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Higher incidence of Acanthamoeba keratitis persists more than 10 years after outbreak

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PHILADELPHIA — The incidence of Acanthamoeba keratitis, although still rare, is about 10 times greater than before an outbreak of the disease occurred in 2004, according to a study presented here.

“Acanthamoeba keratitis, after the outbreak in 2004, really reached a peak in 2007, but we saw that the incidence never returned to its pre-2004 baseline,” Travis C. Jenkins, MD, said at the Wills Eye Alumni Conference.

Acanthamoeba keratitis is a rare corneal infection caused by a parasitic free-living amoeba found in water and soil. A majority of patients affected by Acanthamoeba keratitis wear contact lenses. Major risk factors for infection are swimming in contact lenses, rinsing contact lenses in tap water and reusing contact lens solution, Jenkins said.

In 2007, the Centers for Disease Control and Prevention associated the outbreak with Complete Moisture Plus (Advanced Medical Optics), which was subsequently withdrawn from the market.

The retrospective case series included 36 patients who presented with Acanthamoeba keratitis at Wills Eye Hospital between July 2011 and December 2014. Average patient age was 32.8 years. The average duration of symptoms to a correct diagnosis was 35.5 days.

All 36 patients wore contact lenses. About half of the patients reported some form of contact lens abuse such as swimming, showering or sleeping in lenses and cleaning lenses with tap water, Jenkins said.

Sixty-four percent of patients were treated with oral or topical antiviral medications before getting a correct diagnosis, Jenkins said.

“We would like to emphasize that [herpes simplex virus] keratitis remains a very common misdiagnosis, so we recommend that you include Acanthamoeba in your differential any time you suspect HSV keratitis in a contact lens wearer, particularly if they’re not improving on antivirals as you would expect them to do,” he said. – by Matt Hasson

Disclosure: Jenkins reports no relevant financial disclosures.