google Scholar
  • 22 Devonshire P, Munro F A, Abernethy C. et al . Microbial contamination of contact lens cases in the west of Scotland.  Br J Ophthalmol. 1993;  77 41-45
    PubMedSuche in Google Scholar
  • 23 Donzis P B, Mondino N J, Weissman B A. et al . Microbial contamination of contact lens care systems.  Am J Ophthalmol. 1987;  104 325-333
    PubMedSuche in Google Scholar
  • 24 Dormans J A, von Logten M J. The effects of ophthalmic preservatives on corneal epithelium of the rabbit: A scanning electron microscopial study.  Toxicol Appl Pharmacol. 1982;  62 251-261
    CrossrefPubMedSuche in Google Scholar
  • 25 Douglas M. Notes on the classification of amoeba found by Castellani in cultures of a yeast-like fungus.  J Trop Med Hyg. 1930;  33 258-259
    PubMedSuche in Google Scholar
  • 26 Driebe W T Jr, Stern G A, Epstein R J. et al . Acanthamoeba keratitis: Potential role for topical clotrimazole in combination chemotherapy.  Arch Ophthalmol. 1988;  106 1196-1201
    PubMedSuche in Google Scholar
  • 27 Elder M J, Kilvington S, Dart J KG. A clinicopathologic study of in vitro sensitivity testing and acanthamoeba keratitis.  Invest Ophthalmol Vis Sci. 1994;  35 1059-1064
    PubMedSuche in Google Scholar
  • 28 Elder M J, Dart J KG. Letter to the editor.  Lancet. 1995;  345 791-792
    PubMedSuche in Google Scholar
  • 29 Essepian J P, Rajpal R K, O’Brien T P. Non-invasive diagnosis of infectious keratitis using confocal microscopy.  Invest Ophthalmol Vis Sci. 1994;  35 1673
    PubMedSuche in Google Scholar
  • 30 Ficker L A, Kirkness C M, Rice N SC. et al . The changing management and improved prognosis for corneal grafting in herpes simplex keratitis.  Ophthalmology. 1989;  96 1587-1596
    PubMedSuche in Google Scholar
  • 31 Ficker L A, Kirkness C M, Wright P. Prognosis for keratoplasty in acanthamoeba keratitis.  Ophthalmology. 1993;  100 105-110
    PubMedSuche in Google Scholar
  • 32 Gray T B, Cursons R TM, Sherwan J F. et al . Acanthamoeba, bacterial, and fungal contamination of contact lens storage cases.  Br J Ophthalmol. 1995;  79 601-605
    CrossrefPubMedSuche in Google Scholar
  • 33 Hamburg A, DeJonckheere J F. Amoebic keratitis.  Ophthalmologica. 1980;  181 74-80
    PubMedSuche in Google Scholar
  • 34 Hammill M B, Osato M S, Wilhelmus K R. Experimental evaluation of chlorhexidine gluconate for ocular antisepsis.  Antimicrob Agents Chemother. 1984;  26 793-796
    PubMedSuche in Google Scholar
  • 35 Hargrave S L, McCulley J P, Husseini Z. et al . Results of a trial of combined propamidine isoethionate and neomycin therapy for Acanthamoeba keratitis.  Ophthalmology. 1999;  106 952-957
    CrossrefPubMedSuche in Google Scholar
  • 36 He Y G. A pig model of Acanthamoeba keratitis: Transmission via contaminated contact lenses.  Invest Ophthalmol Vis Sci. 1992;  33 126-133
    PubMedSuche in Google Scholar
  • 37 Hirst L W, Green W R, Merz W. et al .Management of Acanthamoeba keratitis; a case report and review of the literature. Ophthalmology 1984 91: 1105-1111
    Suche in Google Scholar
  • 38 Hiti K, Walochnik J, Haller-Schober E M. et al . Viability of Acanthamoeba after exposure to a multipurpose disinfecting contact lens solution and two hydrogen peroxide systems.  Br J Ophthalmol. 2002;  86 144-146
    CrossrefPubMedSuche in Google Scholar
  • 39 Holland G N, Donzis P B. Rapid resolution of early Acanthamoeba keratitis after epithelial debridement.  Am J Ophthalmol. 1987;  104 87-89
    PubMedSuche in Google Scholar
  • 40 Hwang T S, Hyon J Y, Song J K. et al . Disinfection capacity of PuriLens contact lens cleaning unit against acanthamoeba.  Eye & Contact Lens. 2004;  30 42-43
    PubMedSuche in Google Scholar
  • 41 Illingworth C D, Cook S D, Karabatsas C H. et al . Acanthamoeba keratitis: Risk factors and outcome.  Br J Ophthalmol. 1995;  79 1078-1082
    PubMedSuche in Google Scholar
  • 42 Illingworth C D, Cook S D. Acanthamoeba keratitis.  Survey Ophthalmol. 1998;  42 493-508
    CrossrefPubMedSuche in Google Scholar
  • 43 Ishibashi Y, Matsumoto Y, Kabata T. Oral itraconazole and topical miconazole with debridement for Acanthamoeba keratitis.  Arch Ophthalmol. 1990;  109 121-126
    PubMedSuche in Google Scholar
  • 44 Jones D B, Visvesvara G S, Robinson N M. Acanthamoeba polyphaga keratitis and Acanthamoeba uveitis associated with fatal meningoencephalitis.  Trans Ophthalmol Soc UK. 1975;  95 221-231
    PubMedSuche in Google Scholar
  • 45 Jones D B. Acanthamoeba - the ultimate opportunist?.  Am J Ophthalmol. 1986;  102 527-530
    PubMedSuche in Google Scholar
  • 46 Key S N, Green W R, Willaert E. Keratitis due to Acanthamoeba castellanii. A clinicopathological report. Arch Ophthalmol 1995 98: 475-479
    Suche in Google Scholar
  • 47 Kilvington S. Letter to the editor.  Lancet. 1995;  345 792
    PubMedSuche in Google Scholar
  • 48 Kingston D, Warhurst D C. Isolation of amoebae from the air.  J Med Microbiol. 1969;  2 27-36
    PubMedSuche in Google Scholar
  • 49 Lai S, Asgari M, Henney H R. Non-radioactive DNA probe and polymerase chain reaction procedures for the specific detection of Acanthamoeba.  Mol Cell Probes. 1994;  8 81-89
    CrossrefPubMedSuche in Google Scholar
  • 50 Larkin D FP, Kilvington S, Easty D L. Contamination of contact lens storage cases by Acanthamoeba and bacteria.  Br J Ophthalmol. 1990;  74 133-135
    CrossrefPubMedSuche in Google Scholar
  • 51 Larkin D FP, Kilvngton S, Dart J KG. Treatment of Acanthamoeba keratitis with polyhexamethylene biguanide.  Ophthalmology. 1992;  99 185-191
    PubMedSuche in Google Scholar
  • 52 Lawande R V, Abraham S N, John I. et al . Recovery of soil amoebas from the nasal passages of children during the dusty harmattan period in Zaria.  Am J Clin Pathol. 1979;  71 201-203
    PubMedSuche in Google Scholar
  • 53 Lehmann O J, Keys M F, Green S M. et al . Early diagnosis of Acanthamoeba keratitis with the polymerase chain reaction.  Invest Ophthalmol Vis Sci. 1995;  36 182
    PubMedSuche in Google Scholar
  • 54 Lewis E J, Sawyer T K. Acanthamoeba tibiashi n. sp., a new species of fresh water amoebida.  Trans American Microbiol Soc. 1979;  98 543-549
    PubMedSuche in Google Scholar
  • 55 Lindquist T D, Fritsche T R, Grutzmacher R D. Scleral ectasia secondary to Acanthamoeba keratitis.  Cornea. 1990;  9 74-76
    PubMedSuche in Google Scholar
  • 56 Lund O, Stefani F H, Dechant W. Amoebic keratitis: A clinicopathological case report.  Br J Ophthalmol. 1978;  62 373-375
    PubMedSuche in Google Scholar
  • 57 Ma P, Willaert E, Juechter K B. et al . A case of keratitis due to Acanthamoeba in New York, and features of 10 cases.  J Infect Dis. 1981;  143 662-667
    PubMedSuche in Google Scholar
  • 58 Ma P. Naegleria and Acanthamoeba infections: Review.  Rev Infect Dis. 1990;  12 490-513
    PubMedSuche in Google Scholar
  • 59 MacRae S C. Epidemiologic aspects of contact lens-associated infection. Raven Press The Cornea: Transactions of the World Congress on the Cornea III New York; Cavanagh HD 1988: 289-291
    Suche in Google Scholar
  • 60 Mannis M J, Tamaru R, Roth A M. et al .Acanthamoeba sclerokeratitis. Determinig diagnostic criteria. Arch Ophthalmol 1986: 1313-1317
    Suche in Google Scholar
  • 61 Mathers W D, Sutphin J E, Folberg R. et al .Outbreak of keratitis presumed to be caused by Acanthamoeba. Am J Ophthalmol 1996: 29-142
    Suche in Google Scholar
  • 62 Mauger T F. Antimicrobials. Mosby Ocular pharmacology St. Louis, Missouri, USA; Mauger TF, Craig EL 1994: 331-332
    Suche in Google Scholar
  • 63 McClellan K, Coster D J. Acanthamoebic keratitis diagnosed by paracentesis and biopsy and treated with propamidine.  Br J Ophthalmol. 1987;  71 734-736
    PubMedSuche in Google Scholar
  • 64 Moore M B, McCulley J P, Luckenbach M. et al . Acanthamoeba keratitis associated with soft contact lenses.  Am J Ophthalmol. 1985;  100 396-403
    PubMedSuche in Google Scholar
  • 65 Moore M B, McCulley J P, Kaufman H E. et al . Radial keratoneuritis as a presenting sign in Acanthamoeba keratitis.  Ophthalmology. 1986;  104 1310-1315
    PubMedSuche in Google Scholar
  • 66 Moore M B, McCulley J P, Newton C. et al .Acanthamoeba keratitis. A growing problem in soft and hard contact lens wearers. Ophthalmology 1987 94: 1654-1661
    Suche in Google Scholar
  • 67 Moore M B, McCulley P J. Acanthamoeba keratitis associated with contact lenses: Six consecutive cases of successful management.  Br J Ophthalmol. 1989;  73 271-275
    PubMedSuche in Google Scholar
  • 68 Nagington J, Watson P G, Playfair T J. et al . Amoebic infection of the eye.  Lancet. 1974;  2 1537-1540
    PubMedSuche in Google Scholar
  • 69 Perry H D, Donnenfeld E D, Foulks G N. et al . Decreased corneal sensation as an initial feature of Acanthamoeba keratitis.  Ophthalmology. 1995;  102 1565-1568
    PubMedSuche in Google Scholar
  • 70 Pfister D R, Cameron J D, Krachmer J H. et al . Confocal microscopy findings of Acanthamoeba keratitis.  Am J Ophthamol. 1996;  121 119-128
    PubMedSuche in Google Scholar
  • 71 Radford C F, Minassian D C, Dart J K. Acanthamoeba keratitis in England and Wales: Incidence, outcome and risk factors.  Br J Ophthalmol. 2003;  87 516-517
    CrossrefPubMedSuche in Google Scholar
  • 72 Reinhard T, Schilgen G, Steinert M. et al . Nummular infiltrates in Acanthamoeba keratitis.  Acta Ophthalmol. 2003;  81 541-543
    PubMedSuche in Google Scholar
  • 73 Rivera F, Galvan M, Robles E. et al . Bottled mineral water polluted by protozoa in Mexico.  J Protozool. 1981;  28 54-56
    PubMedSuche in Google Scholar
  • 74 Samples J R, Binder P S, Luibel F J. et al .Acanthamoeba keratitis. Possibly aquired from a hot tub. Arch Ophthalmol 1984 192: 707-710
    Suche in Google Scholar
  • 75 Schreiber W, Olbrisch A, Vorwerk C K. et al . Combined topical Fluconazole and corticosteroid treatment for experimental Candida albicans Keratomycosis.  Invest Ophthalmol Vis Sci. 2003;  44 2634-2643
    CrossrefPubMedSuche in Google Scholar
  • 76 Seifert K, Duchêne M, Wernsdorfer W H. et al . Effects of miltefosine and other alkylphosphocholines on human intestinal parasite Entamoeba histolytica.  Antimicrob Agents Chemother. 2001;  45 1505-1510
    CrossrefPubMedSuche in Google Scholar
  • 77 Sharma S, Srinivasan M, George C. Acanthamoeba keratitis in non-contact lens wearers.  Arch Ophthalmol. 1990;  108 676-678
    PubMedSuche in Google Scholar
  • 78 Sharma S, Garg P, Rao G N. Patient characteristics, diagnosis, and treatment of non-contact lens related acanthamoeba keratitis.  Br J Ophthalmol. 2000;  84 1103-1108
    CrossrefPubMedSuche in Google Scholar
  • 79 Silvany R E, Dougherty J M, McCulley J P. et al . The effect of currently available contact lens disinfection systems on Acanthamoeba castellanii and Acanthamoeba polyphaga.  Ophthalmology. 1990;  97 286-290
    PubMedSuche in Google Scholar
  • 80 Stehr-Green J K, Bailey T hM, Visvesvara G S. The epidemiology of acanthamoeba keratitis in the United States.  Am J Ophthalmol. 1989;  107 331-336
    CrossrefPubMedSuche in Google Scholar
  • 81 Stern G A, Buttross M. Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease.  Ophthalmology. 1991;  98 847-853
    PubMedSuche in Google Scholar
  • 82 Syam P P, Narendran R, van der Hoek J. Persistent acanthamoeba keratitis in a non-contact lens wearer follwing exposure to bird seed dust.  Br J Ophthalmol. 2005;  89 388-389
    CrossrefPubMedSuche in Google Scholar
  • 83 Theodore F H, Jakobiec F A, Juechter K B. et al . The diagnostic value of a ring infiltrate in Acanthamoeba keratitis.  Ophthalmology. 1985;  92 1471-1479
    PubMedSuche in Google Scholar
  • 84 Tripathi R C, Monninger R HG, Tripathi B J. Contact lens-associated acanthamoeba keratitis: a report from the USA.  Forschr Ophthalmol. 1989;  86 67-71
    PubMedSuche in Google Scholar
  • 85 Varga J H, Wolf T C, Jensen H G. et al . Combined treatment of Acanthamoeba keratitis with propamidine, neomycin and polyhexamethylen biguanide.  Am J Ophthalmol. 1993;  115 466-470
    PubMedSuche in Google Scholar
  • 86 Vodkin M H, Howe D K, Visvesvara G S. et al . Identification of Acanthamoeba at the generic and specific levels using the polymerase chain reaction.  J Protozool. 1992;  39 378-385
    PubMedSuche in Google Scholar
  • 87 Vogelberg K, Boehnke M. In vitro toxicity of polyhexanide (PHMB).  Invest Ophthalmol Vis Sci. 1994;  35 1337
    PubMedSuche in Google Scholar
  • 88 Walochnik J, Duchêne M, Eibl H. et al . Die Behandlung der Acanthamoeba-Keratitis: Möglichkeiten, Probleme und neue Wege.  Wien Klin Wochenschr. 2003;  115 (Suppl 3) 10-17
    PubMedSuche in Google Scholar
  • 89 Wilhelmus K R, McCulloch R R, Osato M A. Photomicrography of Acanthamoeba cysts in human cornea.  Am J Ophthalmol. 1988;  106 628-630
    PubMedSuche in Google Scholar
  • 90 Winchester K, Mathers W D, Sutphin J E. et al . Diagnosis of Acanthamoeba keratitis in vivo with confocal microscopy.  Cornea. 1995;  14 10-17
    PubMedSuche in Google Scholar
  • 91 Witschel H, Sundmacher R, Seitz H M. Amöbenkeratitis. Ein klinisch-histopathologischer Fallbericht. Klin Mbl Augenheilk 1984 185: 46-49
    Suche in Google Scholar
  • 92 Wright P, Warhurst D, Jones B R. Acanthamoeba keratitis successfully treated medically.  Br J Ophthalmol. 1985;  69 778-782
    PubMedSuche in Google Scholar

T. Reinhard

Augenklinik des Universitätsklinikums

Killianstr. 5

79106 Freiburg

Telefon: ++ 49/7 61/2 70 40 06

Fax: ++ 49/7 61/2 70 40 63

eMail: Reinhard@aug.ukl.uni-freiburg.de