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2011 OMIG Abstract 20

Acanthamoeba keratitis with polymicrobial infections
P. Oellers, D. Miller, C.L. Karp, A. Galor, E.C. Alonso
Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL

Purpose: To determine the incidence and significance of polymicrobial co-infections in Acanthamoeba keratitis (AK).

Method: Retrospective chart review.

Participants: Twenty-one culture proven AK with corneal co-infections.

Results: From 1987 to 2010, 162 consecutive culture-positive AK patients were seen at the Bascom Palmer Eye Institute. Of these, 21 (13%) had polymicrobial keratitis, of which 15 (71%) were bacteria; 4 (19%) fungi and 2 (10%) herpes simplex. In 10 (48%) cases, the co-infection was primary (at the time of diagnosis), and in 9 (43%), the patients with AK developed secondary infections during the course of their treatment. Contact lens (CL) wear was positive in 14 (67%) and negative in 7 (33%), contact lens culture was performed in 6 cases, of which 4 (66%) were positive for Acanthamoeba polymicrobial; 1 (16%) negative for Acanthamoeba but positive for a bacterium and 1 (16%) completely negative. Of the positive CL case cultures, none harbored the same co-infections found in the corneas. The average time to diagnosis was 89 days (median 48); time to cure was 238 days (median 256). Penetrating keratoplasty (PK) was done in 11 (52%) of the patients. Mean follow up was 720 days (median 71). Subgroup analysis between primary and secondary polymicrobial co-infections showed that primary was more likely to be CL wear (100% vs 33%, p=0.0006) and less likely to receive PK (20% vs 78%, p=0.0012). Final visual acuity was 20/40 or better in 50% in the primary and 33% in the secondary group (p=0.38).

Conclusions: There is a significant incidence of polymicrobial co-infections in AK, which do not correlate with CL cultures. CL related AK may have a higher risk to present with polymicrobial co-infection at diagnosis and non CL related AK may have a higher risk of developing secondary polymicrobial co-infections in the disease course. Future studies are needed to investigate how endosymbionts relate to AK co-infections and to compare polymicrobial and monomicrobial AK.

Grant: Supported in part by an unrestricted grant from Research to Prevent Blindness, NY and the Max-Kade-Foundation, NY.

Disclosure: N

2011 Abstract List | < Previous | Next >