Acanthamoeba Treatment & Management

  • Author: Nancy F Crum-Cianflone; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Nov 28, 2011
 

Medical Care

Medical therapy for Acanthamoeba infection is not well established. Listed below are treatments that have been reported in the literature.

  • Keratitis
    • Successful treatment of keratitis consists of early diagnosis and aggressive surgical and medical therapies.[6]
    • Medical treatment consists of topical antimicrobial agents, which can achieve high concentrations at the site of the infection.
    • Because the cyst form may be highly resistant to therapy, a combination of agents is generally used.
    • Many authorities recommend a combination of propamidine 0.1%, miconazole nitrate 1%, and neomycin. Others suggest a combination of a diamide (propamidine isethionate) with a cationic antiseptic (polyhexamethylene biguanide [PHMB] or chlorhexidine).
    • These topical antimicrobials are administered every hour immediately after corneal debridement. These agents are then continued hourly during waking hours for 3 days (at least 9 times/day is recommended). The frequency is then reduced to every 3 hours. Two weeks may be required before a response is observed, and the total duration of therapy is a minimum of 3-4 weeks. Some advocate treating for 6-12 months. When therapy is discontinued, close observation is warranted to rule out recurrent disease.
    • No clear consensus exists about use of steroids. Most authorities recommend that steroid use is probably best avoided. Patients receiving steroids should continue antiamebic therapy for several weeks after the steroids are stopped. Rabinovitch and coworkers (1991) showed that steroid use was significantly greater among patients in whom medical therapy failed than in those whose medical therapy was successful.[7] A more recent study by Park et al (1997) revealed no difference in response to medical therapy in patients who used topical steroids compared with those who did not. However, in this study, patients treated with topical steroids required longer duration of medical therapy (38.5 wk vs 20 wk).[8]
  • Granulomatous amebic encephalitis
    • Treatment is not standardized and is limited. Most use a combination of therapies for the treatment of GAE, which should be urgently administered. Antibiotic sensitivity testing should be performed and may help guide therapy.
    • In vitro and in vivo data suggest that the following medications have activity against Acanthamoeba:
      • Ketoconazole, miconazole, itraconazole, fluconazole
      • Pentamidine
      • Amphotericin B
      • Paromomycin
      • Polymyxin
      • Trimethoprim-sulfamethoxazole
      • Sulfadiazine
      • Flucytosine
      • Clotrimazole
      • Rifampin
    • Two immunocompetent children survived with treatment that consisted of ketoconazole, rifampin, and trimethoprim-sulfamethoxazole. A recent case reported discussed the use of this combination, but the patient ultimately relapsed and died of progressive leukemia.[9]
    • Other potential regimens include (1) fluconazole and sulfadiazine or (2) pentamidine, amphotericin, flucytosine, rifampin, itraconazole, and chlorhexidine.
  • Disseminated disease: A case that involved only the skin was treated with intravenous pentamidine, topical chlorhexidine gluconate, and 2% ketoconazole cream, followed by oral itraconazole.
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Surgical Care

  • Keratitis: The abnormal epithelium is débrided. Penetrating keratoplasty may be necessary in cases that do not respond to medical therapy.
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Consultations

  • Keratitis
    • Infectious diseases specialist
    • Ophthalmologist
  • Granulomatous amebic encephalitis and disseminated disease
    • Infectious diseases specialist
    • Neurologist
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Contributor Information and Disclosures
Author

Nancy F Crum-Cianflone  MD, MPH, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego

Nancy F Crum-Cianflone is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

David Hall Shepp, MD  Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Gilead Sciences Salary Management position

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor William B. Harley, MD, to the development and writing of this article.

References

  1. Kurbanyan K, Hoesl LM, Schrems WA, Hamrah P. Corneal nerve alterations in acute Acanthamoeba and fungal keratitis: an in vivo confocal microscopy study. Eye (Lond). Nov 11 2011;[Medline].

  2. Nazar M, Haghighi A, Niyyati M, Eftekhar M, Tahvildar-Biderouni F, Taghipour N, et al. Genotyping of Acanthamoeba isolated from water in recreational areas of Tehran, Iran. J Water Health. Sep 2011;9(3):603-8. [Medline].

  3. Schaumberg DA, Snow KK, Dana MR. The epidemic of Acanthamoeba keratitis: where do we stand?. Cornea. Jan 1998;17(1):3-10. [Medline].

  4. Wilhelmus KR, Jones DB, Matoba AY, et al. Bilateral acanthamoeba keratitis. Am J Ophthalmol. Feb 2008;145(2):193-197. [Medline].

  5. Parmar DN, Awwad ST, Petroll WM, et al. Tandem scanning confocal corneal microscopy in the diagnosis of suspected acanthamoeba keratitis. Ophthalmology. Apr 2006;113(4):538-47. [Medline].

  6. Oldenburg CE, Acharya NR, Tu EY, Zegans ME, Mannis MJ, Gaynor BD, et al. Practice patterns and opinions in the treatment of acanthamoeba keratitis. Cornea. Dec 2011;30(12):1363-8. [Medline]. [Full Text].

  7. Rabinovitch T, Weissman SS, Ostler HB, et al. Acanthamoeba keratitis: clinical signs and analysis of outcome. Rev Infect Dis. Mar-Apr 1991;13 Suppl 5:S427. [Medline].

  8. Park DH, Palay DA, Daya SM, et al. The role of topical corticosteroids in the management of Acanthamoeba keratitis. Cornea. May 1997;16(3):277-83. [Medline].

  9. Gupta D, Panda GS, Bakhshi S. Successful treatment of acanthamoeba meningoencephalitis during induction therapy of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. Jun 2008;50(6):1292-3. [Medline].

  10. Acanthamoeba keratitis in soft-contact-lens wearers. MMWR Morb Mortal Wkly Rep. Jul 3 1987;36(25):397-8, 403-4. [Medline].

  11. Acanthamoeba keratitis multiple states, 2005-2007. MMWR Morb Mortal Wkly Rep. Jun 1 2007;56(21):532-4. [Medline].

  12. Cunha BA. Antibiotic Essentials. 5th ed. Royal Oak, Mich: Physician's Press; 2006.

  13. De Jonckheere JF. Ecology of Acanthamoeba. Rev Infect Dis. Mar-Apr 1991;13 Suppl 5:S385-7. [Medline].

  14. Hammersmith KM. Diagnosis and management of Acanthamoeba keratitis. Curr Opin Ophthalmol. Aug 2006;17(4):327-31. [Medline].

  15. Kaji Y, Hu B, Kawana K, et al. Swimming with soft contact lenses: danger of acanthamoeba keratitis. Lancet Infect Dis. Jun 2005;5(6):392. [Medline].

  16. Lindquiest td. Treatment of Acanthamoeba keratitis. Cornea. 1998;17:11-16.

  17. Marciano-Cabral F, Cabral G. Acanthamoeba spp. as agents of disease in humans. Clin Microbiol Rev. Apr 2003;16(2):273-307. [Medline].

  18. Martinez AJ. Infection of the central nervous system due to Acanthamoeba. Rev Infect Dis. Mar-Apr 1991;13 Suppl 5:S399-402. [Medline].

  19. Mathers WD, Nelson SE, Lane JL, et al. Confirmation of confocal microscopy diagnosis of Acanthamoeba keratitis using polymerase chain reaction analysis. Arch Ophthalmol. Feb 2000;118(2):178-83. [Medline].

  20. Migueles S, Kumar P. Primary cutaneous acanthamoeba infection in a patient with AIDS. Clin Infect Dis. Dec 1998;27(6):1547-8. [Medline].

  21. Nachega JB, Rombaux P, Weynand B, et al. Successful treatment of Acanthamoeba rhinosinusitis in a patient with AIDS. AIDS Patient Care STDS. Oct 2005;19(10):621-5. [Medline].

  22. Oliva S, Jantz M, Tiernan R, et al. Successful treatment of widely disseminated acanthamoebiasis. South Med J. Jan 1999;92(1):55-7. [Medline].

  23. Paltiel M, Powell E, Lynch J, et al. Disseminated cutaneous acanthamebiasis: a case report and review of the literature. Cutis. Apr 2004;73(4):241-8. [Medline].

  24. Schaumberg DA, Snow KK, Dana MR. The epidemic of Acanthamoeba keratitis: where do we stand?. Cornea. Jan 1998;17(1):3-10. [Medline].

  25. Singh U. Free-Living Amebas. Mandell, Douglas, and Bennetts Principles and Practices of Infectious Diseases.

  26. Singhal T, Bajpai A, Kalra V, Kabra SK, Samantaray JC, Satpathy G, et al. Successful treatment of Acanthamoeba meningitis with combination oral antimicrobials. Pediatr Infect Dis J. Jun 2001;20(6):623-7. [Medline].

  27. Sison JP, Kemper CA, Loveless M, et al. Disseminated acanthamoeba infection in patients with AIDS: case reports and review. Clin Infect Dis. May 1995;20(5):1207-16. [Medline].

  28. Slater CA, Sickel JZ, Visvesvara GS, et al. Brief report: successful treatment of disseminated acanthamoeba infection in an immunocompromised patient. N Engl J Med. Jul 14 1994;331(2):85-7. [Medline].

  29. Stapleton F, Seal DV, Dart J. Possible environmental sources of Acanthamoeba species that cause keratitis in contact lens wearers. Rev Infect Dis. Mar-Apr 1991;13 Suppl 5:S392. [Medline].

  30. Sun X, Zhang Y, Li R, et al. Acanthamoeba keratitis: clinical characteristics and management. Ophthalmology. Mar 2006;113(3):412-6. [Medline].

  31. Thebpatiphat N, Hammersmith KM, Rocha FN, et al. Acanthamoeba keratitis: a parasite on the rise. Cornea. Jul 2007;26(6):701-6. [Medline].

 
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